Local Competency Restoration

As humans we are hardwired to quickly detect when another person’s behavior appears outside the norm. It’s an aspect of human intuition that is instantly recognizable but hard to put into words. But if you are charged with either a misdemeanor or a felony and your defense attorney or, less frequently, a judge, doubts your competency to understand the judicial process, work cooperatively with your attorney or understand the rudiments of the case against you, under California law your legal processing temporarily stops in its tracks and you are referred to a competency evaluation – and that begins an official paper trail that will ultimately measure and determine your competency to resume your trial. 

The clock then starts ticking and a psychiatrist or psychologist has 15 days to recommend to the court whether further competency restoration treatment should be ordered for you. If that treatment is ordered, you have just run into the sticky wicket that could find you languishing in jail for up to one year if you’re charged with a misdemeanor or up to two years if you’re charged with a felony, even though you’ve never been proven guilty of anything. It’s a waiting game while you’re waiting for an available slot for a competency evaluation program. 

With misdemeanors, it’s the county mental health director who recommends treatment. With felonies, it is the state hospital’s responsibility to provide your “restoration of competency” treatment, which, until recently, has been performed at one of the three state hospitals that provide it – usually Napa, in Mendo’s case. The trouble is, there’s no room at the inn.

“The last time I checked there were over a thousand people on the waiting list for the three state hospitals that provide these competency restoration programs,” said local psychologist J. Holden, PhD, “and the number doubled in just the last 18 months.” 

Though smaller facilities are being built around the state, most do not offer these state-mandated programs. And while demand for them climbs right along with the rising social pathologies on our streets and in our communities, the state hospital programs have fallen further behind in moving defendants through their programs in a timely way. Part of the problem is the gradual closure of the state’s large psychiatric hospitals and the death, at least for now, of the government’s enthusiasm for grand ideas – like building enough large hospitals to shoulder the load. 

The State of California’s website writes that “between 1955 and 1994 roughly 487,000 mentally ill patients were discharged from state hospitals,” largely due to the ascendance of “community-based care” championed by, among others, California Governor Ronald Reagan, mental health professionals, and advocates for Californians with disabilities. “At the time this was considered to be the most humane way to treat people,” Holden said. “But what happened is that people showed up on Market Street living in boxes and created the homeless problem.”

Back to Mendo’s criminal justice system, Holden said that, “A third of homeless people in this country, this state, and this county have serious mental health issues. The jails have become de facto mental health facilities.” He added that jail is just about the worst place for this vulnerable population. “Second only to executing somebody, the worst thing you can do to them is place them in solitary confinement,” he said. “For their own protection they are often kept in a cell by themselves…since they are easy targets in the general population, easy to provoke, easy to manipulate. It’s a question of cruel and unusual punishment without ever being found guilty of anything.”

Enter the non-proprietary “Mendocino Method,” which Holden developed and runs as an independent contractor for the county. Its goal is to reduce waiting time in the jail and serve as an alternative to competency evaluations at state hospitals.  He said that the county program began incrementally four or five years ago with defendants with intellectually developmental disabilities, then expanded to misdemeanors, then, finally, late last July, to defendants charged with felonies. (Felony defendants’ treatments have to be coordinated with and approved by the California Department of State Hospitals.) “Now, finally, we have competency-based training for any defendant who needs it, right here in Mendocino County,” Holden said. “…and nobody is transferred to Napa anymore.” He said there’s also no waiting list.

The county program had to clear some legal hurdles along the way and gain approvals from the Mendocino County Board of Supervisors (who voted unanimously to support it and asked no questions, according to Holden), the jail, and the county’s mental health department to legally designate the jail as a treatment facility. (Defendants are still housed at the jail during their competency training.) “That opened the door for us to provide treatment,” Holden said. 

In these fraught and contentious times, such unanimous approval is as rare as hen’s teeth, especially where public monies for new programs are concerned. But whatever the program’s laudable goals of reducing overall jail time and keeping defendants close to their families, the Mendocino Method’s goal to prevent transfer to state hospitals for competency restoration training is saving cold, hard cash big time; it’s the bedrock of  both its broad, unanimous support and its fast-growing popularity elsewhere around the state. Holden told me that the county is charged $100,000 per person for the state’s average of 70 days for competency restoration training at a state hospital. “We can restore competency for an average of $25,000 per person, a savings of $75,000 per client. You’re talking a million and a half in savings per year just in this county alone,” Holden said. In these cost-cutting, anti-tax times, savings like that clearly get everyone’s attention and support. Holden also said that the county can complete the training in around 50 days, for even greater savings. “Who’s gonna turn down a proposal?” he asked, rhetorically. “An innovative program that’s humanistic to begin with, that saves a million a year. It would be a feather in the caps of the supervisors.” 

So what exactly is involved in this competency restoration training? “First, there’s an education piece about the courts: the role of prosecutors, defense attorneys, the meaning of time served, how the law works,” Holden said. Following that is a section where factual questions are asked about a hypothetical case, basically to test understanding of the legal system. “The last thing is understanding their own cases ─ what the police report says, what happened, a basic understanding of their own cases,” he said. Basically, according to the U.S. Constitution, you have to understand what the charges are against you and be able to work with an attorney on a rational defense to stand trial. The final piece is the meds. If a “doc-in-a-box” psychiatrist interviewing a defendant via a live TV feed (called Tele-Psychiatry) recommends mandatory anti-psychotic medication and the court agrees, that defendant is compelled to take that medication through the end of his or her trial. Though this raises the disturbing specter of a scene from the film One Flew Over the Cuckoo’s Nest, Holden says this is the only circumstance under which a defendant can be forced to take medication, but that most defendants agree to take the meds orally. “…or they’ll come into your cell, hold you down, and shoot you up with it,” he said, most likely with a long-acting 30-day dose.  

So the upside of all this is that defendants spend less time confined to the jail while awaiting a slot in the competency training queue, space in the frequently crowded jail is freed up, defendants can move more quickly through the judicial process, and all of these things together save a lot of money. 

But, not to be picky, does the program create any long-term benefits to defendants in a larger sense? Does the more humane treatment of less waiting time spent in jail (having never been convicted of a crime), the general training about the criminal justice system, and the greater understanding of their own cases make defendants less likely to reoffend and end up right back where they started?  

Nobody knows, because the diversion program doesn’t track recidivism: it’s not part of the program. The question is not even included in the program contract. It ends with the trial, which starts up again where it left off before a defendant was declared restored to competency. There will always of course be those who are so ill they cannot be restored to competency, which is a whole other discussion. But what happens to those who are restored to competency and are eventually released back into the mean streets from whence they came? 

“The typical client is seriously mentally ill, schizophrenic, has a history but is not taking prescribed meds, is homeless almost without exception and impoverished, also almost without exception,” Holden said. How likely is it that less jail time and a 50-day competency restoration program can roll back the societal forces that have landed that client on the streets in the first place? Holden says he’s always hopeful, and that sometimes the first attempt to turn your life around takes more than one go. He likened it to his struggle to quit smoking cigarettes, which he said took several attempts before he quit for good. I get it; like many of my fellow Boomers I smoked for years before quitting a long time ago. It was a struggle at times, nicotine being as addictive as it is, and it did take more than one attempt to kick the habit. But I was an educated, gainfully employed news professional, not an impoverished, homeless, schizophrenic woman off her meds. 

Holden said as soon as defendants are restored to competence and finish out their trials or subsequent jail sentences, he encourages them to go immediately to Redwood Community Services ─ the largest spoke in the Redwood Quality Management Company umbrella  that contractually oversees dozens of social services for both adults and children in Mendocino County ─ so that they can put a plan together to break the cycle of their former lives on the street that indirectly landed them in the criminal justice system in the first place. So what happens then?

Former county social worker and pastor Dan Anderson, former office manager for Redwood Community Services, is now CEO of Redwood Quality Management Company (RQMC). He told me he believes that the county’s fledgling state hospital diversion program, aside from its cost savings, is a better, more humane solution for defendants than letting them wait around in jail for up to two years before  being sent off to Napa for 70 days. “It’s hard to stay in touch with support when you’re out of county, and can exacerbate mental health issues,” he said. “Support and building social connections…is a huge piece of recovery.” He added that 80-percent of the county’s homeless are local, have families, and went to high school here.

Though RQMC doesn’t track recidivism rates for graduates of the county’s diversion program, or for that matter what ultimately happens to others who pass through the county’s other patchwork of day-use facilities, counseling, and other services, it does track the number of hospitalizations and connections to services following hospitalizations. The need is growing fast. “In 2016 there were 300 clients, now there are over 1,000,” Anderson said. He added that symptom reduction for those in Adult Services is measured every six months, and that the Board of Supervisors does an annual review of all contracts, many of which have numerous subsections.

As in the nation, the state, and California counties, homelessness remains a stubborn, intractable part of recovery from a client’s other problems. Last year I attended a lecture by San Francisco’s Director of Housing. She said that some aspects of serving homeless individuals are easy. Food is easy, there are lots of places to eat. Ditto for clothing. I flashed on visiting a clothing donation warehouse with my then-homeless brother in the Mission. Dozens of Dumpster-like bins were filled to the brim with clothing, each piece available for one dollar. There were designer clothes that still had their original tags, boots in their original boxes, never worn; in a city made up mostly of the very rich and the very poor, the rich are more than happy to trade in clothing they decided they didn’t like after they bought it in exchange for a tax deduction. But housing, there and in counties like Mendo, remains a critical problem with no clear solution in sight. Anderson said there are some available beds in Mendo,  even a handful of apartments available to, among others, foster children aging out of the system at 18. There are also a few units and rooms here and there for others in need of a roof over their heads. He added that a number of other housing projects are also in the works, though their numbers pale beside the growing need.

Like with the diversion program, Anderson said you have to just keep plugging away as best you can. “It’s try, fail, try again, it’s not giving up,” he said.