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94–365 PDF 2004

MENTALLY ILL OFFENDER TREATMENT AND

CRIME REDUCTION ACT OF 2003

HEARING

BEFORE THE

SUBCOMMITTEE ON CRIME, TERRORISM, 

AND HOMELAND SECURITY

OF THE

COMMITTEE ON THE JUDICIARY 

HOUSE OF REPRESENTATIVES

ONE HUNDRED EIGHTH CONGRESS

SECOND SESSION

ON

S. 1194

JUNE 22, 2004

Serial No. 98

Printed for the use of the Committee on the Judiciary

(

Available via the World Wide Web: http://www.house.gov/judiciary 
(II)

COMMITTEE ON THE JUDICIARY 

F. JAMES SENSENBRENNER, JR., Wisconsin, Chairman 

HENRY J. HYDE, Illinois 

HOWARD COBLE, North Carolina 

LAMAR SMITH, Texas 

ELTON GALLEGLY, California 

BOB GOODLATTE, Virginia 

STEVE CHABOT, Ohio 

WILLIAM L. JENKINS, Tennessee 

CHRIS CANNON, Utah 

SPENCER BACHUS, Alabama 

JOHN N. HOSTETTLER, Indiana 

MARK GREEN, Wisconsin 

RIC KELLER, Florida 

MELISSA A. HART, Pennsylvania 

JEFF FLAKE, Arizona 

MIKE PENCE, Indiana 

J. RANDY FORBES, Virginia 

STEVE KING, Iowa 

JOHN R. CARTER, Texas 

TOM FEENEY, Florida 

MARSHA BLACKBURN, Tennessee 

JOHN CONYERS, JR., Michigan 

HOWARD L. BERMAN, California 

RICK BOUCHER, Virginia 

JERROLD NADLER, New York 

ROBERT C. SCOTT, Virginia 

MELVIN L. WATT, North Carolina 

ZOE LOFGREN, California 

SHEILA JACKSON LEE, Texas 

MAXINE WATERS, California 

MARTIN T. MEEHAN, Massachusetts 

WILLIAM D. DELAHUNT, Massachusetts 

ROBERT WEXLER, Florida 

TAMMY BALDWIN, Wisconsin 

ANTHONY D. WEINER, New York 

ADAM B. SCHIFF, California 

LINDA T. SA ́ NCHEZ, California

PHILIP G. KIKO, Chief of Staff-General Counsel 

PERRY H. APELBAUM, Minority Chief Counsel 

SUBCOMMITTEE ON CRIME, TERRORISM, AND HOMELAND SECURITY

HOWARD COBLE, North Carolina, Chairman

TOM FEENEY, Florida 

BOB GOODLATTE, Virginia 

STEVE CHABOT, Ohio 

MARK GREEN, Wisconsin 

RIC KELLER, Florida 

MIKE PENCE, Indiana 

J. RANDY FORBES, Virginia 

ROBERT C. SCOTT, Virginia 

ADAM B. SCHIFF, California 

SHEILA JACKSON LEE, Texas 

MAXINE WATERS, California 

MARTIN T. MEEHAN, Massachusetts

JAY APPERSON, Chief Counsel 

ELIZABETH SOKUL, Counsel 

KATY CROOKS, Counsel 

JASON CERVENAK, Full Committee Counsel 

BOBBY VASSAR, Minority Counsel 
(III)

C O N T E N T S 

JUNE 22, 2004

OPENING STATEMENT 

Page 

The Honorable Howard Coble, a Representative in Congress From the State 

of North Carolina, and Chairman, Subcommittee on Crime, Terrorism, and 

Homeland Security ............................................................................................... 1

The Honorable Robert C. Scott, a Representative in Congress From the State 

of Virginia, and Ranking Member, Subcommittee on Crime, Terrorism, 

and Homeland Security ....................................................................................... 2

WITNESSES 

Ms. Cheri Nolan, Deputy Assistant Attorney General, Office of Justice Programs, U.S. Department of Justice 

Oral Testimony ..................................................................................................... 4

Prepared Statement ............................................................................................. 6

Mr. Ted Sexton, Sheriff, Tuscaloosa County Sheriff’s Office, Tuscaloosa, Alabama 

Oral Testimony ..................................................................................................... 9

Prepared Statement ............................................................................................. 11

Professor John Monahan, Ph.D., Henry and Grace Doherty Professor of Law, 

University of Virginia, and Director, MacArthur Research Network on Mandated Community Treatment 

Oral Testimony ..................................................................................................... 12

Prepared Statement ............................................................................................. 14

Mrs. June P. Poe, Past President, National Alliance for the Mentally Ill 

of Roanoke Valley, Roanoke, VA, on behalf of the National Alliance for 

the Mentally Ill 

Oral Testimony ..................................................................................................... 17

Prepared Statement ............................................................................................. 19

APPENDIX 

MATERIAL SUBMITTED FOR THE HEARING RECORD

Prepared Statement of the Honorable Ted Strickland, a Representative in 

Congress From the State of Ohio ........................................................................ 30

Prepared Statement of the Honorable Ms. Sheila Jackson Lee, a Representative in Congress From the State of Texas .......................................................... 33

Prepared Statement of the Honorable William D. Delahunt, a Representative 

in Congress From the State of Massachusetts .................................................. 38

Letter from Jamie Fellner, Director of Human Rights Watch ............................. 41

Letter from Larry E. Naale, Executive Director of the National Association 

of Counties ............................................................................................................ 43

(1)

MENTALLY ILL OFFENDER TREATMENT AND 

CRIME REDUCTION ACT OF 2003

TUESDAY, JUNE 22, 2004

HOUSE OF REPRESENTATIVES, 

SUBCOMMITTEE ON CRIME, TERRORISM,

AND HOMELAND SECURITY

COMMITTEE ON THE JUDICIARY, 

Washington, DC.

The Subcommittee met, pursuant to notice, at 3:03 p.m., in Room 

2141, Rayburn House Office Building, Hon. Howard Coble (Chair 

of the Subcommittee) presiding. 

Mr. COBLE. Good afternoon, ladies and gentlemen. The Judiciary 

Subcommittee on Homeland Security, Terrorism, and Crime will 

come to order. 

Before I begin, I am told, Ms. Nolan, you need to depart at 4:15 

today, so we will try to accommodate you to that end. 

The Bureau of Justice Statistics estimated in 1999 that 16 percent of State prison inmates, seven percent of Federal inmates, and 

16 percent of those in local jails who are on probation reported either a mental condition or an overnight stay in a mental hospital. 

According to BJS, white inmates or Caucasian inmates were more 

likely than blacks or Hispanics to report a mental illness, and offender mental illness was highest for those between the ages of 45 

and 54. 

According to this study and others, homelessness and unemployment are more prevalent among the mentally ill. Additional statistics show that six in ten mentally ill State inmates were under the 

influence of alcohol or drugs at the time of the offense, and a third 

of all mentally ill offenders were alcohol dependent. 

BJS also found that six in ten of the mentally ill received treatment while incarcerated. These statistics show the importance of 

mental health treatment as well as additional assistance for the 

mentally ill non-violent offenders who end up in the criminal justice system. The statistics also reveal the importance of treatment 

of not only the drug or alcohol abuse issues, but also the underlying mental illness. 

This hearing will examine the prevalence of mental illness in the 

criminal justice system and explore methods of addressing this 

problem. Currently, the Department of Justice administers a Mental Health Court grant program in some States. This legislation, 

which we will review today, S. 1194, the ‘‘Mentally Ill Offender 

Treatment and Crime Reduction Act of 2003,’’ would create a grant 

program to encourage more States to address this issue. 
2

Now, I have discussed this bill in detail with Senator DeWine, 

and he is enthusiastically supportive, as am I, but I have some second thoughts about the authorized cost. We can talk about that another day or perhaps today. 

But I look forward to hearing from our witnesses today to shed 

some light on this important issue, and I am now pleased to recognize the distinguished gentleman from Virginia, Mr. Bobby Scott, 

the Ranking Member. 

Mr. SCOTT. Thank you, Mr. Chairman. I am pleased that you 

have scheduled this hearing on the ‘‘Mentally Ill Offender Treatment and Crime Reduction Act of 2003.’’ This bill, which passed 

the Senate by unanimous consent on October 27, 2003, is sponsored 

by Senators DeWine and Leahy. It is essentially the same as H.R. 

2387, sponsored by Representative Strickland, except for the provisions to include substance abuse programs among those with which 

there is required collaboration under the bill. 

This legislation represents phase two of an effort that started in 

the 106th Congress when Congressman Strickland and Senator 

DeWine led a successful effort in getting, quote, ‘‘Americans Law 

Enforcement and Mental Health Project Act’’ passed. That bill created a Department of Justice grant program which helped State 

and local governments establish Mental Health Courts. These 

courts provide specialized dockets which bring mental health professionals, social workers, public defenders, and prosecutors together to divert mentally ill offenders into a treatment plan. 

The indication is that the pilot Mental Health Courts projects 

that we authorized have been proven successful. We will hear the 

details from our witnesses, but it is clear that a significant number 

of Mental Health Courts and other diversion programs have sprung 

up since the law was passed. It is also clear that they have successfully diverted individuals with mental health problems from the 

criminal justice system into treatment, restoring individuals to 

healthy, productive lives, and saving money, comparing the lower 

cost of treatment to incarceration. 

S. 1194 will build on the Law Enforcement and Mental Health 

Project Act’s success by providing additional resources for communities that wish to create Mental Health Courts. The bill will make 

a significant commitment to addressing the needs of both the criminal justice system and the mentally ill offender population. It offers 

grants to communities to develop diversion programs, mental 

health treatments in jails and prisons, and transition and aftercare services to facilitate reentry into the community. The bill also 

requires collaboration between criminal justice, mental health 

treatment, and substance abuse and other agencies at the local 

level in collaboration with the Federal level through creation of an 

interagency task force. 

This is clearly necessary, appropriate, and helpful legislation to 

address a serious problem in the criminal justice and mental 

health treatment administration. I look forward to the testimony of 

our witnesses and working with you and our colleagues, Mr. Chairman, in getting this bill signed into law. 

Mr. COBLE. I thank the gentleman, and I am pleased to welcome, 

as well, the distinguished gentleman from Florida, Mr. Feeney, and 

the distinguished gentleman from Virginia, Mr. Goodlatte. 
3

Mr. GOODLATTE. Mr. Chairman? 

Mr. COBLE. The gentleman from Virginia? 

Mr. GOODLATTE. Mr. Chairman, I would ask unanimous consent 

that a statement from Representative Strickland from Ohio be entered into the record. 

Mr. COBLE. Without objection, it will be received. 

[The prepared statement of Mr. Strickland follows in the Appendix] 

Mr. COBLE. Our first witness today is Ms. Cheri Nolan. Ms. 

Nolan was appointed as Deputy Assistant Attorney General for the 

Office of Justice Programs in July of 2001. She has served four Attorneys General and three Presidents. Prior to her service at OJP, 

Ms. Nolan worked for the television show ‘‘America’s Most Wanted,’’ known to all of us, as well as serving in the White House staff 

of President Ronald Reagan and in various cabinet agencies, including the Departments of Commerce, Energy, and Treasury. 

Our second witness is Mr. Ted Sexton. Mr. Sexton has been the 

Sheriff of Tuscaloosa County since January 1991 and is currently 

serving in his fourth term. As Sheriff, Mr. Sexton served eight 

courts and has law enforcement jurisdiction over 1,340 square 

miles within Tuscaloosa County. He is currently Vice President of 

the National Sheriffs Association and will be President of the Association in 2005. Mr. Sexton earned his Bachelor of Arts degree at 

the University of Alabama and is a graduate of the FBI National 

Academy. And Mr. Sexton—pardon my immodesty, I am a fairly 

decent geographer—I assume Tuscaloosa County is in Alabama. I 

didn’t know that was certain, but I figured that. [Laughter.] 

Next, we have Dr. John Monahan. Dr. Monahan is a psychologist 

and holds the Doherty Chair of Law at the University of Virginia, 

where he is a professor of psychology and psychiatric medicine. Dr. 

Monahan has been appointed to the Committee on Law and Justice 

of the National Research Council. His work has been cited in numerous court decisions, and he has received distinguished awards 

for two of his books, The Clinical Prediction of Violent Behavior 

and Rethinking Risk Assessment. 

Finally, we welcome Mrs. June Poe. Mrs. Poe, I believe you are 

a constituent of Congressman Goodlatte, and he has requested the 

honor of introducing you. 

Mr. GOODLATTE. Mr. Chairman, thank you very much. Thank 

you for holding this hearing on what is clearly a very important 

issue that needs to be carefully examined because I don’t think we 

are giving our courts and our prison system, frankly, the kind of 

flexibility they need to have treatment and punishment fit the circumstances of the individuals who present themselves to them. 

We have somebody here with us today who can speak from personal experience. She is speaking on behalf of the National Alliance 

for the Mentally Ill, but she has five children. She is a widow, and 

I know that that has been a challenge for her because one of her 

children does have a mental illness and has had some problems 

with our criminal justice system as a result. 

So I very much welcome her and am delighted to have the opportunity. I thank you, Mr. Chairman, for inviting her to testify today. 

Mr. COBLE. I thank the gentleman from Virginia. 
4

Representative Strickland, the gentleman from Ohio, I know you 

have been very interested in this legislation, and even though you 

don’t sit as a Member of this Subcommittee, we would be happy to 

have you join us up here. You would not be able, however, to participate and question the witness. If you would like to come up and 

sit with us, you would be welcome to do so. 

Mr. STRICKLAND. Thank you, Mr. Chairman. 

Mr. COBLE. Ladies and gentlemen, it has become the practice of 

the Subcommittee to administer the oath to our witnesses appearing before us, so if you all would please stand and raise your right 

hands. 

Do each of you solemnly swear that the testimony you are about 

to give this Subcommittee shall be the truth, the whole truth, and 

nothing but the truth, so help you, God? 

Ms. NOLAN. I do. 

Mr. SEXTON. I do. 

Mr. MONAHAN. I do. 

Mrs. POE. I do. 

Mr. COBLE. Let the record show that each of the witnesses has 

answered in the affirmative and you may be seated. 

Again, I welcome you all. Folks, so you will be familiar with the 

drill, we operate under the 5-minute rule here. When you see that 

red light illuminate in your eye, that is your warning that the 5 

minutes have elapsed, and if you don’t cease and desist I am going 

to order Sheriff Sexton to take you—— [Laughter.] 

Mr. Scott and I are not that hard-hearted, but in view of Mrs. 

Poe’s schedule, as well, we do try to do the 5-minute rule. Your testimony has been examined. The amber light will appear first and 

the amber light will tell you that the ice is becoming thin, then the 

red light, the 5 minutes have expired. 

Ms. Nolan, if you will commence. 

TESTIMONY OF CHERI NOLAN, DEPUTY ASSISTANT ATTORNEY 

GENERAL, OFFICE OF JUSTICE PROGRAMS, U.S. DEPARTMENT OF JUSTICE 

Ms. NOLAN. Thank you, Mr. Chairman. Mr. Chairman, Mr. Scott, 

and Members of the Subcommittee, I am Cheri Nolan, Deputy Assistant Attorney General of the Office of Justice Programs. I am 

pleased to be here on behalf of the United States Department of 

Justice, especially the Office of Justice Programs, to discuss how 

the criminal justice system responds to individuals with mental illness who are involved with the system. 

This is an issue that cuts across Federal, State, and local boundaries, with mentally ill individuals being held everywhere from city 

lockups to Federal prison facilities. For example, OJP’s Bureau of 

Justice Statistics reported that in the year 2000, 13 percent of 

State prisoners were receiving some mental health therapy and 

nearly 10 percent were receiving psychotropic medications. Those 

figures translate to 143,000 prisoners receiving mental health therapy and 110,000 on medications. 

Another BJS report found that 16 percent of correctional detainees self-reported that they had a mental illness. This increasing 

number of people with mental illness in the criminal justice system 

has become one of the most pressing problems facing law enforce-
5

ment in corrections today and it is an issue with both major public 

safety and fiscal implications. 

However, we need to be clear at the outset that individuals who 

are found guilty of committing crimes must be held accountable. If 

they commit a serious crime, then they need to be incarcerated 

whether or not they are mentally ill. We will not absolve someone 

of responsibility for committing a crime simply because he or she 

has a mental illness. 

At the same time, we hear from police, prosecutors, judges, and 

correctional administrators that they are frustrated with existing 

responses to people with mental illness who commit less serious 

non-violent crimes. On the one hand, when these individuals are 

not incarcerated and remain in the community, they continue to 

tax public safety resources and can be a threat to public safety. On 

the other hand, even when those with mental illness do spend time 

in jail, the criminal justice system is a revolving door with extremely high recidivism rates for persons with mental illness. 

Without connections to treatment, support services, and housing, 

mentally ill individuals will continue to re-offend and jeopardize 

public safety. That is why pre-release planning and cross-agency 

collaboration are vital to the successful reentry of these individuals 

into the community. 

Today, however, this collaboration is the exception, not the rule, 

but we believe that OJP can be a valuable resource to State and 

local governments in these efforts. We can promote promising practices, provide technical assistance, and conduct research that will 

stimulate the development and replication of programs and policies 

that will increase public safety and make the justice system more 

efficient. 

For example, OJP’s Bureau of Justice Assistance has published 

a monograph which is the first in-depth examination of Mental 

Health Courts and will be a guide to communities in developing 

their own courts. BJA has also provided grants totaling approximately $5.5 million to 37 jurisdictions in 29 different States to fund 

Mental Health Courts. These 2-year grants, totaling about 

$150,000 per site, have helped some existing courts add key components to their programs and have helped other courts launch their 

operations. 

BJA sponsored the first ever national meeting of mental health 

court practitioners in Cincinnati, Ohio, this past January, which 

was part of OJP’s overall goal of providing information and technical assistance to the field. We will also publish guides for implementing and operating Mental Health Courts later this year. 

Through these activities and through our own interagency collaboration with the Department of Health and Human Services, as 

well as with the Council of State Governments, we are able to demonstrate to State and local governments that the collaboration between mental health and criminal justice agencies is not only possible, but extremely valuable. 

My experience over the years and most recently at OJP tells me 

that no one sector or one agency alone can resolve the issues surrounding the involvement of mentally ill individuals in the criminal 

justice system. However, together, we can come closer to an out-
6

come that will both provide necessary treatment and preserve public safety. 

I thank you for your interest in this critical issue and I will be 

pleased to answer any questions that you might have. 

Mr. COBLE. Thank you, Ms. Nolan. 

[The prepared statement of Ms. Nolan follows:]

PREPARED STATEMENT OF CHERI NOLAN

Mr. Chairman, Mr. Scott, and Members of the Subcommittee, I am Cheri Nolan, 

Deputy Assistant Attorney General of the Office of Justice Programs. I am pleased 

to be here this afternoon on behalf of the U.S. Department of Justice (DOJ) and especially the Office of Justice Programs to discuss how the criminal justice system 

responds to individuals with mental illness who are involved with the system. 

This is an issue that cuts across federal, state, and local boundaries, with mentally ill individuals being held everywhere from city lockups to federal prison facilities. 

It is becoming clear that the increasing number of people with mental illness in 

the criminal justice system is one of the most pressing problems facing law enforcement and corrections today. This issue has both major public safety and fiscal implications. 

To understand the policy implications facing us, I would like to highlight some 

data about what prisons and jails are doing, and what has become a more and more 

common profile among offenders. According to a special report by the Office of Justice Programs’ Bureau of Justice Statistics (BJS), in 2000, nearly all (95 percent) 

state adult confinement facilities screened inmates for mental health problems. Of 

the nation’s 1,558 state public and private adult correctional facilities, 1,394 reported they provided mental health services to their inmates. Nearly 70 percent of 

facilities housing state prison inmates reported that as a matter of policy they 

screened inmates at intake, 13 percent of state prisoners were receiving some mental health therapy or counseling services at midyear 2000, and nearly 10 percent 

of state prisoners were receiving psychotropic medications. BJS’s report was based 

on the ‘‘2000 Census of State and Federal Adult Correctional Facilities,’’ which included—for the first time—items related to facility policies on mental health screening and treatment. 

Another BJS report found that 16 percent of correctional detainees self-reported 

they had a mental illness. We all recognize that the accuracy of this estimate depended on the ability and willingness of inmates to report such problems, which 

makes a strong argument for using uniform, proven assessment and screening tools. 

However, if this prevalence rate of mental illnesses among correctional detainees 

were used as the actual rate for program planning, there would be approximately 

2 million individuals with serious mental illnesses admitted to U.S. jails and prisons 

each year. 

I’m sure that we agree that all individuals who are found guilty of committing 

crimes must be held accountable. If the crime is serious, incarceration is the appropriate response, regardless of whether the perpetrator has a mental illness. Our policy is clear: we will not absolve someone of any responsibility for committing a crime 

simply because he or she has a mental illness. 

At the same time, police, prosecutors, judges, and corrections administrators regularly voice their frustrations about existing responses to people with mental illness 

who commit low-level, less-serious crimes. When incarceration is not the answer, individuals with mental illness often are returned to the community, where, without 

access to appropriate housing and comprehensive mental health care and support 

services, they are more likely to be picked up for low level crimes once again in a 

costly and repetitive cycle. 

Yet, even for those with mental illness who spend time in jail, the criminal justice 

system is a ‘‘revolving door.’’ Recidivism rates for individuals with mental illness are 

extremely high. Let me cite two examples: first, according to an October 1998 article 

in Psychiatric Services, more than 70 percent of inmates with mental illness released from the Lucas County, Ohio jail were re-arrested over the course of 3 years, 

and second, according to the Los Angeles County Board of Supervisors’ Task Force 

on Incarcerated Mentally Ill, about 90 percent of Los Angeles County jail inmates 

with mental illness are repeat offenders, and almost one-third of the inmates have 

been incarcerated 10 or more times. 

These figures are a testament to the difficulty of ensuring that people with mental 

illness leaving correctional facilities are connected to needed treatment, support 
7

services, and housing. Without those connections, these individuals will continue to 

re-offend and public safety will continue to be jeopardized. 

The involvement of people with mental illness in the justice system also is extremely expensive. County jails are forced to use huge portions of their pharmacy 

budgets for mental health treatment. According to Oregon’s Lane County Sheriff’s Office and Tennessee’s Benjamin Harrington/Knox County Mental Health Association, respectively, in the past year, 58 percent of the pharmacy budget in Lane 

County and 80 percent in Knox County were spent on psychotropic medications. 

Many inmates with serious mental illness require 24-hour suicide watch. The New 

York Monroe County Sheriff’s Office, which houses just over 1,000 inmates in its jail, spent $315,000 in 1 year alone on overtime for officers assigned to this responsibility. 

Managing individuals with mental illness in prison is no less costly. The Pennsylvania Department of Corrections estimates that an inmate with serious mental illness costs $140 per day to incarcerate, nearly twice as much as an inmate without 

serious mental illness. 

In response to the need to address the combined problems of offender management and increasing costs, state and local governments across the country are developing programs and policies unique to their jurisdiction’s criminal justice systems 

that aim to improve the response to people with mental illness from the initial contact with law enforcement through the offender’s re-entry to the community from 

prison. 

For example, state and local governments have encouraged police departments to 

form crisis intervention teams, developed pretrial screening for defendants with 

mental illness, established mental health courts, specialized caseloads for probation 

officers, introduced new instruments to screen newly admitted inmates for mental 

illness, implemented therapeutic communities in jails and prisons for offenders with 

co-occurring substance abuse and mental health disorders, and formed multidisciplinary teams to work on inmates’ re-entry planning. 

At the heart of each of these emerging strategies is collaboration between the 

criminal justice and mental health systems, the crucial involvement of substance 

abuse treatment providers and other social service providers, and the need for affordable housing and employment. As we have demonstrated in the cross-agency Serious and Violent Offender Re-entry Initiative in which DOJ has partnered with the 

Department of Labor and the Department of Health and Human Services, no one 

sector or agency can solve this problem working alone. Together, they can make a 

difference. 

Today, however, this collaboration is the exception, not the rule. As we have 

learned, even those leaders in the criminal justice and mental health systems who 

are interested in working together are unsure of what they can do, and, despite the 

possibility of generating significant savings to the state and county, the limited 

budgets in most jurisdictions make it very difficult to experiment with new ideas. 

Yet, I believe that OJP can be a valuable resource to state and local governments. 

By promoting promising practices, providing technical assistance, and working with 

other DOJ agencies as well as with both the Substance Abuse and Mental Health 

Services Administration (‘‘SAMHSA’’) (in the Department of Health and Human 

Services) and NIMH to conduct research, we can stimulate the development and 

replication of programs and policies that will increase public safety and make the 

justice system more efficient. 

For instance, the Bureau of Justice Assistance (BJA) has supported the investigation and implementation of mental health courts. In 2000, BJA published the first 

in-depth examination of mental health courts, ‘‘Emerging Judicial Strategies for the 

Mentally Ill in the Criminal Caseload.’’ This monograph described the organization 

and operation of four of the earliest mental health courts and has helped guide communities in developing their own mental health courts. 

In the Fiscal Year 2003 appropriation, BJA received funding for mental health 

courts, which we have administered according to the parameters established in P.L. 

106–515, ‘‘America’s Law Enforcement and Mental Health Project.’’ BJA has provided grants totaling approximately $5.5 million to 37 jurisdictions in 29 different 

states. These two-year grants, totaling approximately $150,000 per site, have helped 

some existing mental health courts add key components to their program and 

helped other courts in the planning stages launch their operations. 

Beyond direct grant funding, it is our responsibility to the field to provide information and technical assistance grounded in research and representing sound criminal justice practice, regardless of whether the project receives OJP funding. That 

is why, in addition to the grant funding, OJP promotes technical assistance. 

Through this technical assistance, BJA sponsored the first-ever national meeting of 

mental health court practitioners in Cincinnati, Ohio this past January. In addition, 
8

grantee courts are receiving guidance on issues such as connecting court clients to 

housing, responding to the particular needs of women, and gathering outcome data. 

Later this year, BJA will publish guides for implementing and operating mental 

health courts. As with all of our programs, we are working with the field to collect 

outcome data, which will further inform our policy decisions in this area. OJP’s National Institute of Justice (NIJ), is one of BJA’s partners in these endeavors. NIJ 

plans to publish the results of its examination of the referral and decision-making 

processes of seven BJA-funded mental health courts. 

While mental health courts can be a component of addressing the problems associated with offenders with mental illness, other approaches are needed as well. That 

is why BJA has supported the Criminal Justice/Mental Health Consensus Project, 

which is coordinated by the Council of State Governments. The landmark Consensus 

Project Report provides hundreds of recommendations that policymakers and practitioners agree will improve the response to people with mental illness who come in 

contact with the criminal justice system. 

In recent months, we have taken several steps at BJA to help state and local governments think about this issue from arrest through re-entry. 

First, the Director of BJA has appointed a senior policy advisor for criminal justice and mental health issues. This is the first time the agency has had such a position. It demonstrates our recognition that the involvement of people with mental illness in the justice system is becoming one of the most important issues facing local 

and state criminal justice agencies and that BJA must be responsive to their needs. 

Second, some grantees are using Serious and Violent Offender Re-Entry Initiative 

funds, better known as ‘‘re-entry,’’ to improve the transition that people with mental 

illness make from prison to the community. 

Third, BJA is currently developing a strategic plan to support the efforts of law 

enforcement, corrections, and courts in dealing with individuals with mental illness. 

In fact, earlier this month, a group of court and mental health experts met to develop recommendations to BJA on what activities we and our federal partners could 

undertake to support court-based efforts to better address defendants with mental 

illness. 

Increasing collaboration between criminal justice and mental health agencies is 

essential at the state and local levels, as well as at the federal level. We are coordinating our efforts with SAMHSA, particularly with regard to their Targeted Capacity Expansion (TCE) Grants for Jail Diversion Programs. While the programs are 

similar in nature, SAMHSA is providing grants for pre- and post-booking diversions 

that do not involve continuous judicial oversight, treatment, and case disposition. 

BJA is funding models that provide continuous judicial oversight and intensive case 

management, ensuring that offenders remain accountable throughout the process. 

Our cooperative efforts with SAMHSA will also help ensure that the federal government does not fund overlapping grant programs. 

In addition, the technical assistance providers for both agencies’ programs, the 

Council of State Governments and the TAPA Center for Jail Diversion (part of the 

GAINS Center funded by DOJ and SAMHSA), are working closely to coordinate 

their efforts. These organizations meet quarterly and are working together on a 

number of key issues, including promoting judicial leadership and better understanding the fiscal impact of mental illness in the justice system. 

This coordination helps us maximize the value of each agency’s grant program. 

Furthermore, this collaboration enables us to leverage each agency’s resources, expertise, and credibility with our respective constituencies in state and local governments. Most important, it allows us to demonstrate to state and local governments 

that the collaboration between mental health and criminal justice agencies is not 

only possible, but extremely valuable. 

And, BJA is working with SAMHSA to implement the policies identified in the 

July 2003 report of the President’s New Freedom Commission on Mental Health to 

maximize the utility of existing resources, improve coordination of treatments and 

services, and promote successful community integration for adults with a serious 

mental illness. 

Mr. Chairman, from my work at OJP I have come to believe that the increasing 

number of people with mental illness in the criminal justice system is one of the 

most pressing issues facing our police departments, jails, prisons, and courts. State 

and county governments have demonstrated that thoughtful policies and programs 

can be developed to address this problem. The federal partners are committed to 

doing all we can to support practitioners through our grant programs and technical 

assistance. 

We very much appreciate the interest you and your colleagues have shown in this 

critical issue. I welcome the opportunity to answer any questions that you may 

have.
9

Mr. COBLE. Sheriff Sexton. 

TESTIMONY OF TED SEXTON, SHERIFF, TUSCALOOSA COUNTY 

SHERIFF’S OFFICE, TUSCALOOSA, AL 

Mr. SEXTON. Mr. Chairman, my name is Ted Sexton and I am 

the Sheriff of Tuscaloosa County. I serve on the Executive Committee and Board of Directors of the National Sheriffs Association. 

I appreciate the opportunity to share with you some thoughts from 

NSA and the larger enforcement community on the need for S. 

1994, the ‘‘Mentally Ill Offender Treatment and Crime Reduction 

Act’’ now under consideration by this Committee. Before I begin, let 

me say that we strongly supported S. 1194, which passed the 

United States Senate unanimously and welcome these hearings in 

the House. 

Most of the people suffering mental illness with whom law enforcement officers interact are non-violent, low-level offenders who 

are demonstrating signs of untreated mental illness in public. For 

the most part, these individuals pose a low risk of harming others, 

but act inappropriately enough to cause members of their community to be concerned. Many of the calls my office receives are actually placed by family members who are seeking law enforcement 

help to control behavior of someone who is off their medication. 

It is clear that without proper training on how to respond to 

these individuals, law enforcement may not be able to appropriately handle the situation. These contacts have a great potential 

for rapid escalation of both threat and force. Minor situations can 

easily escalate into a violent confrontation that jeopardizes the 

safety of both officers and the individual. 

In many circumstances, arresting the mentally ill individual is 

an inappropriate response, even if the officer believes that arresting the individual for a criminal charge is appropriate under the 

circumstances. County jails are not equipped to house a large number of mentally ill offenders. Jails are jails. They are not treatment 

facilities nor are they hospitals. Jails ought not to be the treatment 

option of first resort, but sadly, they have become just that because 

there is nothing else readily available. 

In my own community, we have seen a steady rise in the number 

of calls related to mentally ill individuals. This rise in calls for response has largely corresponded to the decline in population of 

large institutions within my community that have traditionally 

provided services to the mentally ill. As these individuals have 

been moved from an institutional setting to community based programs, we have seen a rise in the number of contacts that officers 

have with them. 

In response to the increased frequency in calls for service relating to this particular population of our community, my senior staff 

and I set out to develop a program within our office that trains officers to more effectively deal with mentally ill individuals. The 

training program provides officers with a better understanding of 

mental health issues and provides a number of suggested options 

other than arrest. 

The training is not limited to patrol officers who are most likely 

to come in contact with mentally ill individuals, but also includes 

dispatch officers who field the calls for service. In addition, we pro-
10

vide the training to other law enforcement agencies, fire/rescue 

squads, EMTs, and our volunteer fire departments. Last year, the 

training program was presented to more than 100 officers from various agencies, and currently there are more than 180 officers scheduled to receive the training. The Alabama Peace Officers Standards 

and Training Commission has recently established this program as 

a pilot for eventual State-wide implementation. 

Providing this training to law enforcement officers is a critically 

important element of providing service to the mentally ill in our 

community, but it is only one of the elements. Providing meaningful alternatives to incarceration is another equally critical component. As things stand now, the officer in the field is often left to 

choose between the unappealing alternatives of locking up the 

mentally ill individual or leaving them on the scene. Right now, 

there is very little middle ground and no real other options. 

The problems with these choices are obvious. Simply leaving the 

individual at the scene is unacceptable and serves neither the sick 

individual nor the public. Taking these individuals to jail, however, 

is often just as problematic. County jails are not equipped to handle mentally ill individuals. There is limited space in which to 

house these individuals apart from the general population at the 

jail. 

Of course, they are in jail because they were causing problems 

outside. Their offensive behavior does not magically improve in the 

jail setting. In fact, behavior often deteriorates in jail. Conflicts 

with other detainees or the inability to follow the rules of the facility often escalate into situations that threaten the safety of an officer or the individual. 

Providing medical care for these individuals in a jail setting is 

a tremendous concern, as well. Tuscaloosa County houses approximately 600 inmates. At any given time, roughly 10 percent of the 

jail population is on some sort of psychotropic medication. The vast 

majority of those are on multiple medications. In the final quarter 

of last year, the cost of those medications cost my office and the 

taxpayers of Tuscaloosa almost $75,000. Additional costs are incurred because the staff of the jail has to be extra vigilant in monitoring mentally ill individuals. Frequently, they are on suicide 

watch, which requires additional detention officers to monitor 

them, thus increasing manpower needs. 

A mentally ill person in jail receives very basic and limited mental health assistance. I would hesitate to call it treatment. The fact 

is, they receive far less mental health care than they need and are 

subsequently released back into society without either a safety net 

or a system in place to ensure compliance with a treatment plan. 

Frequently, the cycle is repeated over and over again. The mentally 

ill are being arrested after they have failed to keep up the prescribed medication regime. 

The still unresolved problem for us, as for virtually all sheriffs’

offices across the country, is finding an alternative placement for 

those individuals for whom jail is not appropriate. As I said earlier, 

the jail is not designed nor equipped to provide treatment for mentally ill. Jails are designed for holding those individuals awaiting 

trial or incarceration of those serving sentences and should not be 

viewed as an alternative treatment facility for mentally ill. For 
11

those who do require incarceration, placing them in the appropriate 

setting will help minimize the time that they actually spend in custody. 

Additionally, a system for monitoring these individuals once they 

are released from jail is also needed to ensure that we can break 

the cycle I have outlined. It is a disservice to everyone involved if 

we cannot arrange some more appropriate treatment than locking 

up the mentally ill in jail. 

For our part in Tuscaloosa, we are partnering with mental health 

professionals within our community to try to address these issues 

and we believe that H.R. 2387 will provide the resources and guidance we need to develop and implement creative solutions. Thank 

you. 

Mr. COBLE. Thank you, Sheriff. 

[The prepared statement of Mr. Sexton follows:]

PREPARED STATEMENT OF SHERIFF TED SEXTON

Mr. Chairman, my name is Ted Sexton, and I am the Sheriff of Tuscaloosa County, Alabama. I serve on the Executive Committee and Board of Directors of the National Sheriffs’ Association where I am the incoming First Vice President. I appreciate the opportunity to share with you some thoughts from NSA and the larger law 

enforcement community on the need for S. 1194, the Mentally Ill Offender Treatment and Crime Reduction Act now under consideration by this committee. Before 

I begin, let me say that we strongly support S. 1194, which passed the U.S. Senate 

unanimously and welcome these hearings in the House. 

Most of the people suffering mental illnesses with whom law enforcement officers 

interact are non-violent, low-level offenders who are demonstrating signs of untreated mental illness in public. For the most part, these individuals pose a low risk 

of harming others, but act inappropriately enough to cause members of the community to be concerned. Many of the calls my office receives are actually placed by family members who are seeking law enforcement help to control the behavior of someone who is ‘‘off their medication.’’

It is clear that without proper training on how to respond to these individuals, 

law enforcement officers may not be able to appropriately handle the situation. 

These contacts have a great potential for rapid escalation of both threat and force. 

Minor situations can easily escalate into a violent confrontation that jeopardizes the 

safety of both the officers and the individual. 

In many circumstances, arresting the mentally ill individual is an inappropriate 

response. Even if the officer believes that arresting the individual for a criminal 

charge is appropriate under the circumstances, county jails are not equipped to 

house a large number of mentally ill offenders. Jails are jails; they are not treatment facilities nor are they hospitals. Jails ought not be the treatment option of first 

resort, but sadly they have become just that because there is nothing else readily 

available. 

In my own community, we have seen a steady rise in the number of calls related 

to mentally ill individuals. This rise in the calls for response has largely corresponded to the decline in the population of large institutions within my community that have traditionally provided services to the mentally ill. As these individuals have been moved from an institutional setting to community-based programs, 

we have seen a rise in the number of contacts that officers have with them. 

In response to the increased frequency in calls for service relating to this particular population of our community, my senior staff and I set out to develop a program within our office that trains officers to more effectively deal with mentally ill 

individuals. The training program provides officers with a better understanding of 

mental health issues, and provides a number of suggested options other than arrest. 

The training is not limited to patrol officers who are most likely to come in contact 

with mentally ill individuals, but also includes our dispatch officers who field the 

calls for service. In addition, we provide the training to other law enforcement agencies, fire/rescue squads, EMTs, and our volunteer fire departments. Last year, the 

training program was presented to more than 100 officers from the various agencies 

last year and currently, there are more than 180 officers scheduled to receive the 

training. The Alabama Peace Officers Standards and Training Commission has re-
12

cently established this program as a pilot program for eventual statewide implementation. 

Providing this training to law enforcement officers is a critically important element of providing service to the mentally ill in our community; but it is only one 

of the elements. Providing meaningful alternatives to incarceration is another, 

equally critical component. As things stand now, the officer in the field is often left 

to choose between the unappealing alternatives of locking up a mentally ill individual or leaving them on the scene. Right now, there is very little middle ground 

and no real other options. 

The problems with these choices are obvious. Simply leaving the individual at the 

scene is unacceptable and serves neither the sick individual nor the public. Taking 

these individuals to jail, however, is often just as problematic. County jails are not 

equipped to handle mentally ill individuals. There is limited space in which to house 

these individuals apart from the general population at the jail. Of course, they are 

in jail because they were causing problems on the outside. Their offensive behavior 

doesn’t magically improve in the jail setting. In fact, behavior often deteriorates in 

jail. Conflicts with other detainees or the inability to follow the rules of the facility 

often escalate into situations that threaten the safety of an officer or the individual. 

Providing medical care for these individuals in a jail setting is a tremendous concern as well. The Tuscaloosa County Jail houses approximately 600 inmates. At any 

given time, roughly 10 per cent of the jail population is on some type of psychotropic 

medication. The vast majority of those are on multiple medications. In the final 

quarter of last year, the cost of those medications cost my office and the taxpayers 

of Tuscaloosa almost $75,000. Additional costs are incurred because the staff at the 

jail has to be extra vigilant in monitoring mentally ill individuals. Frequently they 

are on suicide watch, which requires additional detention officers to monitor them, 

thus increasing manpower needs and costs. 

A mentally ill person in jail receives very basic and limited mental health ‘‘assistance’’. I would hesitate to call it treatment. The fact is that they receive far less 

mental health care than they need and are subsequently released back into society 

without either a safety net or a system in place to ensure compliance with a treatment plan. Frequently, the cycle is simply repeated over and over again with the 

mentally ill being arrested after they have failed to keep up with their prescribed 

medication regimen. 

The still unresolved problem for us, as for virtually all Sheriff(s Offices across the 

country, is finding an alternative placement for those individuals for whom jail is 

not appropriate. As I said earlier, the jail is not designed nor equipped to provide 

treatment for the mentally ill. Jails are designed for the holding of individuals 

awaiting trial or incarceration of those serving sentences and should not be viewed 

as an alternative treatment facility for the mentally ill. For those who do require 

incarceration, placing them in an appropriate setting will help minimize the time 

that they actually spend in custody. Additionally, a system for monitoring these individuals once they are released from jail is also needed to ensure that we can break 

the cycle I’ve outlined. It is a disservice to everyone involved if we cannot arrange 

some more appropriate treatment than locking up the mentally ill in jail. 

For our part in Tuscaloosa, we are partnering with mental health professionals 

within our community to try to address these issues, and we believe that HR 2387 

will provide the resources and guidance we need to develop and implement creative 

solutions to this chronic problem. 

Mr. Chairman, I am ready to take your questions and I look forward to working 

with you to address this issue in a way that is helpful to the mentally ill and provides them with the treatment and services that they need.

Mr. COBLE. I failed to mention earlier, folks, your entire statements will be made a part of the record. 

Dr. Monahan. 

TESTIMONY OF JOHN MONAHAN, Ph.D., HENRY AND GRACE 

DOHERTY PROFESSOR OF LAW, UNIVERSITY OF VIRGINIA, 

AND DIRECTOR, MACARTHUR RESEARCH NETWORK ON 

MANDATED COMMUNITY TREATMENT 

Mr. MONAHAN. Thank you, Chairman Coble, Congressman Scott, 

and Members of the Subcommittee for inviting me here this afternoon. In addition to my day job at the University of Virginia School 

of Law, I direct the Research Network on Mandated Community 
13

Treatment for the MacArthur Foundation. The network is now engaged in a partnership with the National Institute of Justice to 

evaluate seven of the Mental Health Courts funded by Congress 2 

years ago that Mr. Scott mentioned. 

I will begin with the bottom line. The ‘‘Mentally Ill Offender 

Treatment and Crime Reduction Act’’ is the most evidence-based 

piece of Federal legislation on mentally ill offenders that I have 

seen in my 30 years as a researcher in this field. 

I say this for five reasons. First, the evidence is that the number 

of people this Act will affect is staggering. As you mentioned early 

on, Mr. Chair, 16 percent of adults in contact with the justice system are estimated to be mentally ill. This means that on any given 

day in the United States, there are over 200,000 prison inmates, 

100,000 jail detainees, and 700,000 people under the supervision of 

community corrections—over one million people in all—with a serious mental illness. Three-quarters of these mentally ill people also 

have a co-occurring substance abuse disorder. 

Women in the justice system have nearly twice the rate of mental illness as the male, but only one-third of the men and one-quarter of the women with a mental illness in jail report receiving any 

treatment for that mental illness while they were in jail. 

Another piece of evidence about the magnitude of this problem 

is the large number of communities that have taken it upon themselves to do something about people with mental illness in the justice system. The number of Mental Health Courts in the United 

States has mushroomed from one in 1997, to a dozen in 2002, to 

close to 100 this month. 

By the most recent count, there are almost 300 jail diversion programs now operating in the United States. This means that 7 percent of all counties have a police or a court-based program to divert 

defendants with a mental illness from jail. This also means that 93 

percent of all counties are without any program to keep non-violent 

defendants with a mental illness from crowding their jails and from 

committing more crime. 

Second, the evidence is that we can make a difference. Offenders 

with a mental illness can, in fact, be dealt with in ways that can 

reduce crime, save taxpayers money, or both. 

In terms of crime reduction, consider the MacArthur Violence 

Risk Assessment Study of over 1,000 people who have been hospitalized for mental illness, about half of whom had a prior contact 

with the criminal justice system. Now, the people who received no 

medication or therapy in the community after they get out of the 

hospital, 14 percent soon committed a violent act. Of the people 

who received an inadequate amount of treatment, about one treatment session a month, the violence rate was reduced from 14 percent to about 9 percent. But of the people who received the amount 

of treatment that they needed, about one session a week, the violence rate went from 14 percent to less than 3 percent. Amazingly 

enough, the people with mental illness who were receiving adequate treatment in the community were actually less violent than 

their neighbors who were not mental illness at all. 

In terms of saving taxpayer money, consider the pioneering 

Broward County, Florida, Mental Health Court. Compared to a 

nearby county without a Mental Health Court, the Broward de-
14

fendants are twice as likely to actually receive service for their 

mental illness and are no more likely to commit a new crime, despite the fact that the number of days they spent in jail is reduced 

by 75 percent, at enormous savings to the public. 

Third, the evidence is that one size does not fit all in terms of 

effectively dealing with mentally ill offenders. This Act is remarkably adaptable to local conditions in the pragmatic approach it 

takes to mentally ill offenders. Funded programs may include pretrial diversion in one jurisdiction, a Mental Health Court in another, a reentry program from jail or prison in a third, and some 

combination of these options in a fourth jurisdiction. 

Fourth, the evidence is that collaboration is essential to get anything accomplished having to do with mentally ill offenders. As the 

Council on State Government’s Criminal Justice/Mental Health 

Consensus Project concluded after 5 years of intensive study, and 

as Ms. Nolan just noted, neither mental health nor criminal justice 

can do the job alone. This Act creates powerful incentives for cooperation between the Department of Justice and the Department 

of Health and Human Services and among agencies at the Federal, 

State, and local levels. Crime and mental illness deeply affect all 

of our communities, and perhaps for this reason, the turf battles 

that doom many reform efforts seem to have been carefully avoided 

in drafting this Act. 

Finally, the evidence is that we need more evidence. We know a 

lot about how to deal with mentally ill offenders, vastly more than 

we knew even 5 years ago. But by no means do we know all we 

need to state with confidence what the best practices are for dealing with different kinds of mentally ill offenders in different kinds 

of American communities. By imposing strict requirements for objective assessments of the measurable outcomes of the programs 

that are implemented with its funds, the Act will generate a selfcorrecting body of knowledge that uses findings about the effectiveness of past practice to shape improvements in future practice. 

As Sheriff Sexton noted, the Act was born of the frustration of 

criminal justice officials in seeing ever more people with mental illness further crowd the already overcrowded jails, rarely receive the 

mental health treatment that they so plainly need, and continue to 

appear before them for the commission of yet another crime. The 

Act before you can set State and local governments on a course to 

put a stop to this revolving door. 

The evidence is there. I urge you to pass the ‘‘Mentally Ill Offender Treatment and Crime Reduction Act’’. 

Mr. COBLE. Thank you, Doctor. 

[The prepared statement of Mr. Monahan follows:]

PREPARED STATEMENT OF JOHN MONAHAN

Thank you, Chairman Coble and Congressman Scott, for inviting me to testify before you today. I am Dr. John Monahan, a psychologist, and I hold the Doherty 

Chair in Law at the University of Virginia, where I am also a Professor of Psychology and of Psychiatry. I have been involved in Federally-funded research on 

mentally ill offenders since the publication of my first book, Community Mental 

Health and the Criminal Justice System, in 1976. I currently direct the Research 

Network on Mandated Community Treatment for the John D. and Catherine T. 

MacArthur Foundation, which is concerned with how the criminal justice system 

can be used as ‘‘leverage’’ to get offenders with a mental disorder to accept treat-
15

1 A list of Network publications can be found at http://macarthur.virginia.edu 2 Redlich, A., Steadman, H., Monahan, J., Petrila, J., & Griffin, P. (in press). The second generation of mental health courts. Psychology, Public Policy, and Law. 3 Abram, K., & Teplin, L. (1991). Co-occurring disorders among mentally ill jail detainees. 

American Psychologist, 46, 1036–1045. 4 National GAINS Center. (2002). The prevalence of co-occurring mental illness and substance 

abuse disorders in the justice system.Delmar, NY: GAINS Center. 5Massaro, J. (2004). Working with people with mental illness involved in the criminal justice 

system: What mental health service providers need to know (2nd ed.). Delmar, NY: TAPA Center 

for Jail Diversion. 6Survey of Mental Health Courts. (2004). Available at http://

www.mentalhealthcourtsurvey.com 7TAPA Center for Jail Diversion. (2004). What can we say about the effectiveness of jail diversion programs for persons with co-occurring disorders? Available at http://www.gainsctr.com/

pdfs/tapa/WhatCanWeSay.pdf 8Steadman, H. (2004). A national perspective on diversion and linkage to community-based 

services. Available at http://www.gainsctr.com/ppt/NationalPerspectiveon 

DiversionanLinkage.ppt 9Monahan, J., Steadman, H., Silver, E., Appelbaum, P., Robbins, P., Mulvey, E., Roth, L., 

Grisso, T., & Banks, S. (2001). Rethinking risk assessment: The MacArthur study of mental disorder and violence. New York: Oxford University Press. 

ment for their illness.1 The Network is now engaged in a productive partnership 

with the National Institute of Justice to evaluate seven of the mental health courts 

funded by Congress as part of the 2000 America’s Law Enforcement and Mental 

Health Project Act.2

I will begin with the bottom line: the Mentally Ill Offender Treatment and Crime 

Reduction Act of 2003 is the most evidence-based piece of federal legislation on mentally ill offenders that I have seen in 30 years as a researcher in this field. I say 

this for five reasons. 

FIRST, THE EVIDENCE IS THAT THE NUMBER OF PEOPLE THIS ACT

WILL AFFECT IS STAGGERING. 

In its initial finding, the Act notes that the Bureau of Justice Statistics, using a 

broad definition of mental illness, concludes that over 16 percent of adults in contact 

with the justice system are mentally ill. This means that on any given day in the 

United States, there would be over 200,000 prison inmates, 100,000 jail detainees, 

and 700,000 people under the supervision of community corrections—over one million people in all—with a serious mental illness. Three-quarters of these mentally 

ill people also have a co-occurring substance abuse disorder.3 Women in the justice 

system have nearly twice the rate of mental illness as men.4 But only one-third of 

the men and one-quarter of the women with a mental illness in jail report receiving 

any treatment while they were detained.5

Another piece of evidence about the magnitude of the problem that the Act addresses is the large number of communities that have taken it upon themselves to 

do something about people with mental illness in the justice system. The number 

of mental health courts in the United States has mushroomed from one in 1997, to 

a dozen in 2002, to close to 100 this month.6 By the most recent count, there are 

almost 300 jail diversion programs now operating in the United States.7 This means 

that 7 percent of all counties have a police or court-based program to divert defendants with a mental illness from jail.8 This also means that 93 percent of all counties 

are without any program to keep non-violent defendants with a mental illness from 

crowding their jails and committing more crime. 

SECOND, THE EVIDENCE IS THAT WE CAN MAKE A DIFFERENCE: OFFENDERS WITH A

MENTAL ILLNESS CAN IN FACT BE DEALT WITH IN WAYS THAT REDUCE CRIME, SAVE

TAXPAYERS’ MONEY, OR BOTH. 

In terms of crime reduction, consider the MacArthur Violence Risk Assessment 

Study of over 1,000 people who had been hospitalized for mental illness, about half 

of whom had a prior contact with the criminal justice system.9 Of the people who 

received no medication or therapy in the community after they got out of the hospital, 14 percent soon committed a violent act. Of the people who received an inadequate amount of treatment—about one treatment session a month—the violence 

rate was reduced from 14 percent to about 9 percent. But of the people who received 

the amount of treatment that they needed—about one session a week—the violence 

rate went from 14 percent to less than 3 percent. Amazingly enough, the people 

with a mental illness who were receiving adequate treatment were actually less violent than their neighbors in the community who were not mental ill. 
16

10 Boothroyd, R., Poythress, N., McGaha, A., & Petrila, J. (2003). The Broward Mental Health 

Court: Process, outcomes, and service utilization. International Journal of Law and Psychiatry, 

26, 55–71. 11 Cristy, A., Poythress, N., Boothroyd, R., Petrila, J., & Mehra, S. (submitted for publication). 

Evaluating the efficiency and community safety goals of the Broward County Mental Health 

Court. 12Morris, S. & Steadman, H.J. (1994). Keys to successfully diverting mentally ill jail detainees. American Jails, July/August, 47–49. 13 Council of State Governments. (2002). Criminal Justice/Mental Health Consensus Project.

Available at www.consensusproject.org 

In terms of saving taxpayers’ money, consider the pioneering Broward County (Ft. 

Lauderdale), Florida, Mental Health Court, whose rigorous evaluation is also being 

supported by the MacArthur Foundation. This court presents mentally ill misdemeanor defendants with the choice of accepting mental health treatment in the 

community, or having their cases processed in the business-as-usual way, which 

may well mean jail time. Perhaps not surprisingly, 95 percent of the defendants 

given this option choose treatment. Compared to a nearby county without a mental 

health court, the Broward defendants are twice as likely to actually receive services 

for their mental illness 10 and are no more likely to commit a new crime, despite 

the fact that the number of days they spend in jail for the current offense is reduced 

by 75 percent, at enormous savings to the public.11 While the NIJ/MacArthur-funded evaluation of mental health courts receiving federal grants is still in progress, 

the Broward study demonstrates that courts have a central role to play in responding to people with mental illness in the justice system. 

THIRD, THE EVIDENCE IS THAT ONE SIZE DOES NOT FIT ALL IN TERMS OF EFFECTIVELY

DEALING WITH MENTALLY ILL OFFENDERS. 

‘‘First and foremost,’’ leading researchers have concluded, ‘‘it must be clear that 

there is no one best way to organize a program [of diverting mentally ill offenders 

from jail]. An approach that works in one community may not be practical somewhere else.’’ 12

The Act is remarkably adaptable to local conditions in the programmatic approach 

it takes to mentally ill offenders. Funded programs may include pre-trial diversion 

in one jurisdiction, a mental health court in another, a re-entry program from jail 

or prison in a third, or some combination of these options in a fourth. 

What Justice Brandeis wrote in 1932 and the Supreme Court has quoted on three 

dozen subsequent occasions is true today. ‘‘It is one of the happy incidents of the 

federal system that a single courageous state may, if its citizens choose, serve as 

a laboratory; and try novel . . . experiments without risk to the rest of the country.’’

This Act is one of those happy incidents. 

FOURTH, THE EVIDENCE IS THAT COLLABORATION IS ESSENTIAL TO GET ANYTHING

ACCOMPLISHED HAVING TO DO WITH MENTALLY ILL OFFENDERS. 

Neither mental health nor criminal justice can do the job alone. This Act 

incentivizes cooperation between the Department of Justice and the Department of 

Health and Human Services, and among agencies at the federal, state, and local levels. Crime and mental illness deeply affect all of our communities, and perhaps for 

this reason the turf battles and the narrow single-issue concerns that doom many 

reform efforts seem to have been carefully avoided in drafting this Act. 

As the Council of State Government’s Criminal Justice/Mental Health Consensus 

Project concluded after five years of intensive study: 13

The single most significant common denominator shared among communities that 

have successfully improved the criminal justice and mental health systems’ response 

to people with mental illness is that each started with some degree of cooperation 

between at least two key stakeholders—one from the criminal justice system and 

the other from the mental health system (p. xx). 

FINALLY, THE EVIDENCE IS THAT WE NEED MORE EVIDENCE. 

We know a lot about how to deal effectively with mentally ill offenders—vastly 

more than we knew even five years ago. But by no means do we know all we need 

to state with confidence what the ‘‘best practices’’ are for dealing with different 

kinds of adult and juvenile mentally ill offenders in different kinds of American 

communities. By imposing strict requirements for objective assessments of the 

measurable outcomes of the programs that are implemented with its funds, the Act 

will generate a self-correcting body of knowledge that uses findings about the effectiveness of past practice to shape improvements in future practice. In mandating 
17

empirical evidence of program performance, the Act avoids simply throwing money 

at a problem. Instead, it assigns accountability and it demands results. 

The Act was born of the frustration of criminal justice officials in seeing ever more 

people with mental illness further crowd their already over-crowded jails, rarely receive the mental health treatment that they so plainly need, and continue to appear 

before them for the commission of yet another crime. The Act before you can set 

state and local governments on a course to put a stop to this revolving door. 

The evidence is there. I urge you to pass Mentally Ill Offender Treatment and 

Crime Reduction Act of 2003.

Mr. COBLE. Mrs. Poe. 

TESTIMONY OF JUNE P. POE, PAST PRESIDENT, NATIONAL ALLIANCE FOR THE MENTALLY ILL OF ROANOKE VALLEY, ROANOKE, VA, ON BEHALF OF THE NATIONAL ALLIANCE FOR 

THE MENTALLY ILL 

Mrs. POE. Thank you, Chairman Coble, Representative Scott, 

and other distinguished Members of the Committee for this opportunity to speak to you on the importance of S. 1194. I also thank 

my representative, Congressman Goodlatte, for being here, and 

also thank Congressman Strickland for his leadership on the issues 

that we are discussing today. 

I am June Poe from Roanoke, Virginia, and I have one of my five 

children who suffers from severe mental illness. I have worked in 

the field of psychiatry as a Licensed Clinical Social Worker and my 

husband was a physician. My family has experienced the heartbreaking lack of vital services needed to help prevent unnecessary 

contacts of people with mental illnesses with the criminal justice 

system. 

I am also pleased to be here today to testify on behalf of NAMI, 

the National Alliance for the Mentally Ill, and at the outset, I 

would also like to recognize the support of the Campaign for Mental Health Reform, representing the broad mental health community for S. 1194. 

You have heard these distinguished witnesses. Now, my son and 

I want to put a human face on this bill. In 1974, John, a brilliant 

student and athlete, suffered his first psychotic break as an 18-

year-old freshman at Wake Forest University. He was diagnosed 

with paranoid schizophrenia. For the next 12 years, he struggled 

courageously to try to continue his education and employment as 

he dealt with the pain of his chronic severe mental illness. He was 

hospitalized nine times and received some community mental 

health services, but in those days, the 1970’s and 1980’s, psychiatric treatment and services for people with severe mental illness was still in the dark ages. 

In 1987, unfortunately, he stopped taking his medication and we 

finally had to call the police because we did not feel safe due to his 

psychotic behavior. He was arrested and jailed for breaking and entering our home, destroying property. My husband and I were very 

well educated about medicine and the mental health system. We 

sought help from every possible source. Despite this, John had to 

suffer the horrible experience of being locked up in jail and treated 

as a criminal. He was becoming sicker without treatment. 

The darkest day in my memory was that day when I realized 

that the court did not have the ability to provide him the help he 

desperately needed. A felony conviction was the worst thing that 
18

could have happened to him. Physicians take an oath of ‘‘do no 

harm.’’ Lawyers should take the same oath. The judge sent him 

back to jail with no other than an admonition to take his medication. John was not able to comply because of his mental illness. 

When John was psychotic, he did not know he was sick. 

The horrendous manner in which my son’s case was handled 

demonstrates the profound need for education and cross-training of 

criminal justice and mental health personnel. Most of the individuals involved in my son’s case at that time had no knowledge about 

schizophrenia, its symptoms, and its treatments, and there was no 

system in place for coordinating services between the criminal justice and mental health. 

The story gets worse. While in jail, John’s condition continued to 

deteriorate. After his release from jail, the mental health professionals could not make him take his medications. He was jailed two 

more times. Having to call the police about your own child and 

then visiting him in jail is an agony that I pray no one in this room 

will ever have to endure. 

John’s incarcerations only made his psychiatric symptoms worse 

and we could do nothing to help him. The services he needed to recover were not available. 

Finally, in 1990, a gifted probation officer and mental health professional helped my son begin a tortuous journey back to recovery. 

The road has not been smooth. John was hospitalized on three 

more occasions and even attempted to commit suicide. Throughout 

the 1990’s, John had periods when he was able to maintain a degree of independence and periods when he was very ill and symptomatic. 

In 2001, John again stopped taking his medication and became 

psychotic. He had a paranoid delusion that neighbors were harming their dogs, so he opened the gate and let them escape from 

being hurt by their owners and the owners wanted to call the police 

and have him arrested. This time the Assertive Community Treatment, the PACT team, intervened and prevented his arrest and incarceration. With this excellent, intensive community care he is 

now back on medication, has an understanding of his illness, and 

is stabilized. Unfortunately, these high-quality mental health services and supports are not available to most people. 

I am excited about the purpose of S. 1194, to foster local collaborations. In our Roanoke Valley, we have developed collaborations 

for providing better services for people like John who need treatment, not punishment. The only thing lacking are resources to implement our ideas and our plans. S. 1194, if enacted, will provide 

the needed resources. 

In conclusion, I strongly urge passage of S. 1194, a bill that will 

greatly benefit both people with serious mental illnesses and entire 

communities. In 1974, John, a brilliant young freshman at Wake 

Forest University, suffered paranoid schizophrenia. In 1987, he 

was cast away by the criminal justice system. Today, at age 48, 

John, instead of being incarcerated as a criminal, is living independently in the community. He is truly a courageous survivor. 

I have asked permission to read a very short statement that he 

asked me to read to you. ‘‘Thank you for this opportunity to testify 

why I support S. 1194. I am John Poe, June Poe’s son. I am men-
19

tally ill and have been sent to jail on two misdemeanors and one 

felony, non-violent and non-drug abuse crimes. If the Mental 

Health Court and the PACT team had been in effect at that time, 

it would have made my life more comfortable. Jail is a very bad 

place for people with mental health. People with mental health 

cannot get proper treatment in jail. I urge you to vote for this bill. 

Signed, John Poe.’’

Thank you for giving me the opportunity to testify. 

Mr. COBLE. Thank you, Ms. Poe. You indicated John was a courageous young man. I think his mom is a pretty courageous person 

in her own right. 

Mrs. POE. And I have three of my children back here who are 

courageous, too. 

Mr. COBLE. It is good to have all of you in the audience with us 

today. 

[The prepared statement of Mrs. Poe follows:]

PREPARED STATEMENT OF JUNE P. POE

Thank you, Chairman Coble, Representative Scott and other distinguished members of the Committee for this opportunity to speak to you on the importance of S. 

1994, a bill that would foster collaborations to ensure that resources are effectively 

and efficiently used to develop alternatives to incarceration for individuals with 

mental illnesses charged with non-violent crimes. 

I am June P. Poe from Roanoke, Virginia, a widow with 5 children, one of whom 

suffers from severe mental illness. I have worked in the field of psychiatry as a Licensed Clinical Social Worker and my husband was a physician. My family has experienced the heartbreaking lack of vital services needed to help prevent unnecessary contacts of people with mental illnesses with the criminal justice system. My 

husband, until his death in 1994, and I have continued to fight for my son, John, 

and many others who fall between the cracks. 

I am pleased to be here today to testify on behalf of NAMI (the National Alliance 

for the Mentally Ill). At the outset, I would also like to recognize the support of the 

Campaign for Mental Health Reform for S. 1194. It is very important to note that 

the mental health community as a whole stands behind this bill. 

You will hear from the other distinguished witnesses how critical the problems 

are and what is needed to alleviate them. My son John and I want to put a human 

face on this bill. John has given me permission to tell this story. This is our story 

but we are not alone. I am speaking for many many families who have similar stories. In most cases, these stories would have been far happier had the services envisioned in S. 1194 been available to people like my son. 

In 1974, John, a member of the High School National Honor Society, former Captain of his High School Track team (voted most valuable member of that team), artist, and a brilliant freshman at Wake Forest University suffered his first psychotic 

break. He was diagnosed with paranoid schizophrenia. For the next 12 years he 

struggled courageously to try to continue his education, and employment as he dealt 

with the pain of his chronic severe mental illness. He was hospitalized nine times 

and received some community mental health services but these services were not 

adequate to keep him stabilized. He struggled with the side effects of the old medications. In those days (1970s and 1980s) psychiatric treatment and services for people with severe mental illnesses were still in the dark ages. Our family has continued to give him love and support through it all. 

In 1987 unfortunately he stopped taking his medications and we finally had to 

call the police because we did not feel safe due to behaviors that were the product 

of his deteriorating psychiatric state. He was eventually arrested and jailed for 

breaking and entering our home at 5:30 AM and destroying property. John said ‘‘I 

just wanted to get some sleep.’’ The Commonwealth’s attorney recommended a felony charge, explaining that this was the only way to get John treatment. My husband and I were very well educated about medicine and the mental health system. 

We had sought help from every possible source—judges, lawyers, and many mental 

health programs and mental health professionals. John had to suffer the horrible 

experience of being locked up in a jail and treated as a criminal. We suffered the 

painful agony and grief of visiting our son in jail. He was becoming sicker without 
20

1 Amador, Xavier, ‘‘I’m Not Sick, I Don’t Need Help’’, Vida Press, revised 2004. 2 Assertive community treatment programs are characterized by intensive, outreach-oriented 

services, available on a 24 hour, seven day a week basis, for people with severe and persistent 

mental illnesses who are at risk of hospitalizations. These programs have proven effectiveness 

in reducing involvement with criminal justice systems, homelessness and other adverse consequences of lack of treatment. 

medication and treatment. The Commonwealth’s attorney and his assistant and 

even our own attorney (my cousin) did not know what to do. 

The darkest day in my memory was that day in court when I realized that the 

court did not have the ability to provide him the help he desperately needed. We 

had been advised that pleading guilty to a felony was the only way to get John 

treatment. In actuality, a felony conviction was the worst thing that could have happened to him. The judge sent him back to jail, with no treatment whatsoever, other 

than an admonition to take his medication. When the judge told my son to take his 

medication, he was not able to comply because of his mental illness. When John was 

psychotic he did not know he was sick.1

The horrendous manner in which my son’s case was handled demonstrates the 

profound need for education and cross training of criminal justice and mental health 

personnel. Most of the individuals involved in my son’s case at the time had no 

knowledge about schizophrenia, its symptoms, and its treatments. And there was 

no system in place for coordinating services between criminal justice and mental 

health. I am very gratified that S. 1194 will allow communities to use available 

funds to provide the training necessary to ensure that those responding to individuals like my son in the future will be better prepared to do so in a humane and 

effective way. 

The story gets worse. While in jail, John’s condition continued to deteriorate. 

For the next 3 years my son and the rest of our family went through hell. After 

his release from jail, the mental health professionals could not make him take or 

stay on his medications. The services he needed to recover, such as assertive community treatment, were not available.2

We had to call the police again. Having to call the police about your own child, 

and then visiting him in jail is an agony that I pray no one in this room will ever 

have to endure. Research proves that people with severe mental illnesses get sicker 

when they do not get necessary medical treatment. We saw our son get sicker and 

could do nothing to help him. His incarcerations only made his psychiatric symptoms worse. 

Finally, in 1990, a gifted probation officer who is also a gifted mental health professional, helped my son get released from jail and begin his tortuous journey back 

to recovery. This is not to say that the road was smooth. John was hospitalized on 

several occasions and even attempted to commit suicide. Schizophrenia is a disease 

known to be episodic in nature. Throughout the 1990’s, John had periods when he 

did quite well, and periods when he was very ill and symptomatic. 

In 2001 John again became psychotic when he stopped taking his medication. He 

had a paranoid delusion that neighbors were harming their dogs so he opened the 

gate and let them ‘‘escape from being hurt by their owners’’. After he had done this 

the third time the neighbors called the police and brought charges to have him arrested. This time his Assertive Community Treatment (PACT) team intervened and 

prevented his arrest and incarceration. With this excellent intensive community 

care he is now back on medication, has an understanding of his illness and need 

for medication and is stabilized. He has received excellent acute care at Catawba 

Hospital (our regional state psychiatric hospital) and excellent services through Blue 

Ridge Behavioral HealthCare (our regional community mental health services). I am 

grateful that mental health care is now available to prevent a repeat of the horror 

of those 3 years when he was in jail. Unfortunately, these high quality mental 

health services and supports are not available to most people. 

I am excited that the purpose of S. 1194 is to ‘‘foster local collaborations’’ which 

will ensure that resources are effectively and efficiently used to reduce the unnecessary incarceration of non-violent offenders with mental illnesses. In the Roanoke 

Valley, we have numerous examples of such collaborations. For example, in 2001, 

under the leadership of Police Chief Ray Lavender of Roanoke County, the County 

established a police Crisis Intervention Team (CIT) program, the first of its kind in 

the Commonwealth of Virginia. The Mental Health Association of Roanoke Valley 

and NAMI-Roanoke Valley worked closely with Chief Lavender in creating this important new program. 

In 2002, I, representing NAMI-Roanoke Valley, helped to establish a Task Force 

to better address the needs of people with mental illnesses who come into contact 

with the criminal justice system in the Valley. Its mission is to ‘‘identify those issues 
21

inhibiting the effective delivery of services for offender populations with a mental 

illness and encourage the development and implementation of a continuum of community based care for persons with mental illness that will reduce the prevalence 

and incidence of offenders with mental illness within the criminal justice system.’’

The Task Force members represent state and federal criminal justice professionals, 

(judges and probation officers in the 23 Judicial Circuit and District Courts and US 

Federal Court) public mental health professionals (the Medical Director of Catawba 

Hospital, Blue Ridge Behavioral Health staff) and advocates (NAMI-Roanoke Valley 

and the Mental Health Association of Roanoke Valley). 

Despite the severe cutbacks in mental health agencies and facilities and criminal 

justice systems due to the state budget crisis, this Task Force, in just its first year 

accomplished the following:

• Established communication between the professionals (including judges) in 

the criminal justice system, mental health agencies, and advocates, which 

previously did not exist because they did not have a forum to communicate 

with each other;

• Identified 11 issues and challenges inhibiting the effective and efficient treatment of offenders who have mental illness within the Roanoke Valley;

• Assessed current capabilities of mental health agencies and facilities and 

criminal justice systems to effectively respond to offenders who have mental 

illness and avoid re-hospitalizations and re-incarcerations;

• Achieved some non-cost approaches to improve the efficiency and effectiveness 

in responding to the needs of this population;

• Developed coordination of services between jails, mental health community 

agencies and hospitals;

• Eliminated duplication of services in the transition of services from jail to 

community; and

• Provided training this past Spring, 2004, to more than 60 attorneys, judges 

and probation officers about mental health issues and treatment resources.

In the Roanoke Valley we are well down the path of developing more humane and 

cost-effective responses to individuals with mental illnesses who, due to non-violent 

offenses, come into contact with criminal justice systems. The only thing lacking are 

resources to implement our ideas. S. 1194, if enacted, will provide communities like 

ours with opportunities to implement services to break the endless cycle of deterioration and arrests for people like my son, who are not criminals but desperately 

need treatment! 

In conclusion, I strongly urge passage of S. 1194, a bill that will greatly benefit 

both people with serious mental illnesses and entire communities. Jail diversion 

programs and community reentry services, coupled with comprehensive community 

mental health treatment such as PACT, are less expensive than a criminal justice 

system without treatment. The benefits are obvious. Today, my son, instead of being 

incarcerated as a criminal, is living independently in the community, volunteering 

weekly in the psychosocial rehabilitation program at Catawba Hospital, participating actively in treatment, and is well along the road to recovery. And, I once 

again feel safe, as do others in my family and community. 

In 1974, John, a brilliant young freshman at Wake Forest University suffered a 

biologically based brain disorder. In 1987, he was ‘‘cast away’’ by the criminal justice 

system. Now, John is truly a courageous survivor. He wrote the following statement 

urging the passage of S. 1194. He asked me to read it to you. 

(Written statement of John Poe, read by June P. Poe).

Thank you for this opportunity to testify why I support S. 1994. 

I am John Poe, June Poe’s son. I am mentally ill and have been sent to jail for 

two misdemeanors and one felony, non-violent and non-drug abuse crimes. 

If the mental health court and PACT had been in effect at that time it would have 

made my life more comfortable. Jail is a very bad place for people with mental illness. People with mental illness cannot get proper treatment in jail. 

I urge you to vote for this Bill.

(signed: John Poe) 
22

Thank you for giving me the opportunity to testify before you today.

Mr. COBLE. Folks, we impose the five minute rule against us, as 

well, so if you all could keep your answers tersely, we would be appreciative. 

Ms. Nolan, one of the criticisms of the Drug Court program is the 

lack of evaluation and the lack of reporting by the grantees. Is 

there any effort in the Mental Health Court program to require 

grantees to provide information for evaluations, and how is the program being evaluated? Furthermore, is there an effort to establish 

best practices for the grantees? 

Ms. NOLAN. Yes, sir, yes, sir, and yes—— Mr. COBLE. It is a multi-faceted question. [Laughter.] 

Ms. NOLAN. The quick answer to your question, sir, is yes to all 

the questions that you posed. The National Institute of Justice, a 

component of the Office of Justice Programs, is currently overseeing a process evaluation of all the currently funded sites. Following that, as was mentioned in the testimony, the MacArthur 

Treatment Foundation will be conducting an outcome evaluation of 

seven of the sites that we are funding. 

In addition, each one of the grantees on a semi-annual basis is 

required to report to us on various performance measures, both 

from the client standpoint and from the community’s standpoint. 

Mr. COBLE. I thank you. 

Sheriff, law enforcement officials must collaborate with mental 

health professionals to most effectively address the lack of treatment of mentally ill non-violent offenders. Have you experienced or 

do you anticipate any difficulties or impediments or road blocks in 

this collaborative effort? 

Mr. SEXTON. No, sir. 

Mr. COBLE. And you have had good experience with it? 

Mr. SEXTON. Yes, sir. 

Mr. COBLE. All right. When I said terse, I think they took me literally. [Laughter.] 

Mr. COBLE. Dr. Monahan, according to your testimony, 95 percent of defendants, when faced with the option of treatment or jail 

time for an active sentence—they choose treatment. In your opinion, should these defendants have that option, A, and why do you 

believe these individuals do not seek treatment on their own without court intervention? Is this generally the first treatment these 

individuals will be involved with? 

Mr. MONAHAN. Sir, many individuals who need mental health 

treatment oftentimes unfortunately don’t avail themselves of it, 

sometimes because of the side effects of those treatments. I think 

that the 95 percent of the defendants in Broward who accept treatment do so in part because the criminal justice system is being 

used as leverage to get them into treatment. As I mentioned, they 

are no more likely to commit a crime if they are diverted from the 

criminal justice system. It saves the community 75 percent on jail 

days, and I think if you can either reduce the crime rate or keep 

the crime rate constant but drastically reduce the cost at no additional risk to the public, that sounds like a winning strategy to me. 

Mr. COBLE. I thank you. 

Mrs. Poe, you mentioned in your testimony that the Roanoke 

Valley Task Force initially identified challenges inhibiting the ef-
23

fective and efficient treatment of mentally ill offenders within your 

community. Identifying these challenges and assessing current capabilities seems essential to developing a strategy to address the 

issue. During this phase, did you discover deficiencies inherent 

within the criminal justice system or the mental health community 

regarding the treatment of mentally ill offenders? 

Mrs. POE. Yes, sir. In the mental health system, there was a 

strong—there was not enough money to provide for the services 

that were needed. Money was one issue. 

There are difficulties in the collaboration—well, there are difficulties with the criminal justice system in dealing with the issues 

of medication, serious problems there which we have been trying 

to address. The problems of having the appropriate medications 

that the doctor has, the psychiatrist has prescribed needs to be 

with that patient. They do not always get those medications in the 

jail. We have been working hard on trying to solve that problem. 

There is also a need for greater education of the people in the 

criminal justice system to understand what mental illnesses are. 

One of our groups, one of our projects has been to have an educational program where we trained this spring with 60 of the lawyers, the judges, and probation officers to begin to understand what 

mental illnesses are and what the medication issues are. 

Mr. COBLE. I see my red light, but before I yield to Mr. Scott, 

let me ask you this question, Mrs. Poe. Is it your belief that the 

bill before us appropriately addresses these problems? 

Mrs. POE. Yes. There is in education—in the bill, there is crosstraining and education that is crucial. Money for the services are 

very important, but the collaboration, fostering the collaboration 

between the systems is of major importance. It is—one of the 

things we found was that until we had this task force, they weren’t 

speaking to each other. Coming together, communicating with each 

other, they found out what their problems were and began to work 

on ways of solving those problems, that when we didn’t have any 

money, we could still be a little bit more efficient in communicating 

on those problems. 

Mr. COBLE. I thank you, and I will say to the gentleman from 

Virginia, I owe you a minute and 3 seconds. [Laughter.] 

Mr. SCOTT. Thank you. Thank you, Mr. Chairman. 

Dr. Monahan, you went to great lengths to talk about the evaluation and research and importance in that. Is this something unusual in criminal justice legislation, to actually evaluate and study 

what you are doing before you do it? 

Mr. MONAHAN. Well, it is certainly not unheard of, sir, but I 

think it is unusual to have the emphasis on evaluation be so integral a part of the bill as it is a part of this bill. I think, ideally, 

people will learn from what they try in the beginning. They will see 

what works and doesn’t work. They will do less of the former and 

more of the latter. 

Mr. SCOTT. Thank you, and I think that is something new. We 

don’t usually do a lot of studying before we jump into it. 

Ms. Nolan, what are the costs involved in setting up a program? 

Ms. NOLAN. It varies, sir. Funding is available currently through 

the Edward Burn Memorial Justice Assistance grant programs as 

one of the purpose areas that States can use to help fund start-up 
24

of Mental Health Courts. In addition, there are a number of jurisdictions that have been able to, through existing resources, been 

able to basically cobble together through existing resources some 

courts. 

As far as specific numbers as to the extent to which, at the low 

end, what courts may cost, and at the high end, I would be happy 

to try to get that information for you and back to you. 

Mr. SCOTT. Thank you. There are two parts of it. One is the administrative expense in setting up the court. You have got the setup costs, administrative, if you have got to hire an administrator 

or a computer or a desk and that kind of thing, and they are ongoing administrative expenses. Also, if it is going to work, you have 

to have some services available for the defendants. Do the courts 

that you have funded have adequate services to refer the defendants to? 

Ms. NOLAN. On those that I am familiar with, yes, there are adequate funds, but again, we are funding only some demonstration 

projects. My understanding of what is going to be offered under the 

pending legislation is that there will be planning and implementation grants so that jurisdictions will be able to determine really 

what their needs are going to be in that particular jurisdiction, 

what kind of funds will be needed. 

Mr. SCOTT. Because this is one of the problems. We have gone 

to community-based mental health rather than institutional-based 

mental health, and Sheriff Sexton has mentioned that some of his 

people run into people in the community that are not getting all 

of the services that they actually need. We run into this with juveniles occasionally. The only way they can get services is if you arrest them on something and then the court can provide the services. 

But it is your understanding that in these courts, there are adequate services available once someone gets into the system? 

Ms. NOLAN. What I would like to focus on, sir, is the importance 

of the collaborative efforts that are involved in each of these Mental Health Courts, that it is not just a criminal justice problem, it 

is not just a mental health problem, but there are various systems 

with their resources that can all come together to help generate the 

resources that are needed. 

One thing that I have found under my leadership with the Serious and Violent Offender Reentry Initiative and the work with the 

other Federal agencies that I do, it is impossible for just one Government agency or one segment of the services that are provided 

to be able to do it alone. It is very important that we are able to 

leverage the resources that we have to be able to address the problem. 

Mr. SCOTT. It has been mentioned also that a lot of the defendants have, what did you call them, co-occurring problems, not only 

mental health but also substance abuse. Are they dealt with in this 

legislation? 

Ms. NOLAN. I am sorry, sir, I don’t know. I am not that familiar 

with the specifics of the legislation. 

Mr. SCOTT. Dr. Monahan, do you—— Mr. MONAHAN. They are explicitly. Defendants with a mental 

disorder who also have a co-occurring secondary substance abuse 
25

disorder are indeed—can have programs for them funded under 

this legislation. 

Mr. SCOTT. Sheriff Sexton, if you don’t arrest the mentally ill, 

what happens to them? 

Mr. SEXTON. That is a great question. Oftentimes, it depends on 

what the family wants to do. Normally, the family calls us in order 

to try to get something done. It also depends on the economic status and well-being of the family at the time. But a majority of the 

times, unfortunately, the only option out there is arrest, so they 

end up coming into the facility. In our particular community with 

the program that we have now, we are using the local cooperative 

venture that we have, the collaborative effort to bring in local mental health, to channel that person to another mechanism. 

The problem comes, as Ms. Nolan mentioned, is when you have 

a felony, you are dealing with a felon. Virtually, there is no way 

to deal with the problem on the front end. It has to be dealt with 

at the back through a circuit judge. In those situations, we are 

somewhat limited, but again, the collaborative effort of this particular bill and the problem of the tennis game of batting the client 

back and forth between the agencies, I think everybody, at least in 

our community, has finally settled in to—and other communities is 

settling down on focusing the problem and solving it. 

Mr. SCOTT. Now, can they get that kind of effort going without 

an arrest? 

Mr. SEXTON. Yes, sir. 

Mr. SCOTT. So they don’t have to be arrested to get services? 

Mr. SEXTON. No, sir. We have crisis intervention, suicide intervention, or get them to the local community mental health officials. 

Mr. SCOTT. Do you have sufficient mental health services to address the need in your community? 

Mr. SEXTON. We are the mental health capital of Alabama. 

[Laughter.] 

Yes, sir, we have, and then we also serve several hospitals for 

the State. So yes, sir, we do. 

Mr. SCOTT. Ms. Nolan, is $150,000 enough to get these things 

going? Are there things that the programs are not doing because 

of insufficient funding? 

Ms. NOLAN. If I may be able to get back with you, sir, with specific information regarding the sites that we are going to be doing 

specific evaluation of and see what their needs are, I would be 

happy to get back to you with that specific information. I do not 

have that with me right now. 

Mr. SCOTT. Mr. Chairman, I know Virginia doesn’t spend as 

much for mental health as some other areas, but I am delighted 

to see that some don’t have the funding problems that I believe we 

do in Virginia. 

Mr. SEXTON. Mr. Scott, if I may, Alabama would be more than 

glad to accept grants—— [Laughter.] 

Let me not shortchange the State. 

Mr. SCOTT. Thank you. 

Mr. COBLE. I thank the gentleman. 

Folks, since only Mr. Scott and I are here and it appears we are 

going to be able to release Ms. Nolan by 4:15, let us do a second 

round. 
26

Sheriff, supporters contend that this legislation will result in a 

huge cost savings. How will this program save local government 

money, A, and how about Federal programs, if you are able to comment to that? 

Mr. SEXTON. Well, the taxpayers immediately would have a 

mechanism to deal with especially the low-level non-violent offender. As I mentioned in my statement, $75,000 was spent in the 

last quarter of our budget last year for psychotropic drugs. This 

will allow us to have other mechanisms. 

One of the problems that we do have when it comes to funding 

is that many community-based health programs can support the 

psychotropic drugs under particular drug programs that are available in the Federal Government now, but as soon as that person 

is incarcerated, we lose the ability of having that same drug coverage. I think it is called a 207(b) program. So, therefore, we are 

having to pay that additional coverage. So once somebody becomes 

incarcerated, we have more strings that tie us up in a jail situation. 

As far as the Federal programming, the ability to be able to possibly intervene in situations earlier, an earlier intervention than 

what we have now, would ultimately save family, save local government, State, and incarceration medical costs. And then we experienced the loss of three police officers in Birmingham last week, 

substance abusers and potential mental health problems. We could 

save the loss of life. 

Mr. COBLE. I thank you. 

Ms. Nolan, does the Bureau of Justice Statistics continue—I 

don’t think we have touched on this—continue to collect data on 

the number of mentally ill within the system and have you seen 

any reduction in the number since you began the Mental Health 

Court grant program? 

Ms. NOLAN. Yes, sir. The Bureau of Justice Statistics is continuing to collect data and the next round of data will be available 

in 2005. We expect in early 2005, the new data will be available. 

And the next part of your question? I am sorry. 

Mr. COBLE. I just discarded it. 

Ms. NOLAN. Okay. [Laughter.] 

Mr. COBLE. Have you seen the reduction? 

Ms. NOLAN. It is too early to tell, sir, because the Mental Health 

Courts have been in existence for such a short period of time. It 

is too early to be able to tell exactly what the results are. 

Mr. COBLE. I thank you. 

Dr. Monahan, you indicated in your testimony that you have 

done research on the Mental Health Court program the Department of Justice is currently managing. How does that program differ from the program described in this bill, A, and what are the advantages and disadvantages of this approach? 

Mr. MONAHAN. Yes, sir. I think that the bill envisions Mental 

Health Courts that could function very much as the courts that are 

currently funded by the Office of Justice Programs. I am involved 

in the evaluation of the first seven of those programs funded by the 

National Institute of Justice. We have a few more months of that 

evaluation, and then the MacArthur Foundation is going to fund 
27

the evaluation, as Ms. Nolan said, of the actual outcomes, which 

will take longer. 

Some of the initial results of this process evaluation, it seems 

like the seven Mental Health Courts, early on, Mental Health 

Courts accepted primarily misdemeanors. The new Mental Health 

Courts, many of them are accepting felonies, primarily non-violent 

felonies. But they are demanding that the defendant plead guilty 

before he or she can get in the Mental Health Court. They are not 

just suspending prosecution. 

And indeed, early on, the Mental Health Courts were very reluctant to place people in jail if they didn’t adhere to mental health 

treatment. The newer Mental Health Courts, if you don’t go to 

treatment, then you do go to jail. And they are also, finally, increasing using the criminal justice system supervision, for example, 

probation rather than some kind of social work. 

Mr. COBLE. I thank you, Doctor, and I say to my friend from Virginia, now you owe me a minute and 4 seconds. [Laughter.] 

Mr. SCOTT. Thank you. Dr. Monahan, do insanity defenses get involved in these? 

Mr. MONAHAN. No, sir, they do not. Insanity defense, despite 

many people’s views to the contrary, are generally raised in about 

one percent of prosecutions. It fails three-quarters of the time that 

it is raised. So only one-quarter of 1 percent of criminal cases are 

disposed of by the insanity defense. Those people usually spend at 

least as much time in the hospital as they would have spent in jail. 

Mr. SCOTT. Mrs. Poe, in your testimony, you ended up that your 

son ended up getting arrested. Were you able to get services for 

him without him being arrested? 

Mrs. POE. No. No. When he became psychotic, he was off of his 

medication—and I could not get the help. 

Mr. SCOTT. And after he was arrested, did you get the help? 

Mrs. POE. No. The treatment, the help only came in 2001 when 

the Assertive Treatment Team became involved, and that did the 

trick. That is a very important part. 

Mr. SCOTT. And was that a result of the criminal justice system 

or the mental health system? 

Mrs. POE. It was a part of the mental health system and June 

Poe. [Laughter.] 

Mr. SCOTT. Okay. Dr. Monahan, we have been talking about coordinating the service delivery system. There is a slight difference 

between coordinated and integrated services, that is whether you 

have two different services, one for drugs and one for mental 

health, or they are provided together. Does this bill address that 

situation, where they might be coordinated but not integrated? 

Mr. MONAHAN. Yes, sir, I think it does. I think, Mr. Scott, exactly 

as you mentioned before, there are two different kinds of funding 

issues here. The first is either the coordination or integration, what 

my colleague Henry Steadman has called the boundary spinner. 

You need somebody to be at that boundary between mental health 

and criminal justice. 

But then, secondly and more expensively, are the services themselves. We often talk about diversion from the criminal justice system. Well, that is important, but the more important issue is diver-
28

sion to what? Where are these people going? You can’t divert people to services that don’t exist. 

So I think that on the integration versus coordination issue, in 

the treatment of co-occurring disorders, the research is clear. What 

you need is integrated, not simply coordinated, services. You can’t 

simply bus people to mental health treatment here and the substance abuse treatment someplace over there. You have to have the 

same people provide treatment for both disorders. This bill certainly allows that. It doesn’t mandate it. 

Mr. SCOTT. That is all. 

Mr. COBLE. I thank the gentleman and we thank you all. This 

has been a very productive hearing, I believe. Ms. Nolan, Mr. Scott 

and I have accommodated you with your request. You will be out 

of here by 4:15. 

I am going to depart from our normal format and let Mrs. Poe— would you like to close out for a minute or two, Mrs. Poe, because 

you have been with this problem far closer than any of the others? 

Mrs. POE. Thank you, sir. I want to state in a positive way that 

I am so grateful for the legislators at the State and the national 

level that are recognizing this problem. I appreciate so much working with the NAMI, National Alliance for the Mentally Ill. I am not 

alone. We have many families, many consumers who recognize the 

seriousness of this and we appreciate being heard. 

We appreciate the opportunity to educate everyone working in 

the system, from professors and teachers in the schools to understand what serious mental illness is, or are, and also the importance of the criminal justice system involvement. This is a very, 

very complicated problem. The more education we can give to the 

public about what struggles you gentlemen are having in trying to 

come up with the money for this is major. We need to give you the 

support, as consumers of this important issue. 

I have fought a long time and I appreciate what you said. If we 

had only had the Mental Health Courts back there in the very beginning when John needed that back in his first jail experience, it 

would have been a far different story. I am delighted to know of 

evidence-based practices going now in what I have heard. 

I wish you gentlemen the very best in continuing to help us in 

solving this problem. And anything that we can do as family members and as consumers, let us know. 

Mr. COBLE. Thank you, Mrs. Poe, Dr. Monahan, Sheriff Sexton, 

and Ms. Nolan. We are delighted to have you all with us. We thank 

you for your testimony today. 

This concludes the legislative hearing on S. 1194, the ‘‘Mentally 

Ill Offender Treatment and Crime Reduction Act of 2003.’’ Thank 

you for your cooperation, and the Subcommittee stands adjourned. 

[Whereupon, at 3:59 p.m., the Subcommittee was adjourned.] 
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A P P E N D I X 

MATERIAL SUBMITTED FOR THE HEARING RECORD
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PREPARED STATEMENT OF THE HONORABLE WILLIAM D. DELAHUNT, A

REPRESENTATIVE IN CONGRESS FROM THE STATE OF MASSACHUSETTS

I would like to thank Chairman Coble and Ranking Member Scott for holding this 

hearing on the ‘‘Mentally Ill Offender Treatment and Crime Reduction Act’’ of 2003. 

I would also like to commend my colleague Rep. Ted Strickland for his continued 

leadership on this bill and other initiatives to improve our nation’s mental health 

systems. I appreciate your courtesy in permitting me, as a former member of this 

subcommittee, to add my voice in support of this much-needed legislation. 

As the distinguished witnesses testified, the mental health community and law 

enforcement are united behind this legislation. And, in a rare instance within the 

current session of Congress, the Senate has already moved forward and passed this 

bill by unanimous consent. I hope that my colleagues on the House Judiciary Com-
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mittee will join me to see that the House moves this legislation quickly in the same 

bipartisan spirit. 

As Thomas J. Conklin, M.D., Director of Health Services of the Hampden County 

Correctional Services of Massachusetts, has observed, ‘‘It can be safely said that 

American jails and prisons have become the nation’s default mental health system.’’

Our nation’s jails and prisons are in a state of crisis as they struggle to provide 

mental health services for incarcerated individuals. Congress should proceed with 

haste. 

It is simply wrong that families must resort to the police in order to obtain treatment for a loved one suffering from an extreme episode of mental illness. Yet, during times of extreme distress, families face no alternative because an individual experiencing symptoms like paranoia, exaggerated actions and impaired judgment 

may be unable to recognize a need for treatment. 

It is unconscionable and, may well be, unconstitutional, that these vulnerable individuals become further marginalized once incarcerated, often denied even minimal 

treatment as a result of inadequate resources. Most mentally ill offenders that come 

into contact with the criminal justice system are charged with low-level, non-violent 

crimes. However, once behind bars, these individuals may face an environment that 

only further exacerbates symptoms of mental illness, which may otherwise be manageable with proper treatment. Then, caught in a revolving door, they may soon be 

back in prison as a result of insufficient and inadequate transitional services upon 

release. This comprehensive legislation is a step in the right direction in order to 

move away from laws that criminalize mental illness. Through this legislation, state 

and local correctional facilities will be able to create appropriate, cost-effective solutions. And low-level, nonviolent mentally ill offenders will have greater access to 

continuity of care. 

Congress must also address an unfunded mandate that has been imposed on the 

states for decades. In Estelle v. Gamble (1967), the Supreme Court held that deliberate indifference to serious medical needs of inmates is unconstitutional ‘‘whether 

the indifference is manifested by prison doctors in their response to the prisoner’s 

needs or by prison guards in intentionally denying or delaying access to medical 

care or intentionally interfering with the treatment once prescribed.’’ Further, in 

Ruiz v. Estelle (1980), the Supreme Court established minimum standards for mental health services in correctional settings. It is hard to imagine that more than 

twenty years later, state and local facilities still do not have nearly enough resources to come even close to meeting these constitutional requirements. 

Congress must do its part to assist state and local governments in meeting this 

burden. We cannot tolerate a system that fails to meet constitutional safeguards. 

Further, we cannot tolerate a system that fails to dedicate resources effectively in 

order to ensure that people are getting help instead of jail time. And as a result 

of state budget cuts, communities are looking to the federal government for help. 

For example, a few years ago Sheriff Michael J. Ashe of Hampden County created 

an innovative inpatient mental health care unit within one of his prisons, providing 

a resource to four counties within the state. A highly successful facility, the unit 

allowed inmates to be treated in a safe and structured environment, thereby reducing costly emergency calls and transfers to the state-run hospital for behavioral disorders. Unfortunately, the Sheriff was forced to shut down this program in 2001 as 

a result of a decision by the Commonwealth’s Department of Mental Health to eliminate all funding for mental health services at correctional facilities. Now, Sheriff 

Ashe is struggling to provide minimum treatment to inmates, many of whom are 

repeatedly returning to jail as a result of the lack of diversion programs and transitional services. Across the state, other correctional facilities and members of law enforcement are battling the same problem—struggling to create innovative solutions 

with very limited resources. 

The Massachusetts Mental Health Diversion & Integration Program (MMHDIP) 

is one such program that continues to advocate for new networks to facilitate the 

diversion of mentally ill persons. The MMHDIP seeks to promote extensive collaboration between police, health and social service providers, consumer advocates, 

judges, and probation officers and, in the past two years, the program has achieved 

many significant accomplishments. The MMHDIP has developed and provided inservice training on crisis intervention, de-escalation and risk management techniques to members of several police departments, including Boston, Worcester and 

Fitchburg. The program also intends to develop a ‘‘No Wrong Door’’ triage center 

to receive persons who are mentally ill and/or chemically dependant at a downtown 

Boston hospital. Through these types of initiatives, persons in crisis who are chargeable with non-serious crimes can be referred to community treatment in lieu of arrest. Despite significant progress, the MMHDIP faces significant hurdles to develop 
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and implement their goals based on the far-reaching needs of communities due to 

statewide funding cuts. 

Consistent with the federal average, 12 to 16 percent of those incarcerated in 

Massachusetts are suffering from serious mental illness. Compared to the average 

rate of mental illness in the general population, inmates in Massachusetts are more 

than twice as likely to have a mental illness. And, consistent with nationwide statistics, the recidivism rates of the mentally ill are much higher than average. 

Unfortunately, the situation in my state is not unique. In every state, the interaction between law enforcement and individuals suffering from mental illness continues to rise. In a very tragic situation just last week in Indiana, a law enforcement officer shot and killed one young man, John Montgomery, diagnosed with bipolar disorder. With four other sheriffs, the deputy had arrived at Mr. Montgomery’s 

home to carry out a court order obtained by the parents of this 29-year-old as the 

only recourse to help him get medical treatment. Even though the deputies knew 

the young man was mentally ill based on previous calls to Mr. Montgomery’s home, 

the officers resorted to deadly force when Mr. Montgomery became violent as a result of his psychotic state. Perhaps this tragic outcome could have been avoided with 

greater resources allocated for adequate training and education for state and local 

law enforcement. And Mr. Montgomery’s parents would have seen their son obtain 

treatment rather than plan for his funeral. 

Having spent over two decades as a state prosecutor, I support the goals of this 

bill to ‘‘foster local collaborations’’ between law enforcement and mental health providers. What works in one community will not necessarily work or be desired in another—solutions must take into account the existing landscape as well as the social 

and political dynamics within each community. Given the complexity of the issues 

surrounding the intersection of mental illness and the criminal justice system, no 

magic solution will solve the problems faced in communities across America. Accordingly, this legislation does not seek to impose a standardized model that must be 

adopted by all state and local jurisdictions. To the contrary, S. 1194 encourages 

funding for specialized programs that will most effectively address the needs of local 

communities. 

Consistent with one of the key objectives set forth by President George W. Bush 

in his State of the Union Address, it is important to note that the Department of 

Justice has endorsed this bill. The federal government needs to provide communities 

with the tools to reduce recidivism among returning inmates. The statistics speak 

for themselves. This year alone the majority of the 600,000 prisoners who will be 

released will return to prison after committing another crime. Congress must continue do all that it can to ensure that state and local law enforcement can address 

this problem, especially given its disproportionate impact on the mentally ill. 

Although I am encouraged that the Judiciary Committees in both chambers are 

giving this issue serious consideration, Congress must continue to address other extraordinary gaps in our current system—such as the ability of prisoners to have continued access to affordable medications, case management and affordable housing 

following release. Looking ahead, federal and state government must not ignore 

these challenges, as nearly 57% of offenders are sent back into our communities 

without any supervision or support. 

With this legislation, Congress can join with local communities in their response 

to this problem. Individuals and their loved ones are struggling with countless challenges and barriers during a mental health crisis. In addition, members of state and 

local law enforcement need access to training and alternatives to improve safety and 

responsiveness. Without adequate funding, projects like those in the Commonwealth 

of Massachusetts will take much longer to achieve their goals due to limited staff 

and resources. Therefore, federal grants must be made available for innovative programs that address the challenges presented by mental illness to public safety in 

our communities. With this bill, Congress can provide significant support to collaborative efforts between law enforcement and mental health experts. Without unnecessary delay, I urge my colleagues on the subcommittee to move forward on their consideration of this legislation so that the House has an opportunity to consider it for 

final passage before the end of this current session of Congress.
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