TheDailyCourier. MAY IS MENTAL HEALTH AWARENESS MONTH YAVAPAI COUNTY'S RESTORATION TO COMPETENCY PROGRAM SETS THE BAR - Part 1 of 3

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1 Thursday, May 01, 2014 TheDailyCourier MAY IS MENTAL HEALTH AWARENESS MONTH YAVAPAI COUNTY'S RESTORATION TO COMPETENCY PROGRAM SETS THE BAR - Part 1 of 3 Scott Orr The Daily Courier Thursday, May 01,2014 Like many major programs, Yavapai County's..._-"""'--~...,...,.,..,._-..,..._-_ Restoration to Competency (RTC) program was borne of necessity. In 2005, the Arizona State Hospital in Phoenix began to transfer the cost of treating prisoners deemed not competent to stand trial to local counties: Maricopa, first, then Pima, in As the economy, both nationally and statewide, began to falter, the hospital began to bill the rest of Arizona's counties in At $670 a day for each inmate the county sent to the State Hospital, the bill, including inmate transportation to and from Phoenix, was in the neighborhood of $2.5 million a year. That was the impetus for three county officials - YCSO Chief Deputy John Russell, who was then a commander; Becky Payne, RN, the jail's health services administrator; and Deputy County Attorney Jack Fields - to develop the county's own in-house Restoration to Competency program, to be conducted in the Camp Verde jail. The program would be an expansion of the mental health services already provided by Wexford Health Sources of Pittsburgh, Penn. The first inmate began treatment on April 5, " t J ', 'j d ;.+ Now, four years and several national awards later, Sheriff Scott Mascher said the Yavapai RTC has attained holy grail status for a government program: it is better, faster, and Ill...

2 cheaper. There's no question that RTC is cheaper. The Yavapai version of RTC costs the county just $240 a day per inmate, and over half of Arizona's other counties now send their inmates to Camp Verde for treatment, generating a profit for the sheriff's office. Courier file photo> Judge Cele Hancock, who presides over the county's mental health court, said the county's Restoration to Competency program, based at the Camp Verde jail, is a "much better alternative" than sending defendants diagnosed as incompetent to sending them to the Arizona State Hospital in Phoenix. It's faster, too. Russell said, "It could take 60 What is Wexford? to 90 days" after the judge's order "before we Wexford Health Sources, Inc., of Pittsburgh, Penn., could get that inmate a bed in the state generates revenues of $125 million a year providing health hospital. So they're going to sit in jail for that care to inmates in county jails, state and federal prisons, time period" without treatment. With the juvenile detention centers, substance abuse treatment local RTC program, he said, once the judge centers, psychiatric hospitals, and correctional centers for orders treatment, "the very next day they're sex offenders. Founded in 1992, Wexford has about 2,000 in the program in Yavapai County. There's no employees and serves nearly 163,000 inmates and patients wait." in 13 states. And Mascher said RTC was designed to be more effective. "We (realized) we could probably do a better treatment, a more personalized treatment - a more close, local treatment, where family and friends could visit and be a part of it - rather than ship them" to Phoenix, he said. "We can do this ourselves better." Yavapai'County paid Wexford $3.2 million for its health services at the Camp Verde jail in It was very difficult to find defense attorneys in Prescott who were willing to talk on the record - or even off the record - about their views on the RTC program; even retiring Public Defender Dean Trebesch declined comment. Told that there was little enthusiasm for comment, one attorney said, "Well, why do you think that is?" apparently referring to the fact that the overwhelming majority of defense attorneys in the area are either employed by the county through the Public Defender's Office or work under contract for it. Asked if there was room for improvement in RTC, Robert Gundacker, a public defender, chose his words carefully. "I would say 'yes.' But there's never been a restoration program, that in my opinion, I've ever been exposed to, that doesn't have room for improvement," he said. "We have been approached by the jail to discuss issues related to the RTC program," he said. "We're interested in engaging in discussion about it." Prescott Valley defense attorney Dan DeRienzo spoke highly of RTC. "I think they do a great job with that program. I have had several clients that have gone through it. I think they care about the patients and keep excellent notes and diagnoses. " Superior Court Judge Cele Hancock, who now runs the county's mental health court, said the RTC program does good work, but can't restore every patient. "They do a great job over there getting them to the point of competency," she said, but "we've had several reports (of defendants) that come back that say they're not competent and they're not going to be restored." Tomorrow: how RTC works

3 Friday, May 02, 2014 TheDailyCourier Legally competent: Helping defendants help themselves Scott Orr The Daily Courier Friday, May 02, 2014 The most important thing to know about the Yavapai County's Restoration to Competency (RTC) program at the Camp Verde jail is that it does not restore defendants' overall mental health, nor does it claim to do that. The sole objective of RTC is to prepare inmates to be able to participate in their own legal defense. That distinction can lead to some sticky situations, Jail Health Administrator Becky Payne, RN, said. "A defense attorney may feel that, '(The defendant) still has this delusional belief about being an Indian spirit god,' and, well, yeah, he does and he probably always will, but he also understands his constitutional rights," she said. The program's narrow focus means that there are two Thinkstock keys to RTC: "The teaching portion and the (medication) management are equally important," Payne said. "Once we can get a good regime of medications on board, and get them to where they can work one-on-one with a counselor and not be actively psychotic... then the counselors start the teaching portion." She called that teaching portion of the program "huge." The RTC staff helps the inmates learn what goes on in a courtroom, what the terms mean, how they should act in court. Some inmates sit in on a mock courtroom so they can see what may happen when they go to the real thing. Since April 2010, 136 defendants have been referred to the program by judges. Of those, 115, or 85 percent, have been restored. Fifteen percent were deemed unrestorable. "That's actually spot-on with the national average," Payne noted. The treatment at RTC, while it is effective, is not permanent. "While there are so many merits to a jail-based restoration program, being jail-based is also its own enemy," Payne said. "This environment makes people not stay together well. We can put the meds in them, but the lack of social interaction with their families, the lack of being able to drive and go out and have fresh air, to be able to go to a movie" all contribute to "decompensating" or losing the benefits of RTC treatment.

4 "To catch them while they're competent and can assist in their own defense, things have to be pretty timely," Payne said. But, she added, one of the merits is that jail is not like Club Med. "It prompts the defendants to hurry and learn their stuff so they can get out of the program." She pointed out that the environment at the Arizona State Hospital (ASH), where defendants were sent for RTC prior to the county developing its own program, was so comfortable that some of the patients were in no hurry to leave. Another problem with ASH, local defense attorney Dan DeRienzo said, is that "sometimes judges want to send people who have been declared incompetent down to ASH, and (at) ASH, I think, their game plan is to fill the people with medication, claim that they're restored, and put them back into the justice system. "I don't feel that way about our program here," he said. "I think our program keeps a good watch on them and really cares about them." Inmates who cannot be restored to competency currently face one of three possible futures, Payne said. They could be placed under guardianship, released with criminal charges dropped, or sent to the Arizona State Hospital for no longer than what their sentence would have been. A bill proposed this session in the state Legislature that never made it to the governor, SB 1249, would have added a fourth option for those who can't be restored: "They could actually - if they were considered dangerous - be held in a state-licensed medical facility... until they either are restored or are no longer dangerous," Payne said. But, she added, if neither of those happened, the inmate could potentially "sit there" for decades. Payne called the bill "well-intentioned" and said, "We need something. I'm just not sure this is the way." Tomorrow: When the jail becomes a mental health hospital

5 Saturday, May 03, 2014 TheDailyCourier Jails forced to double as treatment centers for mentally ill Scott Orr The Daily Courier Saturday, May 03, 2014 More than half of the inmates in United States jails have a mental health problem, a 2006 Justice Department study said, and women incarcerated have a much higher rate than men. "Arizona and Nevada have almost 10 times more mentally ill persons in jails and prisons than in hospitals," a May 2010 joint study by the Treatment Advocacy Center and the National Sheriffs' Association found. "It is thus fact, not hyperbole, that America's jails and prisons have become our new mental hospitals." That reality concerns Yavapai County Sheriff Scott Mascher. Thinkstock "Should the jails be the de facto mental health treatment centers? I don't think we should be," he said. "Are we criminalizing the treatment of mental health?" he asked. "Mental (illness) isn't a crime. But if you get charged with a crime because of your mental health, it falls onto a criminal institution to provide (treatment). " In 1955, there was one bed in a psychiatric ward for every 300 Americans; now there is one for every 3,000, the 2010 study said. "For over a hundred years, mentally ill individuals were treated in hospitals. We have now returned to the conditions of the 1840s by putting large numbers of mentally ill persons back into jails and prisons," the 2010 report said. "There was time when we had mental health hospitals. Then there was a change in which people said, 'You can't imprison people for being mentally ill, '" Superior Court Judge Cel<~ Hancock said. "But there was nowhere for them to be. So now, we're trying to cobble together (a system) to serve this part of our community." The problem is self-sustaining, Mascher said. "We see the revolving door of someone who is delusional, or seriously depressed and suicidal, making threats, and they come to jail and they get stabilized on medication, they go back out into the community, there's no real treatment or the cost of treatment (is) something they can't afford, they get delusional again," he said. "Then they're back getting mental health treatment (in jail)."

6 The public doesn't really understand why so many people with emotional problems end up in jail, Mascher said. He gave an example: "] had a lady call me and say, '] called the sheriff's office because my son was threatening suicide and he was threatening me, and you guys showed up and took him to jail. ] thought you were going to take him to a mental health treatment center.' Well, that is the jail, unfortunately." The 2010 report was blunt: "Deinstitutionalization, the emptying of state mental hospitals, has been one of the most well-meaning but poorly planned social changes ever carried out in the United States. "The present mental health system appears to be bankrupt of ideas for fixing this disaster."

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