It's lunchtime in Room 510 of the Broward County Courthouse, and the judge is clearly worried about the disheveled prisoner with matted hair and glassy eyes sitting shackled before her.
The man has been languishing in the county jail for days on a minor trespassing charge. He's a schizophrenic and alcoholic who says he's been living on the streets and not taking medication for his illness.
In the middle of the hearing, Judge Ginger Lerner-Wren picks up the phone and dials a local mental health program. At first she cajoles the administrator. Then she becomes stern and emphasizes that "the court" really wants this man to get treatment and shelter.
Lerner-Wren hangs up the phone and announces that a bed is waiting for him.
"God bless you, judge," the man yells.
She smiles and calls the next case.
That's a typical scene at the Broward County Mental Health Court, a unique blend of justice and social services, or as Lerner-Wren often calls it, "therapeutic jurisprudence."
The county court, the first in the nation when it was created in 1997, has become a model for more than two dozen communities from Anchorage, Alaska, to Brooklyn, N.Y.
In Florida, mental health courts have cropped up in Sarasota, Osceola, Lee and Alachua counties. Palm Beach and Orange counties are seeking funding to start courts and Okaloosa County is launching one in January.
Law enforcement officials estimate the court has saved the Broward jail system at least a million dollars a year.
The goal is to stop mentally ill defendants arrested on misdemeanors such as disorderly conduct, loitering, petty theft and public drinking from rotating in and out of jail and get treatment for them. In its five years of operation, the court has offered help to hundreds of offenders who otherwise would have been in jail, records show.
"The court needs to give our people a sense that somebody with authority cares," Lerner-Wren says. "On a daily basis, that's what we're striving for."
For defendants who participate, criminal charges are put on hold. The judge evaluates the case, consults with the court's social workers and issues an order specifying treatment and rules they must follow. "This is not a trial court. This is a treatment court for people who have some kind of mental health condition," the judge tells new defendants. "It is purely voluntary."
Some defendants need a case manager. Others require a live-in program and intensive therapy. Many also are substance abusers needing drug or alcohol treatment.
It's a heavy load, especially because it's a part-time court. Lerner-Wren maintains her regular criminal docket and holds mental health court hearings during her lunch hour on weekdays. On Thursdays, she schedules a full afternoon of status conferences to monitor defendants' progress.
The court has no budget and operates with only two employees: a $40,000-a-year county-funded court monitor from Henderson Mental Health Center and a $45,000-a-year licensed clinical social worker from the Florida Department of Children & Families.
Unlike most courts, where a hush falls as the judge appears, mental health court is often a free-for-all. Attorneys and social workers mill about in front of the judge, chatting about defendants' histories. Nova Southeastern University psychology doctoral student interns screen prisoners who are in manacles, jail jumpsuits and black flip-flops, and report their findings to the judge.
"How many times have you been in the hospital for mental health reasons?" the students ask.
"Do you have a place to live?"
"Are you hearing or seeing anything?"
Some prisoners mumble incoherently to themselves or scream obscenities. Others wait patiently for the judge to call on them. Those out on bond sit on benches in the audience, often with family members or friends.
Lerner-Wren asks how they're doing and poses the question: "Is there something this court can do for you?"
"The defendants are treated with more respect than they probably ever had before," says Danielle Levin, a Broward assistant state attorney assigned to the mental health court. "In other courtrooms, people acting inappropriately are either not brought into court or judges don't want to deal with them. This judge talks directly to them."
Kimberly Warner, 37, who first came to the court after an indecent-exposure arrest three years ago, was "very, very ill," as the judge puts it.
Warner, a schizophrenic, says she had suffered a nervous breakdown and couldn't cope. To make matters worse, she was doing crack. "I was on the verge of suicide," she says.
Lerner-Wren sent Warner to a residential treatment program, where she stayed for more than a year. But after she was released and got her own apartment, she relapsed and was arrested on lewdness charges.
Lerner-Wren gave her another shot. Warner moved to a different program and stayed clean. After six months, she transferred to a board and care home, but still attended day treatment and took medications.
At an August hearing, Lerner-Wren handed a glowing Warner a "certificate of achievement" for completing treatment and making "terrific progress."
Around the courtroom, there was a burst of applause.
"This court has helped me a lot," Warner said, tears welling in her eyes. "It helped me get my life together."
Jail, release, jail againMental health court was born of crisis.
It stemmed from the highly publicized case of Aaron Wynn, a young man who suffered brain damage in a motorcycle accident in the mid-1980s. He couldn't control his anger and acted out with his fists. For years, his parents had tried unsuccessfully to get him help as he moved between the mental health and criminal justice systems.
In 1993, Wynn was arrested in Hollywood after a woman, 85, he knocked down outside a grocery store hit her head on the pavement and died. Wynn was charged with manslaughter but found incompetent to stand trial.
Wynn's case prompted a 1994 grand jury report that blasted the jails filled with mentally ill inmates -- an estimated 6,500 to 10,000 a year -- who got little, if any, treatment from the county's fragmented mental health system.
The same year, Broward Circuit Judge Mark A. Speiser, then head of the court's criminal division, created a mental health task force of attorneys, social service experts, police and advocates.
The task force found that mentally ill people were being arrested for minor offenses and locked up in overcrowded jails because they couldn't make bond, sometimes as little as $25. Some would remain for days or weeks without treatment. Finally, they would plead guilty or no contest and be released, only to be rearrested for similar crimes.
"Severely mentally ill people would sit in jail after being arrested for rummaging through a Dumpster or standing in a parking lot screaming or walking naked into a Denny's," says Doug Brawley, the Broward chief assistant public defender who supervises the county court division. "They'd be sentenced to time served, get released from jail and be on their way. And they'd go right back out and do the same thing again. Nobody was helping those people."
A U.S. Department of Justice study appears to bear out the task force's findings. It revealed that in 1998, an estimated 283,800 mentally ill offenders were locked up in the nation's jails and prisons, representing 16 percent of prisoners. Those in local jails who had been arrested for "public order" offenses served on average 1.3 months more than offenders who weren't mentally ill.
"I was very frustrated as a judge," Speiser recalls. "Our jails were swelling with people who had mental health issues. By releasing them, we were doing a disservice to them and the community. It was like a merry-go-round."
Deinstitutionalization, the sweeping movement to empty psychiatric hospitals that started in the 1960s, compounded the problem. The number of patients in state and county psychiatric hospitals dropped from 558,922 in 1955 to 54,836 in 2000, according to U.S. Department of Health and Human Services statistics, but community programs to help treat them didn't grow to meet the demand.
Chief Assistant Public Defender Howard Finkelstein, who represented Aaron Wynn and was a member of the task force, says he brought up the idea of a mental health court out of frustration.
"Judge Speiser asked what I wanted," Finkelstein says. "I said I wanted a mental health court. Everyone thought about it -- and said OK."
The court would accept defendants arrested on misdemeanors, but not domestic violence or driving under the influence. It would take those arrested for battery, but only if the victim consented.
And it would not include anyone arrested on a felony charge unless it had been reduced to a misdemeanor.
Most important, task force members had to find a judge to make it work.
They chose Lerner-Wren, who had just been elected to the county court bench in the fall of 1996. She had served as the Broward County Public Guardian, responsible for overseeing the health and welfare of disabled adults who were incapacitated. She also had worked for an advocacy center monitoring a settlement agreement over a federal class action lawsuit against South Florida State Hospital, the region's mental hospital.
Broward Chief Judge Dale Ross appointed her to run the new court, which opened for business in June 1997.
"The court came to be out of desperation," says Lerner-Wren, 43. "But it has turned out to be a great vehicle that pulls these bits and pieces of a very broken and fragmented mental health system together."
Those who work in the judicial system are quick to assert that the court is making a difference in the lives of the mentally ill.
"The mental health court has helped a great deal," says Broward Sheriff Ken Jenne. "The judge has developed a real good balance. She isn't getting suckered, but she's also sympathetic."
Jenne says the court was badly needed, not only from a treatment standpoint, but also from a fiscal one.
Broward Sheriff's Office statistics show that it cost taxpayers an additional $638,000 last year to feed, clothe and provide medication to mentally ill inmates in the jails.
From March through October of this year, the county jails made 342 referrals to mental health court, or about 42 a month, statistics show. While sheriff's officials don't keep statistics on exactly how much that may have saved them, they point out that it costs about $235 a day to care for a mentally ill inmate.
"At the end of the day, this community is 100 times better having the mental health court," the sheriff says.
`A lost soul' savedFor 48-year-old Scott Cormiea, mental health court was the end of the line.
A homeless alcoholic suffering from severe depression, he couldn't hold a job. He ended up on the streets, feeding himself by rummaging through trash bins. He says he tried to kill himself by walking in front of a bus and by drinking himself to death.
"I turned into an animal living on the street," Cormiea says. "I kept hearing voices to kill myself because I was worthless."
Fort Lauderdale police arrested Cormiea on New Year's Eve 2000 on a charge of trespassing at a gas station. In September 2001, he was cited again for drinking a beer while sitting on a milk crate on the sidewalk.
Later that month, he was brought to jail on a warrant for an open-container charge and was referred to the mental health court.
Cormiea was hearing voices and was suicidal when he first appeared before Lerner-Wren, records show. The judge ordered him into a crisis unit for evaluation.
Once stabilized, Cormiea went to live at "Cottages at the Pines," a mental health court program based at a cluster of brightly painted houses that once belonged to doctors on the grounds of South Florida State Hospital in Pembroke Pines.
The cottages are designed mainly for homeless mentally ill defendants from the mental health court. Fifteen beds are reserved for court-ordered defendants and nine are for homeless people referred by county staffers.
Participants in the $1.25 million-a-year program, run by Henderson Mental Health Center and funded by the state and county, receive therapy, sign up for disability benefits and work on developing social skills and reconnecting with their families. When they're done, they usually move into their own apartments or board and care homes.
In April, Cormiea had been living at the cottages for six months. He was attending Alcoholics Anonymous meetings, had signed up for computer courses and planned to get his own apartment.
"I was in such bad shape, but I managed to turn myself around," Cormiea said. "I'd be dead right now if not for this program. I was a lost soul."
Cormiea left the cottages in June and moved into an apartment. He hasn't been arrested since, court records show.
Like Cormiea, about three in 10 defendants who appear before Lerner-Wren report substance abuse problems and an equal number are homeless, according to an annual progress report released by the court.
Many others live with family members or friends. Some are professionals. About a quarter are women, many of whom have been arrested on prostitution, theft or alcohol- or drug-related charges.
One of the court's biggest obstacles is the lack of treatment beds in the community for defendants in her court, Lerner-Wren says. Nor are there enough programs to help mentally ill offenders who are substance abusers, women who've been abused or those looking for work, she adds.
"These are huge problems in the state of Florida," says Lerner-Wren, who was appointed in May to the 15-member President's Commission on Mental Health.
About two-thirds of the cases that come before the court are resolved after the initial hearing before Lerner-Wren. The rest are continued and monitored, according to a study by the University of South Florida's Department of Mental Health Law and Policy.
For defendants who receive mental health services and appear to be stable, Lerner-Wren often withholds adjudication, which means there is no record of a criminal conviction, and closes the case. She usually does the same for defendants who successfully complete treatment.
Court records show that about 12 percent of defendants aren't appropriate for the court. Some might not be mentally ill. Others may have a violent history.
And some defendants choose not to participate. They might not believe they have a mental health problem or be motivated to help themselves. If the charge is minor and they have no outstanding warrants, Lerner-Wren usually will close the case and order them not to return to the place where they trespassed or shoplifted.
Janis Blenden, the court's clinical social worker, says that while there's a good team in place, the court misses many people or can't find services for them.
"We see a lot of alcoholics and homeless people who are not mentally ill," Blenden says. "We can't help them. In the long term, they don't qualify for benefits."
Swift-moving processMost new defendants who appear before Lerner-Wren are sent from magistrate's court, held via television, in the main jail. Nova doctoral students attend morning hearings to screen inmates and pinpoint those who appear to have mental health problems. Inmates' names also are matched against a list of current and former clients kept by Henderson Mental Health Center.
Judges, public defenders, assistant state attorneys, police officers, social workers, family members and advocates also can recommend a defendant to the mental health court.
The process usually moves quickly, often within 24 hours of the arrest.
A mentally ill defendant arrested on Monday night, for instance, would appear in magistrate's court the next morning and could be in front of Lerner-Wren by lunchtime Tuesday.
The whole idea is to divert mentally ill inmates from jail as quickly as possible.
For Lerner-Wren, getting help on the spot is the normal course of business.
When inmates complain they aren't receiving psychotropic medications, she'll phone the jail and insist that they get their meds.
"Honestly, when the judge calls and says, `I need you to do something,' that's going to jump up on the list of things that need to be done," says Timothy Ludwig, mental health coordinator for the county jails. "She takes a personal interest in each case."
Not all cases get to the mental health court quickly, however. Some defendants have a pending felony charge, which must be disposed of before they would be eligible for the court. Others get lost in the jail system.
"If they're not known by the mental health system, someone has to notice them," says Levin, of the state attorney's office. "If they're quiet and don't display overt signs, the jail's not going to recognize it."
Lerner-Wren requires defendants or their case managers to update her regularly about progress, every week or two at first, then every month or so. A case can remain in her court for up to a year.
Those who continually violate her orders are expelled from the program. Some are transferred back to criminal court or taken into custody if they commit a new crime.
Lerner-Wren frequently tells defendants that it's up to them to take their medications and manage their illness. Sometimes she's like a stern parent, scolding those who fail to follow her orders.
To one defendant, she warns: "You're starting to rack up a history. If you don't take your medications, there will be consequences. You're going to see harsher and harsher sentencing."
Sometimes the judge is like an adoring teacher, handing out certificates to those who have succeeded.
"You have really moved forward," she tells one defendant. "We're so pleased with your accomplishments and growth."
Lerner-Wren is proud of the court, noting that visitors have come from as far as the United Kingdom and South Africa to see it in action. Congress also liked the idea, and in 2000, passed legislation creating up to 125 pilot mental health courts throughout the country.
Evelyn Miller, president of the Broward County chapter of the National Alliance for the Mentally Ill, says her group thinks the mental health court has made a difference.
"It's a wonderful thing that these people can be offered treatment, rather than sit in jail because of their illness," Miller says. "You have to help those who need it the most."
Public safety firstNot everyone is a success story. Some mental health court participants are what the attorneys call "frequent fliers" who keep getting arrested again and again.
At 5-foot-11 and 525 pounds, Kalvin Williams was hard to forget, Lerner-Wren says, when he became one of the first defendants in her court.
Williams, 45, suffers from a "schizoaffective disorder," in which patients experience severe mood swings and some of the psychotic symptoms of schizophrenia. He has been arrested dozens of times, usually for creating a public nuisance. He often screams at people, using obscenities, in public places, court records show.
The judge tried sending him to intensive case management and residential programs, to no avail. Now Lerner-Wren says she won't take Williams' cases.
"I feel very disappointed because he has had many opportunities," the judge says. "But you have to respect choice. This is not the court for him."
But mental health court officials are less likely to worry as much about offenders like Williams as they do about those who are violent. They say their deepest fear is that one of their defendants will commit a heinous crime, leading to demands that the court be shut down.
"We don't want anything bad to happen that could cause all of this good to be placed in jeopardy," says Lee Cohen, the Broward assistant state attorney in charge of the county court division. "If it did, I hope it wouldn't kill the court."
Lerner-Wren says the State Attorney's Office does a national criminal background check on every defendant and presents her the history. She wants to weed out those with prior serious violent offenses and send them back to regular court.
"We've been very sensitive about this," she says. "Public safety is of utmost importance."
Unlike drug courts, where success is measured by whether participants stop using drugs, the mentally ill will continue to be mentally ill, so experts have to use other measures to evaluate.
The most obvious is recidivism. Until recently, statistics were hard to come by -- the court, which has no administrative unit, never kept them. This year, however, the Broward court administrator's office analyzed data from October 2001 through September 2002 and found that 27 percent of mental health court participants had been rearrested during that time. Eight percent had returned to the mental health court.
Lerner-Wren says the recidivism is "surprisingly low."
"It's awesome that seven out of 10 aren't re-offending," she says. "It demonstrates that treatment works and recovery is possible."
The court does appear to be offering mentally ill defendants more help than a regular court, according to initial findings from the two-year University of South Florida study.
The study compared a sampling of mentally ill defendants processed in a regular county criminal court in Hillsborough County with those who appeared in Lerner-Wren's court.
It found that mental health court defendants felt they were treated with more respect and fairness than their counterparts, and that it was much more likely they would get follow-up treatment, such as therapy or medication management.
Respect and compassion"Broward County has clearly been a national leader. This court seems to be a significant success," says John Petrila, a USF professor who co-authored the study.
Ultimately, how well the mental health court works depends on what you want it to do, adds Norman Poythress, another co-author and USF professor.
"Legislators look at how much does it cost. Criminal justice looks at whether it reduces crime and how many dollars it saves us in bed days in jails," Poythress says. "Advocates look at whether their relatives are treated with respect."
Court officials say that the one thing they know is that mentally ill offenders who walk into Room 510 usually leave with a feeling that someone cared about them.
"Whether we're making a difference, I don't know," says Finkelstein, of the public defender's office. "I just know that on the day-to-day direct human interchange that goes on in that court, the quality of justice and compassion we give these people is something Broward County should be proud of."
This reporting project was supported by a Kaiser Media Mini-Fellowship in Health.
Jenni Bergal can be reached at email@example.com or 954-356-4592.Copyright © 2014, Los Angeles Times