By Julia Steiny
This is our third look at how Judge Pamela Williams, in her mental health court in Nova Scotia, successfully kept offenders from further contact with police, courts, and jail. Using the CoSA model — see last week’s column — she worked with experts in different fields to figure out how to “help them out of the place that they are in,” as she put it.
Today’s question is: CoSA works, but at what cost?
To set the stage, first conjure in your mind an Excel budget sheet. Labels at the top read: Housing, Health, Mental Health, Prison, Courts, Children Protective Services, Schools, Higher Ed, Workforce Development, and I’m sure you can think of more. Each of these state or city public services has its own mission, and not to confuse things, each has its own huge budget spreadsheet. Hierarchies, job descriptions, and business habits are baked into those budgets, leaving little flexibility. So as we consider another of Judge Williams’ stories illustrating her Court’s challenges, mentally map where various costs might be posted, but remember that Judge Williams herself controls only her portion of the Excel column marked “Courts.”
A woman we’ll call Rosalie was “a very complex case.”
Rosalie had limited intelligence, schizophrenia, anxiety, depression and suicidal ideation. Also, she was an unusually large woman, which added to the extent that she was hard to control at times.
Occasionally she’d sink into a depression so severe she became suicidal. She’d sneak out of her group home and head for a particular bridge where she’d threaten to end her life. Not that she did. But the police couldn’t just let traffic flow by an apparent suicide in progress; they had to close the bridge. Bridges over water, such as this one, have no side streets to which traffic can be diverted.
A competent bean-counter could probably arrive at a solid estimated cost for the small platoon of police needed to get her into an ambulance or patrol car… and the emergency efforts of the Department of Transportation, her subsequent hospitalization, public defenders, and so on. However, it’s impossible to monetize the inconvenienced drivers who were late to appointments, no-shows at job interviews, or charged extra for late daycare pick-up.
Yes, of course they had tried to stop her. Ferverently. Rosalie had been in court repeatedly, jailed, on probation, back in prison — caught in an expensive, vicious cycle. The Law could keep her locked up, but she was a wretched innocent, not a criminal deserving the punishment of prison. The costs of punishing her into compliance were also not cheap, but more importantly, not working.
The traditional courts sent her over to Judge Williams.
Williams assembled her CoSA team of professionals, including the directors of Rosalie’s group home. Obviously the directors had talked to the police and other agencies on her behalf. But under what circumstances, other than a CoSA meeting at Williams’ court, would they sit down together to get it to stop? Typically, the psychiatrist of record hardly talks to the therapist, never mind solves problems with a team that includes family and other stakeholders. Where is the Excel column for cross-agency collaboration?
In any case, the group discovered that Rosalie absolutely treasured her home. It was comfortable, with kind friends who took her back, fed and soothed her. They concluded that her love of her home could be carefully deployed as leverage. No one wants to do tough love. But they worked with Rosalie to get a deal with her — if she did her bridge thing again, she would be banned from the home and need to live somewhere else.
Predictably, in time, it happened once more. Williams didn’t say where Rosalie lived or for how long after her poor choice. Wherever it was, she hated it passionately, as all had hoped. Per prior agreement, and after a painful amount of time, she was allowed back into the home and never offended again. It worked.
Williams says, “We have one mental-health court. Even that court doesn’t have enough resources. It’s expensive to restore broken people and relationships. The people around those offenders are broken. Victims are broken.” Everyone involved in a crime needs the healing powers of restoration — or the problems linger, or worse, fester.
But only through sheer power of persuasion, and judicious use of scarce resources, did Judge Williams get experts from across the Excel spreadsheet to jump their column. Who pays for that? No group home runs on such a cushy margin, they can easily send people for team meetings. Therapists and psychiatrists don’t work for free, so the entire spreadsheet would have to ease up so the resources are there to make up these teams. Think of the cost savings to Police, Health, Transportation, etc.
Recidivism is absurdly expensive. Rosalie’s trips to the bridge cost a fortune. Stopping them, in a humane fashion, saved a lot of money for Police, Transportation, Emergency Medicine, and more, not to mention the taxpaying public. If the real goal of Justice is to reduce recidivism, Judge Williams has excellent answers. What we’re doing now doesn’t work for anyone.