Reporting from San Francisco — Milton Conley's mental illness has cost him — and society — more than he cares to tally.
An abusive father recruited Conley at age 9 into a life of what he calls "doing wrong things." A psychotic break in his 30s was followed by homelessness and four imprisonments, products of schizophrenia; addiction to crack cocaine and marijuana; and what Conley dolefully labels "being lonely."
The cycle is familiar: arrest, incarceration, release, descent into illness, re-arrest. But these days, Conley — earnest, with a flirtatious gleam and a tidy 1970s-style Afro — is living in a treatment program for substance abusers, meeting often with his caseworker and taking psychiatric medication.
The shift, hard and long in the making, comes thanks to San Francisco County's Behavioral Health Court, where a judge doles out weekly encouragement with occasional tough talk to keep clients engaged in comprehensive treatment.
"It's been a terrible life, but it's getting better, as long as I stay off drugs and alcohol and take my medication," Conley said recently as he waited for his weekly courtroom check-in.
About a fourth of California's jail and prison inmates are diagnosed with serious mental illness, according to a recent draft report by the Judicial Council's Task Force for Criminal Justice Collaboration on Mental Health Issues. Probationers are nearly twice as likely to reoffend if they are mentally ill, the report says, and mentally ill parolees are 36% more likely to violate their terms of release.
Given those realities, mental health courts are gaining credibility for their measureable successes.
In the normally staid courtroom, group applause rings out often, along with San Francisco Superior Court Judge Garrett Wong's pervasive "Good for you!" A deputy public defender and deputy district attorney work toward the same goals in a rare convergence. Mental health caseworkers facilitate housing, vocational training, counseling and other help for as many as 140 clients.
Participation is voluntary and comes in lieu of incarceration. The crime must be linked to the client's mental illness. Success can wipe charges off the books. Those who stumble seriously or often are removed from the program and re-jailed.
Today, there are 41 collaborative mental health courts in 29 California counties, up from 21 courts four years ago, according to the Judicial Council's Administrative Office of the Courts. Among the council task force's draft recommendations: that each county adopt a comparable approach that fits its needs.
Results are strong. A study published in the Archives of General Psychiatry this month examined San Francisco's court and three others nationwide and found "consistent evidence" that they are good for public safety, said Hank Steadman, the study's lead author.
Of those examined, San Francisco's court served the highest proportion of participants with schizophrenia and the greatest percentage who committed crimes against people rather than property. Yet San Francisco's program showed the greatest drop among the four courts in re-arrests compared to control groups, a 39% reduction compared to a 7% drop.
The control group also returned to incarceration for significantly longer periods than the mental health court participants.
Jennifer Johnson, a San Francisco deputy public defender who has helped craft the 8-year-old court, takes pride in the data and notes that "a program can't say it is protecting public safety unless it is directly addressing violence. That means accepting clients that actually put the community at risk."
San Francisco Dist. Atty. Kamala Harris said her office has objected to the participation of certain serious offenders. But Harris, who is running for California attorney general, said: "When you look at the numbers, you see that it actually makes sense, because we are reducing crime in the community."
About three years ago, Los Angeles County launched a similar court for those with multiple disorders of substance abuse and mental illness that can serve 54 people, said Alisa Dunn, who heads the county's Mental Health Court Linkage Program.
Dunn also oversees a program launched in 1987 that sends caseworkers into 25 courts from Long Beach to Pomona to counsel families and ensure that mentally ill defendants are plugged into an array of services, both in jail and upon release.
Although it is not a traditional behavioral court model — it does not promise diversion from jail nor does it always offer the chance of reduced or waived charges — Dunn said it works well for such a vast county. Last year, it served more than 2,600 people.
Through another program, Dunn's staff can now recommend that mentally ill inmates be diverted to a locked treatment facility of 46 beds or an unlocked alternative with 17, where they get intensive case management and care.