Specialized court aims to treat mentally ill, rather than imprison them

May 3 2013 - 12:40am

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Eddie Escobedo poses outside the courtroom before his mental health court hearing at the 2nd District Courthouse in Ogden on Monday. (BRIAN NICHOLSON/Special to the Standard-Examiner)
Eddie Escobedo appears in front of Judge Noel Hyde for his mental health court hearing at the 2nd District Courthouse in Ogden on Monday. (BRIAN NICHOLSON/Special to the Standard-Examiner)
Eddie Escobedo poses outside the courtroom before his mental health court hearing at the 2nd District Courthouse in Ogden on Monday. (BRIAN NICHOLSON/Special to the Standard-Examiner)
Eddie Escobedo appears in front of Judge Noel Hyde for his mental health court hearing at the 2nd District Courthouse in Ogden on Monday. (BRIAN NICHOLSON/Special to the Standard-Examiner)

OGDEN -- Eddie Escobedo sat on his porch, the breeze of a warm spring evening rustling the trees in his yard, while Boots, a tan cattle dog, sniffed around his feet. After a while, Escobedo, 44, who has paranoid schizophrenia and is a former drug addict with exactly 411 days of sobriety, retired to his dining room.

He spoke of how he came to be there, surrounded by yellow-painted walls and the smell of home-cooked food, rather than the bars of a prison cell.

Easing into a seat at the wooden table cluttered with books, Escobedo explained that he is one of several people in the Top of Utah whose lives have been changed by mental health courts, which offer an alternative to traditional criminal justice for mentally ill people charged with a crime.

That Escobedo met the narrow eligibility requirements for mental health court took a stroke of good fortune. Many others aren't so lucky.

The criteria one must meet to be eligible are strict, said Jackie Rendo, a National Alliance on Mental Illness advocate in the Salt Lake City mental health courts. The crime must not be of a violent or sexual nature, and the person must plead guilty to the charges. But perhaps the most restrictive of the requirements is this: People must fit one of only three diagnoses -- schizophrenia, schizoaffective disorder or bipolar disorder.

The diagnosis criterion results from a lack of funding, as money the federal government allots for the day-to-day operation of the courts -- such as judges and staffing -- allows the courts to serve only a limited number of people. So unless a court receives additional funds from other sources, such as county funding, to give it some wiggle room, people with such illnesses as anxiety, obsessive-compulsive disorder, panic disorder and major depression aren't even considered. The diagnosis criterion, Rendo said, serves essentially as triage for the courts.

"These courts were meant to address the most seriously ill people," said Rendo. "I don't know that we'd ever have enough funding for a mental health court that could cover everybody."

Cheaper than jail

A 2007 study funded by the MacArthur Foundation suggests that treating a criminal in mental health court may be cheaper in the long run than jail or prison, due to decreases in recidivism rates and inpatient care. But in Utah, funding varies. Some courts are given county funding for the treatment, Rendo said, while others are forced to require people to have Medicaid coverage. Treatment services for Escobedo's court, the Weber County Mental Health Court, are run through Weber Human Services, which only accepts people with Medicaid.

Medicaid coverage ensures people in the Weber County court pay nothing out of pocket, but the court has had to turn away a few people who were not covered by Medicaid, said Klay Reeder, a social worker with WHS. Escobedo thanks God he wasn't one of them.

Fear, uncertainty

Cell pod F4, Weber County Jail; four rooms, eight beds apiece, the isolation inescapable. Escobedo's memory of that day in May 2012 bursts back, and he's again laying on his bunk. He was brought in on a second-degree felony charge of possession. He has long struggled with substance abuse problems and had been to jail a few times in the past -- but never for anything this serious. Desolation envelops him, stories he's heard of prison yanking always at his mind. If convicted, he could spend up to 15 years locked away, and that reality hammers him each time someone from his pod is hauled to prison.

"I didn't know what was going to happen, and I didn't have my meds," he said. "I was unstable in there. I didn't know if I was going to prison or what."

For 45 days he lives with that uncertainty. It torments him when he goes to sleep and pecks at him when he rises. Then one day, he is brought before a judge and evaluated for mental health court. He is accepted into the program and signs the paperwork. His brother Miguel picks him up from the jail and brings him home. His family is there to greet him; they cascade him with love.

A new life

The months that follow transform him, slowly at first, then more rapidly. He is back on his medication and doesn't miss his regular sessions with a psychologist or his weekly appointment in front of the mental health court judge. Those in court with him form a family, sharing support and encouragement. It isn't mandatory, but he attends Narcotics Anonymous and Alcoholics Anonymous meetings, because knowing others have defeated his enemy invigorates his will.

"The first six to eight months was tough -- I just prayed that I wouldn't relapse," Escobedo said. "But as time goes by, now it's 411 days, I don't even think about alcohol or using or anything."

Back in the dining room, the number turned over in his head and slid off his tongue: 411. Escobedo's sobriety has delivered rewards, both emotional and physical. When he's not working his job, doing mostly custodial work, he fishes and does yard work to keep busy. He feels like himself again, and the change within him is real. Vigilance, he hopes, will make the change permanent: "I'm an addict. I always will be."

Leaning back in his chair, Escobedo exhales a long breath. His progress, he knows, has come only because mental health court gave him the "second chance at life" thousands of people just like him don't get.

Nationally, mental health courts have been gaining traction for about a decade, and Utah's first one was created in Salt Lake City 11 years ago. Today, there are several throughout the state, including in Weber County, which also serves Morgan County residents, and in Davis County. Box Elder County residents are served by Cache County.

While courts operate slightly differently across the country, their effectiveness has earned praise from experts. Research, such as a 2007 study by University of California, San Francisco researchers, published in the American Journal of Psychiatry, shows recidivism rates are significantly lower for those who participate in mental health courts than for mentally ill people who have not. Treating the mentally ill, research increasingly suggests, accomplishes a rehabilitation that prison or jail doesn't.

That funding may never be available to put the majority of mentally ill criminals through mental health court leaves a reality in which hundreds of mentally ill people are locked up. According to NAMI, Utah prisons in 2008 housed 1,500 mentally ill inmates.

"Does the public want someone to spend 90 days in jail and come out and be just as ill as they were before?" Rendo said. "Or do they want somebody to spend two years or more in mental health court, getting all the services they need to be better, so when they're done, hopefully they'll continue to do those things that kept them out of trouble?"

In June, Escobedo will graduate from mental health court. Hands folded on the table, he envisions himself standing in front of his family on that day. Pride will surge inside him, he said. Humility, too.

"They tell me, 'We're proud of you. We love you. Keep on the straight-and-narrow,'" he said. "I don't want to get in trouble anymore. I know if I was to get another charge, I probably would go to prison next time. So I take one day at a time."

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