Illinois Guardianship Association Spring Conference May 22, :15 am -10:30 am

Transcription

1 Illinois Guardianship Association Spring Conference May 22, :15 am -10:30 am Overview of IDHS DMH Forensic Services Presented By; Dr. Sharon Coleman Associate Deputy Director for Forensics Illinois Department of Human Services Forensic Services Bureau

2 OVERVIEW OF FORENSIC SERVICES ILLINOIS DEPARTMENT OF HUMAN SERVICES/DIVISION OF MENTAL HEALTH Presenter: Sharon Coleman, PsyD Associate Deputy Director for Forensics Illinois Department of Human Services Forensic Services Bureau 1

3 GOALS Provide an overview of Illinois Forensic Services Familiarize the audience with populations served and the forensic hospital system Review of the legal statutes regarding Fitness to Stand Trial, Not Guilty by Reason of Insanity and related clinical issues Describe Illinois procedure for evaluating Fitness and Sanity and recommending treatment Present the goals and focus of forensic treatment

4 FORENSIC SERVICES Populations Served: Unfit to Stand Trial (UST) Not Guilty by Reason of Insanity (NGRI) Sexually Violent Persons (SVP) (725 ILCS 207/) Placement Evaluations for those remanded for forensic treatment within the State of Illinois Inpatient treatment with Adults and Juveniles. Behavior Management Evaluations of Aggressive Patients on Civil & Forensic Units Outpatient Forensic Services in collaboration with community providers. Oversight of the Sexually Violent Person s Program (TDF) Mental Health & Justice Programs & Initiatives(JDL,COE, MHJJ, TTI) 3

5 Illinois Department of Human Services Division of Mental Health Alton Mental Health Center Division of Developmental Disabilities Choate Developmental Center* Chester Mental Health Center Chicago Read Mental Health Center* Elgin Mental Health Center Madden Mental Health Center McFarland Mental Health Center

6 IDHS FORENSIC HOSPITALS REGION 1 & 2 Elgin Mental Health Center (344 beds) Min & Med Security (Males/Females) REGIONS 3 & 4 McFarland Mental Health Center(51 beds) Min & Med Security (Males/Females) REGION 5 Alton Mental Health Center (110 beds) Min & Med Security & Dually Diagnosed (Males/Females) STATEWIDE Chester Mental Health Center (147 beds + 44 med TBA) Med/Max Security (All Male) **IDHS/DD Choate Mental Health Center(26 beds) Med Security (Males/Females) Developmentally Disabled

7 Juvenile Forensic Treatment SBH Streamwood Behavioral Health Center 1400 E Irving Park Rd, Streamwood, IL (630) Contact: Jelena Loderquist Gateway Medical Center 2100 Madison Ave Granite City, IL (618) Contact: Tia Kingsbury Gateway Medical Center

8 FITNESS Unfit to Stand Trial (UST) DHS Remand Treatment Dispositions

9 HISTORY OF FITNESS ISSUE The rule that an individual must be competent to undergo the criminal process can be traced back to the 17th century. Issue of fitness to stand trial originated from a concern that subjecting certain types of individuals to trial was simply unfair. The trial of a defendant who cannot adequately participate in their own defense was deemed inappropriate and irrational. 8

10 FITNESS STATUTE Dusky v. U.S. (1960) In Illinois, a defendant is presumed fit to stand trial and is considered unfit if his mental or physical condition prevents him from understanding the nature and purpose of the proceedings against him or assisting in his own defense. 725 ILCS 5/ Two prongs of the fitness test: Ability to understand the nature and purpose of the proceedings against them, and Abilitytoassistintheirowndefense. 9

11 Fitness vs. Sanity Once charged, the attorneys or the Court may raise the issue of Fitness to Stand Trial. At the time of trial, Criminal Responsibility or Sanity may be raised.

12 INITIAL FITNESS EXAMINATION & REPORT The court orders an examination of the defendant by one or more licensed physicians, clinical psychologists, or psychiatrists chosen by the court. The report should include (per statute): A diagnosis & explanation as to how it was reached A description of the defendant s mental/physical disability, & An opinion as to the likelihood of the defendant attaining fitness within one year if provided with a course of treatment. 11

13 CLINICAL ISSUES RELATED TO FITNESS MENTAL ILLNESS UNFIT INTELLECTUAL DISABILITY UNFIT PYCHOSIS POSITIVE & NEGATIVE SYMPTOMS MOOD INSTABILITY SUICIDAL/HOMICIDAL COGNITIVE DEFICITS 12

14 KNOWLEDGE DEFICITS RELATED TO FITNESS Understanding of: Capacity to: Current legal situation & charges Facts relevant to his case. The legal issues and procedures in the case. Legal defenses available on one s behalf. The dispositions, pleas, and penalties possible. Appraise the likely outcomes. Appraise the roles of court personnel Identify and locate witnesses. Relate to and communicate with defense counsel. Comprehend instructions and advice & make decisions after receiving advice. Maintain a collaborative relationship with his attorney and to help plan legal strategy. Follow testimony and/or testify relevantly contradictions or errors. Tolerate stress at the trial & while awaiting trial. Refrain from irrational and unmanageable behavior during the trial.

15 FITNESS HEARING (104-16) The court conducts a hearing within 45 days to determine the issue of the defendant s fitness and may consider: The defendant s knowledge and understanding of the charge, the proceeding, the consequences of a plea, judgment or sentence and the functions of the participants in the trail process. The defendant s ability to observe, recollect and relate occurrences, especially those concerning the incidents alleged and to communicate with counsel. The defendant s social behavior and abilities; orientation as to time and place; recognition of persons, places and things, and performance of motor processes. 14

16 FITNESS HEARING DISPOSITIONS On the basis of the evidence before it, the court or the jury shall determine whether thedefendantisfittostandtrialortoplead. If it finds that the defendant is unfit, the court or the jury shall determine whether there is a substantial probability, if provided with a course of treatment, the defendant will attain fitness within one year. (Unfit but Fit within a year). If the court or jury finds that there is not a substantial probability, the court shall proceed as in (Unfit Defendants). If the court or jury is unable to determine whether a substantial probability exists, the court shall order the defendant to undergo treatment for the purpose of rendering him fit.(unfit& Uncertain) 15

17 COMMITMENT FOR TREATMENT the court shall select and consistent with the treatment plan the least restrictive and most therapeutic setting Defendants are remanded by court order to the Department of Human Servicesto be placed in a Secure setting* If after the placement evaluation DHS determines the defendant is currently fit to stand trial, it shall immediately notify the court and shall submit a written report within 7 days. Otherwise, upon the completion of the placement process, the sheriff is notified and is responsible for transporting the defendant to the designated facility. 16

18 COMMITMENT FOR TREATMENT DHS Remand to the Least Restrictive & Most Therapeutic Setting Inpatient Outpatient Placement Evaluation Outpatient Evaluation Minimum Security Hospital Unit Medium Security Hospital Unit Maximum Security Hospital Unit Community Agencies

19 Forensic Plan of Correction March 4, 2014 SB 2800 passed full Senate SB 2801 passed full Senate

20 UNFIT TO STAND TRIAL (UST) There are 3 Security Levels for forensic inpatients within the DHS: Minimum(formerly non-secure) Alton, Chicago Read, Elgin, McFarland Medium Alton, Choate*, Chester*, Elgin, McFarland Maximum (Chester MHC) males only 19

21 MINIMUM SECURITY TREATMENT (formerly non-secure) PATIENT PROFILE REQUIRES NON-SECURE ORDER MALE or FEMALE PROTOTYPCIAL CIVIL PATIENT ACUTE PSYCHOSIS, MOOD DISORDER MEDICATION NON-COMPLIANT SCREENED OUT MEDICALLY COMPLEX POSSIBLE NGRI/EXT UST CONVERSIONS ELOPEMENT RISKS DANGEROUS/SEVERE AGGRESSION MODERATE /SEVERE COGNITIVE DEFICITS NOT AN ELOPEMENT RISK LOW LEVEL, NON-VIOLENT OFFENSE * LOW RISK OF AGGRESSIVE ACTING OUT* LOW-MODERATE KNOWLEDGE DEFICITS REQUIRES MINIMAL/MODERATE FITNESS EDUCATION 20

22 MEDIUM SECURITY TREATMENT PATIENT PROFILE REQUIRES SECURE ORDER* MALE or FEMALE ACUTE PSYCHOSIS, MOOD DISORDER MEDICATION NON-COMPLIANT SCREENED OUT PRIMARILY MEDICALLY COMPLEX DEFINITE ELOPEMENT RISKS* DANGEROUS/SEVERE AGGRESSION PRIMARY/SEVERE COGNITIVE DEFICITS* POSSIBLE ELOPEMENT RISK* MISDEMEANOR & FELONY OFFENSES POSSIBLE RISK OF AGGRESSIVE ACTING OUT* LOW-MODERATE-HIGH KNOWLEDGE DEFICITS REQUIRES MINIMAL/MODERATE/SIGNIFICANT FITNESS EDUCATION CAN BE MEDICALLY COMPLEX POSSIBLE NGRI/EXT UST CONVERSION 21

23 MAXIMUM SECURITY TREATMENT PATIENT PROFILE REQUIRES SECURE ORDER* MALE ONLY ACUTE PSYCHOSIS, MOOD DISORDER SIGNIFICANT BEHAVIOR MANAGERENT ISSUE SCREENED OUT FEMALES PRIMARILY MEDICALLY COMPLEX PRIMARY/SEVERE COGNITIVE DEFICITS* MEDICATION NON-COMPLIANT ELOPEMENT RISK* MISDEMEANOR & FELONY OFFENSES SIGNIFICANT AGGRESSIVE ACTING OUT* LOW-MODERATE-HIGH KNOWLEDGE DEFICITS REQUIRES MINIMAL/MODERATE/SIGNIFICANT FITNESS EDUCATION CAN BE MEDICALLY COMPLEX POSSIBLE NGRI/EXT UST CONVERSION 22

24 Bona Fide Doubt of Fitness Unfit to Stand Trial FIT to Stand Trial If restorable, then treatment If not restorable, then court has a range of options Return to Court/Trial

25 FITNESS RESTORATION TREATMENT Review of available records (e.g., placement evaluation, fitness report, police report). Complete interdisciplinary assessments, focusing on ability to become fit for trial, barriers to fitness, risk factors, and aftercare planning issues. Clinical stabilization is the initial goal of treatment. Medication compliance is a significant predictor for attainment of fitness. Participation in recommended treatment groups. Fitness education in both individual and group modes of treatment. Ongoing assessment of stability, cooperation, and understanding of court process. Formal fitness evaluation. Consensus of treatment team regarding fitness. 24

26 FITNESS RESTORATION TREATMENT CLINICAL STABILIZATION Medication assessment & management Enforced medications* Psychological Assessment of malingering& differential diagnosis FITNESS EDUCATION Group and/or Individual treatment as indicated Fitness Psychoeducation Roles of court personnel Basic understanding of court process Assessment of: Capacity to assist counsel Capacity to comport behavior in court

27 FITNESS RESTORATION TREATMENT Individuals with milder forms of intellectual disability are most likely to benefit from fitness restoration training. Medication & Group Counseling Restoration versus Attainment Treatments that, Enhance functional abilities Enhance learning strategies Enhance adaptive skills Promote social competencies

28 Duration of Treatment & Clinical Outcomes In Illinois, the statute provides an inpatient or outpatient commitment to competency restoration for up to one year Individuals with ID and those who are dually diagnosed typically have a longer length of treatment for restoration The extent to which a defendant may benefit from a competency restoration program depends generally on overall intellectual functioning (IQ) and memory proficiency, which is related, in part, to IQ

29 UST Reports 30 Day Report (Admission Report & Treatment Plan) Within 30 days of an order for treatment, a report must be filed with the Court and must include the following: 1. Assessment of the facility s capacity to provide appropriate treatment. 2. An opinion as to the probability of the defendant attaining fitness within one year from the original finding of unfitness. If there is a substantial probability that the defendant will attain fitness within one year, a treatment plan must also be filed and must include: 1. Diagnosis of defendant s disability. 2. Description of treatment goals with respect to rendering defendant fit, a specification of the proposed treatment modalities, and an estimated timetable for attainment of the goals. 3. Name of the person in charge of supervising the defendant s treatment.

30 UST Reports 90 Day Report The treatment supervisor must submit a written progress report to Court: 1. At least 7 days prior to the date for any hearing on the issue of fitness. 2. Whenever the defendant has attained fitness. 3. Whenever it is believed that there is not a substantial probability that the defendant will attain fitness within one year from the date of the original finding of unfitness. The progress report shall contain: 1. Clinical findings and the facts upon which the findings are based. 2. Opinion as to whether the defendant is making progress toward attaining fitness within one year from the original finding of unfitness. 3. If the defendant is receiving medication, the information from the prescribing physician indicating the type, dosage, and the effect of the medication on the defendant s appearance, actions, and demeanor.

31 FITNESS DISPOSITIONS REPORTING Initial 30-Day Admission Report & Treatment Plan Every 90 Days a Progress Report (from date of court order) Restored to Fitness send Letter to Court Hearing on Fitness within 14 days* Unlikely to be Restored within 1 YEAR Letter to Court 30

32 Bona Fide Doubt of Fitness Unfit to Stand Trial FIT to Stand Trial If restorable, then treatment If not restorable, then court has a range of options Return to Court/Trial

33 If the Court Determines a Defendant Cannot Be Made Fit in 1 year: 1. Discharge Hearing* 2. Release the defendant from custody and dismiss with prejudice the charges against him DISCHARGE HEARING NOT GUILTY NGRI 3. Remand to DHS for civil commitment (b3).** NNG or (Extended Treatment) G2 Status (Civil)

34 FITNESS PROCESS FLOWCHART Guilty DOC Fit within 1 Year Trial Guilty but Mentally Ill NGRI DMH Unfit Dismiss with Prejudice Not Guilty Released Not Fit within 1 year Civil Commitment (b)(3) Not Guilty Fit Discharge Hearing Not Not Guilty Unfit and SIA (g)(2) NGRI Released 33

35 SANITY Not Guilty by Reason of Insanity (NGRI) DHS Remand Treatment Dispositions

36 SANITY (CRIMINAL RESPONSIBILITY) The purpose of the insanity defense is related to a very old, well-tested requirement for finding defendants guilty: the prosecution must prove not only that the alleged act was committed, but that the act was committed in a criminal way.

37 Taking is not the same as Stealing ; Killing is not the same as Murder. In general, for a crime to be committed, the actor must intend to commit a crime. M NaughtenRule: Did the defendant know what he was doing, or, if so, that it was wrong? Insanity is a legal state, not a clinical one, which is defined by law, not clinical diagnosis.

38 Legal Definitions (730 ILCS 5/5-1-11) Insanity means the lack of substantial capacity to appreciate the criminality of one s conduct as a result of mental disorder or mental defect.

39 Mental Disorder or Mental Defect Mental Disorder Usually interpreted to mean a serious mental illness, the symptoms of which can be reduced with treatment Mental Defect Usually interpreted to mean an intellectual disability or brain damage Treatment typically does not improve mental defects

40 Forensic Legal Status The court may find the person to be Not Guilty by Reason of Insanity(NGRI) People found NGRI are eligible for conditional release. Maximum commitment time: the amount of time that the person could have served if he or she was convicted of the offense charged (Thiem Date)

41 Forensic Legal Status After a finding of NGRI, then the court must decide if the person is mentally ill or intellectually disabled andsubject to institutionalization by court order If so, then the court decides on the least restrictive and most therapeutic setting consistent with public safety and the welfare of the person. This is usually a secure* inpatient setting

42 Forensic Legal Status After a finding of NGRI, most individuals are committed to the Illinois Department of Human Services Individuals with a Mental Illness are committed to the Division of Mental Health Individuals with primary Intellectual Disabilities are committed to the Division of Developmental Disabilities Individuals with a dual diagnosis can be committed to either the DD Division or the Division of Mental Health Occasionally, individuals may be committed to outpatient treatment* (Conditional Release)

43 Commitment to Treatment The Department shall provide the Court with a report of its evaluation within 30 days of the court order and hold a hearing to determine if the individual is: (a) in need of mental health services on an inpatient basis (b) in need of mental health services on an outpatient basis; (c) a person not in need of mental health services

44 Commitment to Treatment Every 60 days the facility director (or designee) shall file a treatment plan report to the court and shall include: An opinion as to whether the defendant is currently in need of mental health services on an inpatient basis or in need of mental health services on an outpatient basis A summary of the basis for those findings and a summary of the following from the treatment plan: 1. An assessment of the defendant s treatment needs 2. A description of the services recommended for treatment 3. The goals of each type of element of services 4. An anticipated timetable for the accomplishment of the goals, and 5. A designation of the qualified professional responsible for implementation of the plan 6. Privileges*

45 Treatment & Privileging Treatment is focused on reducing violence risk and preparing people for life in the community. Treatment in the hospital involves progression towards increasing privilege levels For less restrictive levels of movement an evaluation and risk assessment are done and decisions are made to request additional privileges, usually by the treatment team Typically, the trial court must approve each increased movement beyond building passes.

46 Privileges Typical Movement levels: 1: On Unit, Restricted 2: Building Pass, Supervised or Unsupervised 3: On Grounds, Supervised or Unsupervised 4: Off Grounds, Supervised 5: Off Grounds, Unsupervised 6: Conditional Release

47 Conditional Release In approving a conditional release, the trial court may set any conditions on the release with respect to the treatment, evaluation, counseling, or control of the defendant or person that the court considers necessary to protect the public safety and the welfare of the defendant or person *Conditional Release is conditional

48 Often for those who have Intellectual Disabilities, part of the challenge is identifying the correct types of supports and residential settings that will best meet their needs and maintain their stability in the community

49 NGRI FLOW CHART Average length of stay for NGRI acquiteesin Illinois is 4 to 5 years. This number may be higher for those with primary Intellectual Disabilities In Need of Inpatient Services Privileging NGRI Acquittal In Need of Outpatient Services Conditional Discharge with Treatment Recommendations Not in Need of Services Released Conditional Release Discharge

50 Point in-time Data for December 11, 2013 # UST #UST Extended # NGRI TOTAL FORENSIC ALOS UST ALOS UST Extended ALOS NGRI ALTON CHESTER CHICAGO READ ELGIN McFARLAND TOTAL

51 DMH/DD FORENSIC CONTACTS Alton Mental Health Center 4500 College Avenue Alton, IL Phone: 618/ ; TDD: 618/ Fax: 618/ Contact: Ron Floyd, Forensic Coordinator Elgin Mental Health Center 750 South State Street Elgin, IL Phone: 847/ x 3120; TDD: 847/ Fax: 847/ Contact: Jeff Pharis, Forensic Coordinator Chester Mental Health Center P.O. Box 31 Chester, IL Phone: ext. 221; TDD: 618/ Fax: 618/ Contact: Dennis Kurz, Forensic Coordinator Andrew McFarland Mental Health Center 901 Southwind Road Springfield, IL Phone: 217/ ; TDD: 217/ Fax: 217/ Contact: Don Henke, Forensic Coordinator Clyde L. Choate Mental Health & Developmental Center 1000 North Main Street Anna, IL Phone: 618/ ; TTY: 618/ Fax: 618/ Contact: Michael Jasmon, Unit Director - DD Forensic Unit Juvenile Forensic Treatment 160 N. LaSalle St. 10 th Floor Chicago, IL Phone: Fax: Contact: Dr. Sharon L. Coleman, Associate Director of Forensic Services

52 Can be found at the Illinois Department of Human Services website under Forensic Services/Program Overview aspx?item=68376 Dr. Anderson Freeman Director of Forensic Services * Dr. Sharon Coleman Associate Director, Forensic Services sharon.coleman@illinois.gov

53 Questions & Discussion