POLL: Should Hamilton County start a mental health court?
In the cellblocks of the county jail, suspected murderers, drug traffickers, burglars, wife beaters and rapists wait for hearings and trials. Somewhere among them sits Dennis James' schizophrenic son.
His crime? He's sick.
Like hundreds in the jail at any given time, he's sick with nowhere to go. He's so sick that his parents can't handle him anymore. He's so sick that the group homes and the halfway houses won't take him until he's stabilized. He's so sick that he won't swallow his medication. But he's not sick enough to get long-term help.
Crisis units and psychiatric hospitals won't take him in involuntarily unless he is posing an immediate threat to himself or someone else. And deciding the level of risk is a judgment call.
Shattering furniture isn't enough. Preaching all hours of the night because of the voice in his head isn't enough. Walking unlit country roads at night alone isn't enough.
For a $5,000 bond James could bring his son, Kyle, home. But he won't. The eight broken windows in his home tell him not to. The holes in the wall tell him not to. His family tells him not to.
Everyone has a breaking point. It took eight years for James to reach his. That's when he realized that his son's worsening mental state was pulling him under, too. The cost of caring has been high: his job as a welder, gone; his health, deteriorating.
"This is as far as I can go," James says.
So last fall he picked up the phone and called a local General Sessions Court judge, begging for help.
If James and his son lived in Nashville, the reply might have put Kyle on the road to wellness. But not here.
Get him arrested, the judge said. Get him a record and a sentence.
Because home for an overwhelming number of the mentally ill these days is a cell with iron bars.
James called the police. His son was jailed in January on charges of disorderly conduct and resisting arrest.
Jail isn't a place for a schizophrenic, but it's the only place that will take and hold Kyle.
Kyle's case is a textbook example of how thousands of mentally ill cycle through -- court and jail, court and jail, court and jail -- with no psychiatric improvement, raising questions about whether judges should be handing down sentences or treatments.
There are people who come in and out of court and learn a lesson. The teenage boy whose parents look on as a judge lectures him about his first DUI. The prostitute who confesses a drug addiction, enters a treatment program and gets clean. The burglar who meets Jesus in prison and promises never to steal again.
But what about the delusional? The man who urinates in public because he no longer is aware of the people around him? The guy who does strange things because the voices tell him to? What about the woman who is so paranoid that she resists police?
How do punishments work to change them?
They don't, many say, and a groundswell of parents, judges, public defenders, mental health workers and advocates wants this to change. They argue that Hamilton County needs a court for the schizophrenic, bipolar and severely depressed where treatment, not punishment, is the priority.
"Courts are so saturated. The follow-up [that the mentally ill need] doesn't happen," said Donna Maddox, director of the Joe Johnson Mental Health Center.
"We need it," said Bill Honeycutt, Hamilton County grand jury foreman and past president of the Chattanooga chapter of the National Alliance for the Mentally Ill. "We are going to be pushing for it."
"This is a critical need," said Hamilton County Sheriff Jim Hammond. "Its time has come."
"The next step in the evolution of all this is to have a mental health court," said William Ventress, CEO of the state mental hospital at Moccasin Bend. "I think we will have one in Hamilton County fairly soon."
Right now, 45 percent of about 500 county jail inmates are on psychotropic drugs. At Silverdale Detention Facility, 300 out of 1,000 are mentally ill, officials said.
And in fact, Hamilton County already has a fully functioning, effective model that is saving the courts money and channeling offenders to treatment. It's called Drug Court.
Participants are given a chance to follow treatment programs and have their sentences dismissed or commuted.
A mental health court would do the same, said Elaine Kelly, coordinator of the Hamilton County Drug Court. Keeping the mentally ill behind bars might free the community from dealing with its sick, but it doesn't fix any problems, she said.
"People are relieved. They think, 'at least they are [in jail],'" she said. But "jail doesn't fix [the mentally ill]. It just warehouses people."
Mental health courts have grown from just a handful of jurisdictions in 2000 to hundreds of cities across the country, including Nashville, Jackson and Johnson City in Tennessee. In 2011, Georgia lawmakers voted to open mental health courts across the state.
If done right, the specialized court could save millions for the county and provide relief for crowded jails.
In Hamilton County, it costs the jail $6,000 a day to house and feed its mentally ill population, law enforcement officials say. In Nashville, every week of mental health court saves that city $152,000, said Tonia Dixon, director of the Davidson County Mental Health Court.
But beginning a mental health court here would take money, a lot of it, for staffing and an expansion of long-term, supervised housing for the mentally ill.
One judge would have to be willing to shepherd the cases; informal talks between judges and public defenders here haven't amounted to much. Samantha Bayles, sentencing advocate for the public defender's office, was working on launching a court, but the effort lost steam.
Ventress said he is on a policy and planning council for Southeast Tennessee that has talked about a mental health court for some time. People say the need is crucial, but no effort has been organized to pave the way.
"We haven't been able to get any traction," he said.
Drug court launched, in part, because Criminal Court Judge Rebecca Stern spearheaded the effort. No judge has come forward for a mental health court.
"It is one of the hardest situations I have," said General Sessions Judge Clarence Shattuck. "I would not envy a judge that would have to make those types of decisions. I see enough of it without having a mental court."
Stern said the county needs a mental health court, but acknowledged the commitment required.
"It comes with a lot of extra time, effort and heartbreak," said Stern.
Aside from the small office space, the county doesn't pay a cent toward the cost of drug court. The $118,000 down payment for the special court came as a congressional earmark secured by then-U.S. Rep. Zach Wamp at Stern's urging. The program has survived grant to grant since.
Drug court has graduated 89 people, and Kelly estimates that more than $12 million has been saved in incarceration costs since the first class graduated in 2005.
A mental health court would have to survive on grants, too. It just takes the will to find and get them, said Kelly. But to really get a mental health court running, more than money is needed.
Hamilton County has a well-publicized housing shortage for the seriously mentally ill. Since 2005 the number of beds has shrunk by 53 percent, from 1,068 to 500, according to NAMI. Moccasin Bend, which now covers more than 50 counties, has 100 acute and 50 sub-acute beds. The state hospital in Knoxville closed last year.
Even those who meet the requirements for civil commitment sometimes get turned away because there is no space, police say.
Parkridge Valley, a for-profit mental health hospital in Chattanooga, accepts the privately insured and some TennCare cases.
Steve Daugherty, chairman of the NAMI legislative advocacy and policy committee and a former chairman of AIM Center housing, said 300 to 400 group home units are available for the mentally ill, but the need is four times that.
The homeless shelters often are full, too.
"It is just a horrible joke," Daugherty said.
"They keep closing the beds on the idea that community services are out there, but they aren't out there. All you have to do is go to the Community Kitchen, the workhouse, the jail. That is where they all are."
Kelly said she has called Moccasin Bend about people so psychotic that they were pulling their own teeth out and Moccasin Bend was too full to accept them.
Those turned away are sent to another state hospital, possibly Nashville or Memphis, but the trip can be difficult for someone who is psychotic.
Kyle James has been in custody for more than a month, moved between the jail, Silverdale Detention Center and Moccasin Bend. Dennis James said the public defender wouldn't tell him why his son has been moved.
Because Dennis James is technically the victim in the case, he has not been allowed to visit his son in jail or talk to Kyle's defense attorney.
And while James knows where his son is, he knows little else.
He doesn't know if his son is getting his medicine or if his medicine has been changed. He doesn't know if Kyle is being victimized by other prisoners or kept in solitary confinement. He doesn't know what a criminal record will mean for his son if he does ever get better.
More than a decade ago, Nashville faced the same glut of mentally ill inmates.
At the time, the jail held more people on psychotropic medication than did Middle Tennessee Mental Health Institute, the nearest state mental hospital.
On average, more than three mentally ill people were arrested every day. Many sat in the jail for months on end, mostly because they couldn't make bond.
Mentally ill women with misdemeanor charges spent, on average, 120 days in custody, while others with the same criminal charges spent 10 days maximum, data from the Davidson County Mental Health Court show.
Then in 2000, a judge proposed a solution. From that proposal came Tennessee's first mental health court. A grant from the U.S. Department of Justice jump-started the effort.
In 2004, General Sessions Court Judge Daniel Eisenstein took the reins and began lobbying the Metropolitan Council to fund it annually. He touted the millions saved in incarceration costs and the quality-of-life improvements, and the money was secured.
"What if hospital and hospital emergency rooms closed or put people on waiting lists for treatment of physical illness such as flu or pneumonia? Where would these sick people get medical care?" he wrote in the Nashville Bar Journal in January of this year. "Certainly it wouldn't be the jail."
Since then the mental health docket has grown from 50 active cases to more than 210 active cases at any given time. Court is held three days a week.
A shrinking mental health care system and changes to TennCare medical coverage continue to drive need. In 2005, 21,000 individuals with serious mental illness were removed from the TennCare rosters and lost coverage, Eisenstein said.
As in Chattanooga, housing for the mentally ill has challenged Nashville officials. So they regularly take stock of their resources, he said. For those who come to court and participate, housing almost always is secured.
With housing, monitors can track participants' medications every day. A case worker checks with them once a week. If they violate their orders to take medication and seek services, they are sent to jail, said Eisenstein. But monitoring typically works.
The recidivism rate is down to 10 percent, he said. However, the court hasn't done long-term tracking.
In many cases, insurance pays the cost of housing and treatment. In other cases, the housing is paid for by a nonprofit arm of the mental health court, he said. The Davidson County drug court also has a residential housing program that accepts mentally ill patients, he said.
"It's not brain surgery or rocket science," he said. "If you get people to take their medicine, get them a place to live and help their financial situation, they stay out of trouble."
Kyle's situation is treatable. Once, when he was in treatment longer than a month his symptoms went into remission. But now if Kyle does get better, he still will have a criminal record. Before he was arrested he received disability payments, but they stopped during his jail time, along with his TennCare medical coverage. Reapplying could delay his medications for weeks after release.
And if he gets medication, no one will mandate that he shows up to appointments or that he actually takes the pills.
Dennis James feels panic, knowing he can't take Kyle home, yet can't send him anywhere else. He has left more messages than he can ever count, trying to find help. He waits by the phone.
He can remember when his son didn't hear voices. He can remember when his son had friends. Ten years ago, Kyle was the pride of Soddy-Daisy High School, a three-time state wrestling champion. He was going to try out for the Olympic team.
People respected him.
"If he did happen to lose (a match), he didn't cry and pitch a fit," said Dennis James. "When he beat someone, he didn't make them look bad. He is not a bad person. ... I have never heard him say the 'n' word. ... He reads his Bible every day."
Now people avoid him.
"He's aggressive. He's angry. He says he has no purpose in life and doesn't want to be here. ... He'll tell me that the devil is telling him that he is going to die and go to hell. Then he'll be dying laughing. Then he'll be cussing."
When Kyle's court day comes, Dennis James shows up at 8 a.m. and waits outside on the long wooden benches. Around 2 p.m. the judge tells him he can come forward. The court time was moved. Then the judge was changed, again. Then the public defender changed, again.
"The state can't give him placement," says the public defender. "We have exhausted every option."
Kyle will wait in a cell until his next court date.
"It's sad that he's sitting in jail," the judge says from the bench.
Then, Kyle is brought out.
"You can't go home today," the judge says.
Kyle looks at his father standing in front of the judge.
"Can I give my dad a hug before I go?" he asks.
"I don't think that would be appropriate," she says.
He looks at her, confused.
"Is this a punishment or just a place to hold me over?"