    [Senate Hearing 107-910]
    [From the U.S. Government Publishing Office]

                                                            S. Hrg. 107-910

                        THE CRIMINAL JUSTICE SYSTEM AND
                             MENTALLY ILL OFFENDERS
    =======================================================================

                                    HEARING

                                   before the

                           COMMITTEE ON THE JUDICIARY
                              UNITED STATES SENATE

                          ONE HUNDRED SEVENTH CONGRESS

                                 SECOND SESSION

                                   __________

                                 JUNE 11, 2002

                                   __________

                              Serial No. J-107-84

                                   __________

             Printed for the use of the Committee on the Judiciary

                           U. S. GOVERNMENT PRINTING OFFICE
    86-518                          WASHINGTON : 2003
    ____________________________________________________________________________
    For Sale by the Superintendent of Documents, U.S. Government Printing Office
    Internet: bookstore.gpo.gov  Phone: toll free (866) 512-1800; (202) 512-1800
    Fax: (202) 512-2250 Mail: Stop SSOP, Washington, DC 20402-0001

                           COMMITTEE ON THE JUDICIARY

                      PATRICK J. LEAHY, Vermont, Chairman
    EDWARD M. KENNEDY, Massachusetts     ORRIN G. HATCH, Utah
    JOSEPH R. BIDEN, Jr., Delaware       STROM THURMOND, South Carolina
    HERBERT KOHL, Wisconsin              CHARLES E. GRASSLEY, Iowa
    DIANNE FEINSTEIN, California         ARLEN SPECTER, Pennsylvania
    RUSSELL D. FEINGOLD, Wisconsin       JON KYL, Arizona
    CHARLES E. SCHUMER, New York         MIKE DeWINE, Ohio
    RICHARD J. DURBIN, Illinois          JEFF SESSIONS, Alabama
    MARIA CANTWELL, Washington           SAM BROWNBACK, Kansas
    JOHN EDWARDS, North Carolina         MITCH McCONNELL, Kentucky
           Bruce A. Cohen, Majority Chief Counsel and Staff Director
                      Sharon Prost, Minority Chief Counsel
                    Makan Delrahim, Minority Staff Director

                                C O N T E N T S

                                  ----------

                        STATEMENTS OF COMMITTEE MEMBERS

    DeWine, Hon. Mike, a U.S. Senator from the State of Ohio,
      prepared statement.............................................    33
    Leahy, Hon. Patrick J., a U.S. Senator from the State of Vermont.     1
        prepared statement...........................................    35

                                   WITNESSES

    Caceci, John, Captain, Monroe County Jail, Rochester, New York...    13
    Margolis, Gary, Director of Police Services, University of
      Vermont, Burlington, Vermont...................................     6
    Mayfield, Kenneth President-Elect, National Association of
      Counties, and Commissioner, Dallas County, Dallas, Texas.......    11
    Strickland, Hon. Ted, a Representative in Congress from the State
      of Ohio........................................................     3
    Sudders, MaryLou, Commissioner of Mental Health, Commonwealth of
      Massachusetts, Boston, Massachusetts...........................     9

                           SUBMISSIONS FOR THE RECORD

    Bazelon, David, Judge, Center for Mental Health Law, letter......    21
    Caceci, John, Captain, Monroe County Jail, Rochester, New York,
      prepared statement.............................................    23
    Margolis, Gary, Director of Police Services, University of
      Vermont, Burlington, Vermont, prepared statement...............    37
    Mayfield, Kenneth President-Elect, National Association of
      Counties, and Commissioner, Dallas County, Dallas, Texas,
      prepared statement.............................................    50
    Strickland, Hon. Ted, a Representative in Congress from the State
      of Ohio, prepared statement....................................    59
    Sudders, MaryLou, Commissioner of Mental Health, Commonwealth of
      Massachusetts, Boston, Massachusetts, prepared statement.......    72
    Wilkinson, Reginald A., Director, Ohio Department of
      Rehabilitation and Correction, Columbus, Ohio, statement.......    75

             THE CRIMINAL JUSTICE SYSTEM AND MENTALLY ILL OFFENDERS

                                  ----------

                             TUESDAY, JUNE 11, 2002

                                  United States Senate,
                                    Committee on the Judiciary,
                                                       Washington, D.C.
        The committee met, pursuant to notice, at 10:05 a.m., in
    Room SD-226, Dirksen Senate Office Building, Hon. Patrick J.
    Leahy, Chairman of the Committee, presiding.
        Present: Senator Leahy.

    OPENING STATEMENT OF HON. PATRICK J. LEAHY, A U.S. SENATOR FROM
                          THE STATE OF VERMONT

        Chairman Leahy. Good morning. Today, this committee is
    going to consider an important but, I am afraid, often
    overlooked criminal justice issue--the impact of mentally ill
    offenders on our justice system. The consideration of the
    committee will be aided by the release of a comprehensive
    report on that topic by the Council of State Governments. We
    are also going to hear from a number of criminal justice and
    mental health experts, who will explain why the issue of
    mentally ill offenders has presented such problems for State
    and local governments. I hope this hearing will raise awareness
    of the role of mental illness in causing crime and help
    Congress valuate what role the Federal Government can play in
    helping State and local governments address this issue.
        Now, we are all too familiar with the role that drug abuse
    plays in promoting crime--from drug trafficking itself, to
    property crimes committed by addicts or those seeking money to
    buy drugs, even to the tragedy of murders committed by dealers
    seeking to gain or maintain control over what have become
    lucrative drug markets. We are also well acquainted with the
    occasional notorious crime committed by mentally ill
    individuals--the assassination attempt, for example, against
    President Reagan. But today we will focus on the persistent
    problem of people with mental illness who repeatedly rotate
    between the criminal justice system and the outside world,
    committing a series of minor offenses that occupy the time of
    law enforcement officers and actually divert them from their
    more urgent responsibilities. Now, some mentally ill offenders
    also abuse drugs and/or alcohol, and that further complicates
    matters.
        We will hear today from witnesses who have expertise in
    this area from varying perspectives, including law enforcement,
    corrections, State mental health systems, and local government.
        I must admit--and I hope people won't believe I am being
    parochial, but I want to give a particular welcome to Gary
    Margolis, who is the Chief of Police Services at the University
    of Vermont. I worked with Chief Margolis on a whole number of
    issues over the years, and not only have I but my staff has
    relied on his very good judgment. And I appreciate
    Representative Ted Strickland coming over from the other side
    of the Hill. He has personal experiences with mentally ill
    offenders. He served as--and tell me, Congressman, if I am
    right on this--a consulting psychologist at the Southern Ohio
    Correctional Facility before coming to Congress. I mention that
    because of how fortunate we are when people who have all these
    different backgrounds come into Congress, and both the House
    and the Senate have benefited from Congressman Strickland's
    expertise.
        The Council of State Governments' report was developed by
    nearly 100 criminal justice and mental health policymakers--
    Republicans and Democrats--who wanted a non-partisan report on
    how to improve the criminal justice system and how it handles
    people with mental illness. They had sheriffs, chiefs of
    police, prosecutors, judges, corrections directors, parole
    board chairmen, mental health professionals. That is pretty
    extensive. The Police Executive Research Forum and the
    Association of State Correctional Administrators worked with
    the Council of State Governments and the Bazelon Center for
    Mental Health Law.
        The evidence shows the severity of the problem. It found
    that more than 16 percent of those incarcerated in jails and
    prisons have a mental illness. The Office of Juvenile Justice
    and Delinquency Prevention reports that more than 20 percent of
    the youth in the juvenile justice system have serious mental
    health problems. The Los Angeles County jail often holds more
    people with mental illness--the Los Angeles County jail--than
    any State hospital or mental health institution in the United
    States. Every State witnesses examples of this.
        Last December, Robert Woodward, a mentally ill man,
    interrupted services at All Souls Church in West Brattleboro,
    threatened first to kill himself, then armed with a knife,
    charged three officers who had responded to the scene. They
    fired back in defense. Mr. Woodward died later that day. This
    is tragic all the way, the tragedy of the effect on the
    officers, the effect on Mr. Woodward, and those who were in the
    church. And so we have to look at these things.
        We should all agree that it makes sense to help State and
    local governments improve the availability of mental health
    services, to train their law enforcement personnel to recognize
    the signs of mental illness, but then to give prosecutors more
    tools in dealing with them.
        Helping people with mental illness is the right thing to
    do. It would improve the safety of all Americans, but we also
    have to give the tools to those we ask to protect all
    Americans. I have worked with Senator Hatch and others to
    increase funding for drug treatment. We want to reduce crime,
    but we should also be interested in this issue. I have proposed
    including a study on the ability of mentally ill offenders to
    reintegrate into society after their release.
        [The prepared statement of Senator Leahy appears as a
    submission for the record.]
        Chairman Leahy. If I might, I would call on Congressman
    Strickland to come forward.
        To give you an idea, as I said, about the background of
    people who come here and absolutely improve the Congress with
    their background, Congressman Strickland represents the 6th
    District of Ohio. He has a master's of divinity degree from
    Asbury Theological Seminary, a doctorate in counseling
    psychology for the University of Kentucky. He served as a
    minister, college professor, and a psychologist. Actually, all
    three are probably necessary just to serve with the rest of us
    up here.
        [Laughter.]
        Chairman Leahy. At least speaking for myself. So,
    Congressman, I am delighted to have you here. Please go ahead,
    sir.

    STATEMENT OF HON. TED STRICKLAND, A REPRESENTATIVE IN CONGRESS
                         FROM THE STATE OF OHIO

        Representative Strickland. Thank you, Mr. Chairman, for
    your graciousness in having me here and giving me the
    opportunity to testify today about the solutions to the
    problems of the mentally ill in the criminal justice system. As
    a psychologist and as someone who has worked in a maximum
    security prison and as a Member of Congress who has worked
    through legislation to try to solve some of these problems, I
    hope that I can provide some helpful insights to you and the
    committee.
        The striking statistic which you have just shared with us,
    Mr. Chairman, and that we will probably hear multiple times
    today is that, according to the Bureau of Justice Statistics,
    over 16 percent of adults in our jails and prisons have a
    mental illness, and the Office of Juvenile Justice and
    Delinquency Prevention tells us that over 20 percent of the
    youth who are in juvenile justice systems have serious mental
    health problems.
        In 1963, Health, Education and Welfare Secretary Anthony
    Celebrezze said, ``The facts regarding mental illness and
    mental retardation reveal national health problems of tragic
    proportions compounded by years of neglect.'' He said that
    large State mental hospitals were primarily institutions for
    quarantining the mentally ill, not for treating them, and that
    ``all levels of government, as well as private individuals and
    groups, must share the responsibilities of a 20th century
    approach to this outstanding national health problem.''
        Well, Congress responded to this ``outstanding mental
    health problem'' by passing the Community Mental Health Centers
    Act, which sought to move as many of the mentally ill as
    possible out of prolonged confinement in overcrowded State
    custodial institutions into voluntary treatment at community
    mental health centers. On October 31, 1963, President Kennedy
    signed the Community Mental Health Centers Act into law.
    Unfortunately, Congress failed to keep the Act's promise by
    failing to fund it, and the money States needed to build
    adequate community mental health infrastructures flowed to
    other priorities.
        Although the reforms were well intended and had the purpose
    of protecting the mentally ill, they resulted in many of the
    most severely ill going without treatment and, in too many
    cases, becoming homeless, incarcerated, suicidal, and
    victimized. Ironically, these efforts are euphemistically
    referred to as ``the deinstitutionalization movement.'' But, in
    my opinion, the huge numbers of mentally ill individuals in
    jails, prisons, homeless shelters, and flop houses demand that
    we call this movement what it has become:
    transinstitutionalization.
        I believe there are two ways we must address this problem.
        First, we must require that health plans stop
    discriminating against mental health treatment. There is no
    scientific justification for treating mental health benefits
    differently from other benefits. S. 543, which has been
    introduced by Senator Domenici, and H.R. 4066, which has been
    introduced by Representative Roukema and of which I am a proud
    cosponsor, would guarantee that health plans offer equal
    coverage of mental health and physical health.
        Second, and most important for the topic at hand today, is
    that we must give the criminal justice system that resources it
    needs to divert and treat the mentally ill.
        Senator DeWine and I worked together in the 106th Congress
    to begin to address some of these issues by creating a
    demonstration program to encourage the creation of mental
    health courts, which are courts with dedicated dockets with a
    dedicated judge where defendants may receive court-supervised
    treatment rather than jail terms. In most instances, the
    existence of the court allows a community to leverage
    additional mental health treatment resources because the base
    of support covers all parts of the criminal justice system,
    including law enforcement and court systems.
        However successful, the mental health court initiative is
    but a small piece in what is needed to address the problem of
    the mentally ill at all stages of the criminal justice system.
    I am glad to be working with Senator DeWine and with you,
    Chairman Leahy, to build on the mental health court initiative.
    We are working to craft a bill that comprehensively addresses
    the problem of the mentally ill in the criminal justice system
    by encouraging law enforcement and criminal justice systems
    within communities to collaborate with treatment providers to
    ensure that individuals with mental illness receive all the
    services they need to live healthy, productive lives.
        The bill under consideration will provide funds for States
    and localities to create diversion programs within the criminal
    and juvenile justice programs; provide training fund and
    materials so that police and correctional officers can
    recognize the symptoms of mental illness and create appropriate
    plans of action when a mental illness is recognized; and ensure
    that treatment and services, including housing, education and
    training, and health care are available when an individual with
    a mental illness is released from prison.
        The bill will allow States and communities the flexibility
    to design a treatment program that meets their individual
    needs, but it will also require collaboration on the part of
    the agencies providing these services.
        For example, a significant percentage of adults with
    serious mental illness in the criminal justice system were
    homeless upon arrest, and a lack of housing is a contributor to
    their difficulties in accessing treatment and other services or
    holding a job.
        The bill we will introduce will seek to address this
    problem by requiring that communities receiving grants
    coordinate with the Department of Housing and Urban Development
    and ensure that they have a plan of action for the housing
    needs of individuals with serious mental disorders, including
    those who are released from prison or jail. If this
    collaboration is successful, fewer individuals with serious
    mental disorders will commit another crime. I truly believe
    that based on my experience.
        Collaboration between education and training as well as
    employment agencies must also occur. The bill will address both
    the juvenile and adult mentally ill populations by ensuring
    that communities receiving grants meet the unique needs of both
    adults and youth. In addition, the bill will have an evaluation
    component to ensure that the communities that receive funds are
    using them for programs that are effective. This will also
    ensure that extremely successful programs are recognized and
    can be replicated in other communities.
        I believe this sort of collaboration is the best way to
    create a legislative mechanisms that will bridge the gap
    between the mental health and the criminal justice systems. It
    is through this gap that so many mentally ill defendants
    currently fall. Both Senator DeWine and I are working hard on
    this bill, and I am hopeful that it will be ready to be
    introduced very soon.
        In conclusion, Mr. Chairman, I want to thank this committee
    for looking closely at a problem which too many of us have
    turned away from. I believe there is a consensus among a broad
    spectrum of stakeholders and political ideologies that lead us
    to the practical steps we can take to stop the criminal justice
    system from being this country's primary caretaker of the
    seriously mentally ill. I am so pleased and proud to be a part
    of this effort, and I thank you, Mr. Chairman, for this
    opportunity to speak to you this morning.
        Chairman Leahy. Well, thank you, Congressman Strickland.
    And I directed my staff to continue working with yours and
    Senator DeWine's on this legislation, introducing it soon.
    Again, just on a personal note, I appreciate your leadership in
    this. You come as well qualified as anybody I have served with
    in the Congress to give that kind of leadership.
        I have no questions. I also know you are supposed to be at
    about five other things in the House right now, so, of course,
    you are excused. But I appreciate you coming over.
        Let's have our staffs work on the final part, and you and I
    can see what we can get passed.
        Representative Strickland. Thank you very much.
        Chairman Leahy. Thank you.
        [The prepared statement of Mr. Strickland appears as a
    submission for the record.]
        Chairman Leahy. We are going to set up for the next panel,
    which will be: Chief Gary Margolis, University of Vermont,
    Director of Police Services; Marylou Sudders, the Commissioner
    of Mental Health, Commonwealth of Massachusetts; Kenneth
    Mayfield, the President-Elect of the National Association of
    Counties, also a Commissioner of Dallas County, Dallas, Texas;
    and Captain John Caceci--how close did I come?
        Mr. Caceci. ``Caceci.''
        Chairman Leahy. I am sorry. I should know that. Captain
    Caceci and I were talking about our Italian heritage earlier.
    My late mother, whose family came here from Italy, would
    probably have a word with me if she heard me mispronounce a
    name like that.
        Please, why don't you all come forward and take your places
    at the table.
        Again, I thank you for taking the time to come here. I
    should note that Chief Margolis is the chief and Director of
    Police Services at the University of Vermont. He is testifying
    on behalf of the Police Executive Research Forum and the
    Council of State Governments. He has a doctorate in educational
    leadership and policy studies. He served on the committee that
    produced the Council of State Governments Criminal Justice/
    Mental Health report.
        Ms. Sudders has served as Commissioner of Mental Health for
    Massachusetts since 1996. To put that in perspective, she
    oversees a mental health system that will deliver services to
    more than 24,500 Massachusetts residents. She previously served
    as New Hampshire's commissioner and is testifying on behalf of
    the National Association of State Mental Health Program
    Directors.
        I mentioned Mr. Mayfield is the Commissioner of Dallas
    County, and I enjoyed talking about mutual friends with him,
    but he is also, more importantly right now, the President-Elect
    of the National Association of Counties.
        The captain has worked in law enforcement for nearly 20
    years and supervises all uniform personnel at the Monroe
    County, New York, jail where, I am sorry to say, he has had
    extensive experience with mentally ill offenders, and I must
    say I am glad to have you here because your experience is not
    in the abstract. I think that would be safe to say.
        We will begin with Chief Margolis.

       STATEMENT OF GARY MARGOLIS, DIRECTOR OF POLICE SERVICES,
               UNIVERSITY OF VERMONT, BURLINGTON, VERMONT

        Chief Margolis. Good morning. Thank you, Senator. This is
    indeed an honor to be here before you today.
        My name is Gary Margolis, and I am the Chief of Police for
    the University of Vermont. As Senator Leahy knows, Vermont is
    struggling like other States across this Nation to improve how
    we respond to people with mental illness in the criminal
    justice system, and I applaud you and this committee for taking
    on this difficult issue.
        Today I am representing the Police Executive Research Forum
    and the Criminal Justice/Mental Health Consensus Project, a 2-
    year initiative coordinated by the Council of State
    Governments. Together with numerous criminal justice
    professionals and mental health professionals along with
    victims' advocates and consumers, we have developed concrete
    recommendations for providing appropriate responses to people
    with mental illnesses at risk of criminal justice involvement.
    In my testimony today, I will describe traditional responses
    and the problem at hand, while suggesting steps this committee
    can take to help us.
        So many police encounters involve people who essentially
    are displaying symptoms of untreated mental illness, and let me
    be clear at this point and from the start that any person who
    commits serious crime should be arrested, prosecuted, and
    appropriately sentenced, including the mentally ill. But as I
    will illustrate, when it comes to the police response to people
    with mental illnesses who commit less serious crimes, we can
    serve them and our communities better by a collaborative
    police-mental health approach.
        Many police encounters involve persons acting in a
    disorderly or disturbing manner, and the examples are
    plentiful. It could be the person urinating on a street corner
    or directing traffic in the middle of Main Street. In other
    cases, a family member called because their loved one with a
    history of mental illness needs immediate help and they don't
    know where to turn. They may be frightened for their own
    safety, or they can no longer take the stress.
        In these scenarios, we all agree that treatment is needed.
    Often the police are the only resources available 24 hours a
    day, 7 days a week, and we simply do not possess the diagnostic
    expertise of mental health professionals. In many rural areas,
    we may be the only resource available within a 45-minutes or
    more drive. In communities without effective partnerships, the
    police have three options: first is to do nothing, and we must
    accept the fact that in some communities with severely
    inadequate treatment services this approach continues to be a
    reality.
        The second is to link the person with appropriate mental
    health services. But, unfortunately, as in the first, in many
    communities such services are simply inaccessible.
        The third and by far most common option is to arrest if a
    minor crime has been committed. When arrested, minor offenders
    with mental illnesses land in a criminal justice system ill-
    equipped to meet their needs, where they often deteriorate
    further. They then re-enter the community far worse and the
    cycle repeats.
        Only the relatively rare police call involves a person with
    mental illness exhibiting threatening behavior and brandishing
    a weapon. These tragic incidents perpetuate the myth that
    people with mental illnesses are more violent than the general
    population, and this is what becomes our front-page news.
        I am going to reiterate a story the Senator began with,
    that on Sunday, December 2, 2001, Robert Woodward interrupted
    service at the All Souls Church in West Brattleboro, Vermont.
    He held a three-and-a-half-inch blade to his right eye while
    threatening to kill himself if folks left the service. Mr.
    Woodward refused to comply with repeated requests from the
    police to drop his weapon, and when he advanced towards the
    officers, he was shot. He died only hours later.
        In a statement to a rescue squad member, Mr. Woodward said,
    ``Please tell the officer I assaulted that I did not want to
    hurt him. I would not have harmed him. I just wanted him to
    shoot me.'' The Vermont Attorney General concluded that the
    shooting death of Robert Woodward, ``although tragic, was
    legally justified.''
        There are far too many examples like this in every
    jurisdiction. Too often, we had been there before, we had known
    of the problem, but the underlying mental health issues were
    never fully addressed. We respond time after time to the same
    locations of individuals, spending considerable resources in a
    helpless cycle, particularly in a time when Federal authorities
    are relying on local police to help in our war on terrorism.
    And on behalf of my colleagues, I am here to state that we are
    frustrated.
        The reality is that police response is dictated by agency
    resources and community support. We must work collaboratively
    to develop solutions. The Consensus Project identified several
    best practices to serve as models. We know that effective
    police response to people with mental illness depends on
    extensive collaborations with the mental health community.
    Funding for the Consensus Project is an excellent example of
    this at the Federal level. The Department of Justice Office of
    Justice Programs and the Department of Health and Human
    Services Substance Abuse and Mental Health Services
    Administration each made extensive contributions. They promoted
    efforts by the State and local governments----
        Chairman Leahy. If you could hold up, somebody has a very
    important phone call. I don't want them to miss it.
        In fact, if he would like to step outside and take it, he
    is more than welcome to.
        Go ahead, chief.
        Chief Margolis. Thank you, sir. We know that effective
    police responses to people with mental illness depend on
    extensive collaboration with the mental health community.
    Funding for this Consensus Project is an excellent example of
    this at the Federal level. The Department of Justice Office of
    Justice Programs and the Department of Health and Human
    Services Substance Abuse and Mental Health Services
    Administration each made extensive contributions. They promoted
    efforts by the State and local governments to develop the
    solutions rather than imposing a one-size-fits-all Federal
    mandate.
        Another important step was the enactment of America's Law
    Enforcement and Mental Health Project, the law that Senator
    DeWine and other committee members originally sponsored. We
    need your help and today's hearing marks an exciting step. I
    respectfully request the committee consider the following:
        First, we need the Federal Government's help in determining
    what works.
        Second, resources from the Federal Government are essential
    to seed new programs and facilitate coordination between
    criminal justice and mental health organizations.
        In closing, in these difficult times it is easy to dismiss
    the issue we raise today. I implore you to think otherwise. Our
    important efforts to combat terrorism cannot impede our
    progress on other fronts. There are solutions described in the
    Consensus Project report which we can implement with your help.
    The bottom line is we can do better. We owe it to the people
    with mental illness who need our help. We owe it to their
    families and loved ones, to the victims and to the communities
    who trust us, the police, to respond effectively to their calls
    for help.
        Thank you, Senator.
        [The prepared statement of Chief Margolis appears as a
    submission for the record.]
        Chairman Leahy. Thank you very much.
        Commissioner?

     STATEMENT OF MARYLOU SUDDERS, COMMISSIONER OF MENTAL HEALTH,
          COMMONWEALTH OF MASSACHUSETTS, BOSTON, MASSACHUSETTS

        Ms. Sudders. Good morning, Mr. Chairman. Thank you for the
    invitation to testify about the interrelationship between
    criminal justice and mental health. Addressing this very
    serious matter requires true leadership and true partnership
    between mental health and criminal justice at all levels.
        I am here in two capacities. First, it is my great honor to
    serve as Commissioner of Mental Health for the great
    Commonwealth of Massachusetts. The mission of the department is
    to improve the quality of life for adults with serious and
    persistent mental illness and children with severe emotional
    disturbance. As you noted, I serve on any given day 24,000
    individuals in Massachusetts. I am also here as a member of the
    Board of the National Association of State Mental Health
    Program Directors, which represents the $20 billion public
    mental health system in the 50 States and the District of
    Columbia. I am authorized to speak on behalf of all State
    mental health authorities and to present a national perspective
    regarding the urgency this issue creates for States in both our
    criminal justice and mental health systems.
        I should note that NASHMHPD, in fact, has formed a task
    force devoted to this very topic. Others here this morning will
    focus on the burden on the criminal justice system. I will
    focus on the challenges in the public mental health system, as
    well as specific action that may be taken by Federal, State,
    and local governments.
        Let me begin by applauding the committee for convening this
    hearing and bringing together what some might consider the
    strangest of bedfellows. As you will hear, however, this
    collaboration--between those responsible for criminal justice
    and mental health systems--is essential and, in some cases,
    long overdue. And we all know the tragedies. Where the seeds of
    that collaboration have been planted, significant outcomes have
    been achieved. But these achievements have been sporadic at
    best. Federal leadership and support at this time is critically
    needed.
        Public mental health systems know much about how to provide
    services for people with mental illness who are at risk of
    criminal justice involvement, but we face significant
    challenges in translating all that we know into practice. We
    must overcome the conflicts and inconsistencies inherent in
    fragmented funding strategies at national, State, and local
    levels.
        Our efforts must involve a two-pronged approach. First, we
    must prevent criminal justice involvement of people with mental
    illness by diverting them into community treatment. And,
    second, we must meet the needs of people with mental illness
    who are returning to the community from jail or prison. And, of
    course, it is essential to ensure that a mentally ill person
    receives good treatment while incarcerated. This involves
    forging links with jails and prisons to develop effective pre-
    release planning, including reinstatement of benefits for those
    who are eligible and identification of suitable housing.
        Any systems approach must include the integration of
    substance abuse and addictions treatment with mental health
    interventions. Co-occurring illnesses must be seen as the
    expectation and not the exception. We know from research that
    when substance abuse co-exists with mental illness, the risk of
    violence significantly increases.
        The Council of State Governments' Criminal Justice/Mental
    Health Consensus Project provides a superb template for action.
    Its report reflects the concept that early intervention yields
    best outcomes. In criminal justice terms, this means fewer
    police encounters for people with mental illness, fewer people
    with mental illness on court dockets or in jail holding cells,
    less time spent behind bars, and a drop in recidivism rates.
    For mental health, this means greater opportunity for
    productive lives and meaningful community members and to reduce
    the stigma associated with mental illness.
        We recognize that people with mental illness will continue
    to come into contact with the criminal justice system.
    Therefore, we need to collaborate with law enforcement on
    training such as that embodied in the Memphis, Tennessee,
    Crisis Intervention Team model and others. In Massachusetts,
    the department provides court clinic services to all juvenile
    and district courts. These clinics function essentially as
    emergency services programs to the district court, performing
    evaluations for competency, criminal responsibilities, and for
    civil commitment. Persons who are a danger to self or others by
    reason of mental illness or by reason of substance abuse can be
    civilly committed from the court after an evaluation by a
    designated clinician, and a hearing, of course. Counsel in
    these commitment hearings are all specially trained in mental
    health law.
        A model for pre-release planning is our Forensic Transition
    Team. The team engages with the individual while incarcerated,
    provides service coordination, continuity, and monitoring. The
    key to success has been strong interagency collaboration with
    criminal justice, cross-training, and very flexible services.
    And there are many other models across the country that have
    proven to be effective.
        There are two final points I would like to offer. The CSG
    report references that mental health systems are either too
    overwhelmed or too frustrated to help some of these
    individuals. Mental health systems have been overwhelmed, in
    part, due to historic underfunding and erosion of base
    resources. We have never realized President Kennedy's dream
    that was envisioned in the Community Mental Health Centers Act
    of 1963 that was represented earlier. And given that more than
    40 States are experiencing significant budget shortfalls, this
    situation is only exacerbated for public mental health systems.
        Some of the solutions are reasonably obvious and not
    controversial. There is no need to invent some new technology.
    The lack of service response is due to funding. Then there are
    a set of issues that may appear to provide the ready solution,
    but the effects of which are largely unproven. And that is one
    of the reasons we need your help. With these new strategies, I
    would urge the thoughtful approach for innovation through
    pilots and rigorous evaluation prior to rolling out in prime
    time. The Substance Abuse Mental Health Services Administration
    under the leadership of Charles Curie is to be commended for
    following such a process through the targeted capacity
    expansion rants for jail diversion programs.
        The Criminal Justice/Mental Health Consensus Project
    provides a model for effective collaboration. We are eager to
    work with partners in law enforcement, the courts, and
    corrections to ensure better outcomes for people with mental
    health at risk of or with histories of criminal justice
    involvement. At the same time, we welcome the advocacy of our
    partners in the project in seeking improved services and
    funding and consistent policies to support them.
        Thank you.
        [The prepared statement of Ms. Sudders appears as a
    submission for the record.]
        Chairman Leahy. Thank you very, very much.
        Commissioner, go ahead.

       STATEMENT OF KENNETH MAYFIELD, PRESIDENT-ELECT, NATIONAL
       ASSOCIATION OF COUNTIES, AND COMMISSIONER, DALLAS COUNTY,
                             DALLAS, TEXAS

        Mr. Mayfield. Chairman Leahy, thank you for inviting me to
    testify this morning on an issue of major importance to county
    governments--the diversion of non-violent mentally ill
    offenders from county jails and juvenile detention facilities.
        My name is Kenneth Mayfield, and I am an elected county
    commissioner from Dallas County, Texas. I currently also serve
    as president-elect of the National Association of Counties.
        From 1980 until 1988, I worked as an assistant district
    attorney for Dallas County, Texas, and eventually became chief
    of its Juvenile Division.
        It was during this period as the county's chief juvenile
    prosecutor that I witnessed firsthand the growing number of
    juveniles that were inappropriately housed in county detention
    centers by virtue of their mental illness. After studying the
    matter, it became apparent that the majority of persons with
    mental illness--be they juveniles or adults--are serving time
    for minor offenses and were usually not taking medication at
    the time of their arrest. It was also clear that many persons
    with a mental disability also suffered from a co-occurring
    disorder, such as substance abuse or homelessness, and did not
    have caregivers to oversee their daily care.
        Over a year ago, I organized a community-based task force
    in Dallas County to put together a comprehensive program to
    divert the mentally ill who commit minor offenses. The key
    focuses of the task force are: funding, housing, treatment
    eligibility criteria, communications, education/training, and
    law enforcement.
        Mr. Chairman, I have been gratified to receive the full
    support of every law enforcement agency in Dallas County. I
    have also met with a number of foundations and agencies
    interested in this program. We are presently in the process of
    submitting grant proposals to fund a full continuum of
    services. At the core of the system is a triage unit that ties
    together intake and assessment, health care, emergency,
    transitional, and permanent housing, among other services.
        The task force has already completed the production of its
    first video to provide education and training for law
    enforcement at every point of contact with the adult criminal
    justice system for persons with mental illness, mental
    retardation, and co-occurring substance abuse disorders. Videos
    to follow will target judges, prosecutors, defense attorneys,
    family members, paramedics, emergency room staff, and the
    community in general.
        Mr. Chairman, the mentally ill in jail and juvenile
    detention are not a problem unique to Dallas County. Of the 10
    million admissions to county jails each year, it is estimated
    that 16 percent are individuals suffering from mental illness.
    Most of these individuals have committed only minor
    infractions, more often the manifestation of their illness than
    the result of criminal intent. In 1999, the Bureau of Justice
    Statistics released a study on the Mentally Ill in Jail. The
    study confirmed that too often mentally ill inmates tend to
    follow a revolving door, from homelessness to incarceration and
    then back to the streets. Too many of these individuals do not
    get adequate treatment and end up being arrested again.
        The study underscores the importance of adequate
    assessments. In Los Angeles County, for example, teams of
    mental health workers and community police officers divert the
    mentally ill from the scene of an incident, but not before they
    make a preliminary assessment. In the vast majority of cases,
    the diversion is to a health unit.
        Mr. Chairman, what the public needs to understand about
    this population is not just that they will significantly
    benefit from a system of comprehensive services, including
    housing, health and human services, but also that it would be
    less expensive and more effective in the long term. For minor
    offenders, community-based mental health care is far less
    expensive than maintaining them in jail.
        By keeping the mentally ill within the health and human
    services system, we are also better able to monitor their
    condition, provide treatment, and to dispense medication if
    needed.
        Jail has the opposite effect. It traumatizes the mentally
    ill and makes them worse. For the county health department
    psychiatrist, it often means working twice as hard to get them
    back to where they were when they entered the jail. For the
    sheriff, it may mean assigning a deputy to carefully monitor
    the individual in jail.
        Mr. Chairman, the confinement of the non-violent mentally
    ill in county jails also represents a major liability problem
    for county governments. In addition, it is a financial drain on
    county budgets since Federal and State funding streams usually
    shut down when a mentally ill individual enters the jail. Even
    the person's own insurance policy may contain an exclusion for
    jail confinement.
        Multnomah County, Oregon, found that the mentally ill
    defendants stay in jail one-third longer than those who are not
    mentally ill. Lengthy incarcerations not only worsen their
    condition, they almost guarantee difficulties after their
    release.
        For example, in many States, even a short stay in the
    county jail is enough to disenroll a mentally ill person from
    such entitlements as Social Security, Medicaid and/or Medicare.
    Once an individual is released from jail, he or she is eligible
    to receive such benefits, but it may take weeks or months for
    the programs to be restored.
        The need for collaboration between criminal justice and
    health and human service agencies at the local level in dealing
    with the mentally ill cannot be overemphasized. The challenge
    is to create a seamless web of comprehensive services.
        King County, Washington, has successfully created
    integrated service systems for people with mental illness and
    other co-occurring disorders. The goal is to share clients,
    share information, share planning, and share resources across
    agency lines. In the words of one former county administrator,
    the experience in King County has demonstrated that the major
    challenge is creating a new system. ``It is a matter of joint
    planning, pooling resources, and more effectively managing
    existing resources toward new goals.''
        In conclusion, Mr. Chairman, the National Association of
    Counties has been working with a coalition of more than 30
    national organizations on a proposal for Federal assistance to
    foster community collaborations between criminal justice and
    health and human service agencies. The proposal provides
    counties with considerable flexibility to design creative
    solutions and to stimulate partnership programs between State
    and county governments.
        Thank you.
        [The prepared statement of Mr. Mayfield appears as a
    submission for the record.]
        Chairman Leahy. Thank you very much, Commissioner, and you
    have raised some very interesting points, including the one
    about the insurance stopping when they are incarcerated.
        Captain?

        STATEMENT OF JOHN CACECI, CAPTAIN, MONROE COUNTY JAIL,
                          ROCHESTER, NEW YORK

        Captain Caceci. I would also like to thank Representative
    Mayfield. I appreciate those words regarding corrections.
        Good morning. My name is John Caceci, and I am captain at
    the Monroe County Jail in Rochester, New York. Thank you,
    Chairman Leahy and Ranking Member Hatch, for inviting me to
    testify. I also want to thank my Senator, Chuck Schumer. I am
    particularly grateful to my sheriff, Patrick O'Flynn, for
    allowing me to represent our jail.
        Speaking for corrections officers across the country, I can
    tell you that identifying inmates with mental illness and
    treating, managing, and preparing them for release is one of
    the greatest, if not the single greatest challenges we face in
    overcrowded jails and prisons.
        I also want to acknowledge the value of the Consensus
    Project report. Although I did not participate in the effort, I
    know that the corrections community was represented
    extensively. The recommendations in that document are exactly
    on point.
        On any given day, there are about 1,400 inmates in our
    jail. Like any jail, the average length of stay for inmates in
    our facility is short. Over the course of a year, over 17,000
    inmates will be booked into our facility.
        Like every county in the country, our jail has experienced
    explosive growth over the last two decades. Our facility also
    resembles most jails in that it is the county's largest mental
    health facility. No other institution in Monroe County holds
    nearly as many people with mental illness, and that is just not
    right.
        We work in a jail and our job is to incarcerate offenders,
    not hospitalize sick people. With my testimony today, I would
    like to review several points. First I want to give you an idea
    of the types of people who have mental illness who land in our
    jail. Second, I would like to explain the services we attempt
    to provide these inmates. Third, I will describe the impact the
    current situation has on the operation of our jail. And,
    finally, I would like to recommend some steps that this
    committee could take to help corrections administrators and
    line staff address this overwhelming problem.
        Between 15 and 20 percent of the inmates in our jail have a
    mental illness, which is consistent with most jails in the
    country. I want to be clear that we incarcerate many offenders
    who have committed serious, violent crimes, and some of those
    people have a mental illness. Like was said earlier, they need
    to be punished and they need to be in jail. There are no two
    ways about that.
        But the majority of people we see with mental illness in
    our jail aren't murderers or sex offenders, or even criminals
    with a history of violence. They are people who have been in
    and out of our jail on countless occasions, charged with
    committing low-level offenses.
        We don't blame law enforcement officers for taking these
    people to our jail. They often don't have any other option.
    Take, for example, the young man whom police recently brought
    to us. He had a history of mental illness and was on several
    mental health medications. He had been giving his mother an
    extremely hard time. He had threatened her, and one evening he
    was particularly menacing. The mother was frightened, so she
    called 911. The police knew the emergency room would not
    provide prolonged care, so they brought him to jail. We placed
    him in a single cell on a 24-hour suicide watch.
        In regard to screening, in New York State we are unique in
    that each jail uses the same screening process. Our protocols
    are extremely effective. Jail suicides have dropped by 70
    percent over the last decade in our State. At some point, we
    hope to establish a system in which the mental health community
    can inform us when someone with mental illness whom they have
    served is in our jail.
        Good release planning is paramount. I know we have talked
    about it earlier. I can't say enough about it. We know an
    effective discharge plan includes appointments with community-
    based treatment providers, a short supply of medications,
    health coverage, and linkage to supportive housing. Meeting all
    of these objectives is difficult, but it is nearly impossible
    with pre-trial detainees. Staff often receive less than 2 hours
    advance notice of these inmates' departure.
        Inmates will mental illness sometimes act out and violate
    rules, which means we have to reassign them to high-security
    cells, typically reserved for dangerous inmates. Other inmates
    with mental illness are vulnerable to predatory inmates. Other
    inmates with mental illness refuse medication or become
    manipulative. We try to discourage our staff from using a
    restraint chair, but sometimes it can't be avoided. I worry
    that as staff try to restrain the inmate, someone will get
    injured.
        I also have in the back of my mind stories I hear from
    colleagues in other facilities across the country that things
    get out of control as the officers try to subdue an inmate,
    inadvertently asphyxiating him or her.
        This is one of many reasons for providing extensive
    training. We are fortunate that Sheriff O'Flynn commits
    extensive time and resources to our annual training.
        We would like to increase mental health coverage in our
    facility 24 hours a day. We are very reluctant, however, to
    advocate for extensive mental health services in our jail. As
    it is, we receive too many people with mental illness. A first-
    rate psychiatric unit in our jail would simply draw more people
    with mental illness into our facility and discourage building
    and facilitating better mental health treatment options in our
    communities.
        For this reason, we would prefer that the community's
    capacity to support people with mental illness improve. We
    would welcome community mental health providers into our
    facilities.
        If we are going to make meaningful change around this
    issue, we will need the leadership of this committee and the
    Federal Government. First, corrections needs to be included in
    any Federal effort or grant program designed to target
    offenders.
        Second, the Federal Government is in a unique position to
    promote collaborative efforts between corrections and the
    mental health community.
        And, third, the importance of training correctional staff
    on mental health issues cannot be overstated. In this regard,
    the National Institute of Corrections is an invaluable
    resource.
        In conclusion, local jails should not be in the business of
    running hospital emergency rooms for people with mental
    illness. When it comes to people with mental illness, we in
    corrections have been handed an incredibly complex problem
    which has to be addressed. We are returning people with mental
    illness to the community many times in no better shape than
    when we received them. We are doing everything we can to make
    sure these people don't hurt themselves and their health
    doesn't deteriorate further. This makes it very difficult for
    us to focus on protecting staff and inmates and the community.
    That is supposed to be our primary mission. Please help us
    fulfill it.
        Thank you very much.
        [The prepared statement of Captain Caceci appears as a
    submission for the record.]
        Chairman Leahy. Thank you very much, Captain.
        I have a statement by Senator DeWine which will be included
    in the record at the opening of this and a statement--written
    testimony, rather, by Reginald Wilkinson, the Director of the
    Ohio Department of Rehabilitation and Corrections. That can be
    included in the record.
        Let me ask, Chief Margolis--and this is a question that
    actually several members on this committee have. What about
    when you get to a rural State, like Vermont, or rural areas of
    a larger State, with the unique problems in a rural area?
        Chief Margolis. Well, certainly, Senator, the problems are
    in any jurisdiction, but in rural jurisdictions, they can be
    exacerbated. Let me answer that question, sir, with a short
    story.
        Sheriff Don Edson of the Washington County Sheriff's Office
    relayed to me just several days ago that 2 weeks ago his
    deputies had taken into custody a person who had committed a
    crime. This person had mental illness.
        Now, Washington County, as you well know, sir, is 790
    square miles with 53,000 residents. That is approximately 67
    people for every square mile. That is fairly rural.
        The individual was brought to the court. The judge, the
    defense, the prosecution all agreed that a mental health
    assessment was needed, and the deputies had to wait for over 2
    and a half hours with that person for someone to come and
    screen. Now, that is 2 and a half hours that those deputies
    were taken away from the community to serve other calls for
    service.
        So this is very common, and it is frustrating, and other
    sheriffs and other police chiefs in our State of Vermont in the
    rural areas echoed this frustration.
        Chairman Leahy. That was about Washington County. I grew up
    there, and I have known Sheriff Edson from the time he was a
    child. I know the situation you talk about.
        The Council of State Governments report has a lot of
    proposals and recommendations. If there are key areas that the
    Federal Government should work on, what are those?
        Chief Margolis. Well, the models that were underscored and
    found, Senator, include areas like crisis intervention teams
    and comprehensive advance response where officers are specially
    trained. They work with mental health responders. In some
    jurisdictions, mental health professionals either respond as
    special units or as mobile crisis teams.
        We have looked at dispatch protocols, how calls are
    handled, and examined the kinds of questions that are asked by
    the dispatcher at the initial intake; on-scene assessment
    skills, how are officers trained to recognize those issues;
    what training topics should be included in police academies and
    in in-service training to help in these areas; information
    gathering and how do we evaluate the success of our response;
    and then, last, and certainly not least, is the collaborative
    areas that we can work with our colleagues in mental health and
    in corrections and in the county governments to begin to
    develop new tools to respond more effectively.
        Chairman Leahy. There have been some places in the country
    where there have been experiments with mental health courts. Do
    you have any experience with that?
        Chief Margolis. Sir, my experience with mental health
    courts is limited. My understanding is that there are a number
    of areas and a number of ways that our criminal justice
    professionals are seeking to address that issue.
        In speaking with members of our Vermont judiciary, what I
    learned was that we have commitment hearings that we use, but
    not very much done in the area of mental health courts per se.
        Chairman Leahy. Captain, I am back to your testimony. I
    think we can all agree that if people commit a crime, then
    there are consequences for criminal conduct. I spent 8 years in
    law enforcement before I was here, and I certainly have no
    question about that.
        Nobody wants to see mental illness used as an excuse to
    avoid such consequences, and we have seen cases where somebody
    has tried to use that as an excuse when it is not applicable.
        So how do you do this? You have got somebody who comes in.
    How do you determine whether they should be staying in jail or
    they should be transferred to mental health services?
        Captain Caceci. In Monroe County, we have a wonderful
    collaborative effort with our mental health staff. The socio-
    legal clinic for the county handles all of our mental health
    situations.
        One of the things we have done is, on a daily basis, we
    meet with medical, mental health, and security commanders in
    the facilities, and we sit down on a daily basis Monday through
    Friday at 11 o'clock, and we go over each case of people with
    serious mental illness who is in custody, all of the cases of
    individuals who may be on suicide watch, and we discuss them
    and we try to figure out who needs to maybe go to a facility
    that has more extensive mental health coverage or could we
    approach one of the judges with mental health, psychiatry, and
    those types of people to see if we can get those people placed
    in some supportive housing or other living situation.
        So we work in a collaborative effort to try to move certain
    people out of the facility.
        Chairman Leahy. But you are welcoming the mental health
    professionals into the jail. You make this kind of
    determination. Is there a general willingness, do you think,
    among law enforcement to do that? I mean, are you unique? Or
    are you seeing this more and more around with other law
    enforcement?
        Captain Caceci. Senator, I recently have gone to the
    American Jail Association's convention in Milwaukee, and I see
    from across the country colleagues such as myself that are
    really trying to move in this direction, are trying to have
    more collaborative efforts with their local mental health
    people, and really trying to move to get those kinds of people
    with serious mental illness out of their facilities, because it
    is a tremendous drain on their resources, staffing, and what
    have you to really watch these people closely. And they don't
    want to see people deteriorate while they are in the facility.
        So I think it is across the country that we are seeing this
    movement.
        Chairman Leahy. Would it be an overstatement to say you
    want to be involved in law enforcement and you want people who
    should be in a mental health situation to be dealt with by
    people who trained to do mental health matters?
        Captain Caceci. Yes, sir.
        Chairman Leahy. Commissioner Sudders, what is your
    experience about how law enforcement and mental health agencies
    work together at the State level to address this? And the
    reason I ask, I am just trying to think about what kind of a
    model we have to talk about at the Federal level between the
    Department of Justice and Health and Human Services, and I am
    just curious. What has been your experience at the State level?
        Ms. Sudders. In Massachusetts, I am lucky and honored to
    have actually a very strong relationship with the commissioner
    of corrections. And so, in fact, the relationship between
    mental health and corrections at the State level is very
    strong. I actually have sort of quality control over the mental
    health services provided in the correctional system in
    Massachusetts to someone who is mentally ill in the prison
    system. They can also in the jails in Massachusetts transfer
    from jails to the public mental health system for inpatient
    care of there is a mentally ill offender who needs--who is
    really acutely ill, they can transfer.
        So the State level in Massachusetts, probably because both
    Commissioner Maloney and I believe very strongly about
    collaboration, we have a strong partnership. And so, in fact,
    on re-entry programs, my staff go into the prisons to start
    working with people who are mentally ill offenders to help, to
    engage with them so that when they are leaving the prison we
    can connect them with benefits and get them into the mental
    health system rather than sort of back on to the streets and
    into crime.
        But that is because of our relationship, I would say, and
    not because of some systems approach, if you would. And I think
    one of the things that I would point out from the CSJ report is
    that there is no one size to fit each State. Massachusetts is
    not a county-based system, for example, so you would not want
    to craft legislation that said it would all be county-based,
    because in Massachusetts that wouldn't be terribly helpful.
        But one of the things the CSJ report talks about in
    collaborations, and anything that the Senate would consider I
    would strongly urge that would require the collaboration and
    true partnership between mental health and criminal justice,
    and then allow States and counties and providers to sort of
    determine what makes the most sense given how we have sort of
    figured out our systems, if you would, but that you would
    require in any legislation, in any funding, true collaboration
    between mental health and criminal justice that you have to
    demonstrate in whatever kinds of applications come forward. We
    all know you can sign a letter saying, yes, you know, we sat
    down and talked, but really true collaborations is the key.
        The other thing I would say that the jails--I think
    sheriffs are doing everything they can to respond out of
    necessity. I think the quality in jails is dependent, again,
    upon who the sheriff is and how many mentally ill people are in
    their jails and whether they want to provide treatment or
    really just have the mental health system take care of them.
    But for me, sir, I would say that what the mental health system
    needs to do with criminal justice is to divert people,
    particularly the low-incidence crimes, you know, the nuisance
    crimes, that our responsibility is to really divert them so
    that they never get into jails. And that is what we need to do,
    and I would urge you, as you ask the question of the chief,
    really looking at the diversion programs, mobile crisis
    intervention teams, assessments, working closely police with
    mental health experts, so that we divert people from ever
    entering into the system to begin within.
        Chairman Leahy. Well, Commissioner, when you mention that,
    it makes me think, Commissioner Mayfield, if I am correct in
    the briefing material I was reading, you helped initiate a
    diversion program in Dallas. I was thinking on the practicality
    of it, because I happen to agree with Commissioner Sudders on
    this. How do you determine who should be diverted to mental
    health services and who, because of either themselves or the
    nature of what they have done, is going to have to be held
    right there in jail?
        Mr. Mayfield. Well, that is a very tricky assessment,
    Senator, but every police department in Dallas County--and
    right now they are gathering statistics for me on the number
    that they think they would divert on a weekly basis to this
    type of program. But every--I met with all of the police chiefs
    in Dallas County, and there are 26 cities within the county.
    And every one--I thought there might be a problem in--we are
    trying to open up a mental health triage that is open 24 hours
    for these individuals who are minor offenders, basically
    victimless crimes that they happen to be arrested and taken to
    the city's holdover and then transferred down to the counties
    because of their behavior, which is usually related to their
    mental health condition. And I thought there might be a problem
    in having them transport these individuals to this location,
    which we would like to locate somewhere close to the county
    jail in some proximity because that is where they used to come
    in. Now, it didn't matter where it is located, where the city
    is located In Dallas County, how far it is. They are willing to
    bring these individuals down to this location so that they can
    get the help they need rather than putting them in their own
    facilities or the county's facilities where they know their
    condition is just going to worsen.
        We have produced a video. We are looking at all of the
    training that they get in their academies. We are making
    recommendations on perhaps some longer training, some in-depth
    scenarios, and we have done this with mentally ill and mentally
    retarded individuals, and police officers in a video to show
    what is the most common encounter that you would have with
    someone who suffers from a mental illness or mental
    retardation, and then how you respond to that.
        Of course, each department has to come up with criteria
    of--we hope it will be uniform, and we think it will be--of
    individuals that they would divert to this system. They have to
    be comfortable that when they bring them down there that they
    are going to be taken care of, they are going to be assessed,
    we are going to find out where they have been getting services,
    if they are homeless. And, by the way, I can't emphasize enough
    permanent housing is the key to this revolving door, because
    you can divert----
        Chairman Leahy. I see a lot of heads shaking yes.
        Mr. Mayfield. You can divert all you want, but if they
    don't--if there is not some sort of supervised living condition
    for these people, who are often homeless, have no friends, have
    no family, or if they do have friends and family, they are not
    engaged with them to monitor them on a casual basis at the
    least, to see what they are doing, they are taking the
    medication that they should be taking at the time that they
    should be taking it, and keeping them out of situations where
    they come into contact with law enforcement.
        So that is a real key, and that is what we are really
    working on. We are working with HUD on vouchers and trying to
    set up not just triage mental health location but emergency and
    transitional housing and then permanent housing for these
    individuals so we can truly keep them out of the jails.
        Chairman Leahy. What is the population of Dallas County?
        Mr. Mayfield. It is 2.2 million people.
        Chairman Leahy. Like the Commonwealth of Massachusetts, we
    have counties, but we don't really have a county form of
    government. But these models are transferable easy enough to
    whatever----
        Mr. Mayfield. Yes.
        Chairman Leahy. Whether you have a State system or a
    Commonwealth system.
        Am I correct that the National Association of Counties has
    put this issue of mentally ill offenders right up near the top?
        Mr. Mayfield. It is at the top. I am the incoming
    president, Senator. It is one of my two initiatives. The other
    is early childhood development. This is diverting the mentally
    ill from county jails. So this is the top priority that NACo
    has--one of the two top priorities.
        Chairman Leahy. Kind of nice to be the boss, isn't it?
        [Laughter.]
        Mr. Mayfield. Yes, sir.
        Chairman Leahy. I was going to say, it is something like
    being a committee chairman. You can set the priorities.
        I want to thank you all for this. We had asked you--you
    know, you are going to get the transcript back of this hearing
    and all. If you get some other ideas, things that I forgot to
    ask or thoughts you have, don't hesitate to add it. We want to
    learn from this, as Congressman Strickland was saying when he
    came in here. Or if you get some ideas and you just want to
    send them to me, just send them directly to me and I will look
    at it. We want a good piece of legislation. We don't want to
    pass something just for the heck of passing something.
        I think it is a major problem. I thought it was a problem
    back when I was a prosecutor, but it has gotten much, much
    worse. You are talking about the homeless situation and all,
    and I want law enforcement to be able to do law enforcement.
    And I want the ability to help those who have mental problems
    that they be helped. Chief Margolis referred to this situation
    we had in Brattleboro. It was a terrible situation. The
    Attorney General's office rules the actions appropriate on the
    part of the police officers. But I am sure for the police
    officers, this is nothing that gave them any great joy to be
    put in a situation like that, and they shouldn't have to be.
        So I thank you. I commend you for what you are doing. I
    think all four of you have extraordinarily difficult jobs. And
    maybe people should realize that those who take a career in
    public service keep this country going, and I applaud all of
    you.
        We will stand in recess.
        Mr. Mayfield. Senator, let me just add, let me just say if
    there is any help that NACo as an organization can give to the
    success of this legislation, and certainly in looking at it and
    helping with comments, but I personally can give--in testifying
    before any committee or lobbying any of my colleagues on the
    Hill, rest assured that we will do it.
        Chairman Leahy. Thank you. I appreciate that. Thank you
    all.
        [Whereupon, at 11:07 a.m., the committee was adjourned.]
        [Submission for the record follow.]
        [GRAPHIC] [TIFF OMITTED] 86518.001

        [GRAPHIC] [TIFF OMITTED] 86518.002

        [GRAPHIC] [TIFF OMITTED] 86518.003

        [GRAPHIC] [TIFF OMITTED] 86518.004

        [GRAPHIC] [TIFF OMITTED] 86518.005

        [GRAPHIC] [TIFF OMITTED] 86518.006

        [GRAPHIC] [TIFF OMITTED] 86518.007

        [GRAPHIC] [TIFF OMITTED] 86518.008

        [GRAPHIC] [TIFF OMITTED] 86518.009

        [GRAPHIC] [TIFF OMITTED] 86518.010

        [GRAPHIC] [TIFF OMITTED] 86518.011

        [GRAPHIC] [TIFF OMITTED] 86518.012

        [GRAPHIC] [TIFF OMITTED] 86518.013

        [GRAPHIC] [TIFF OMITTED] 86518.014

        [GRAPHIC] [TIFF OMITTED] 86518.015

        [GRAPHIC] [TIFF OMITTED] 86518.016

        [GRAPHIC] [TIFF OMITTED] 86518.017

        [GRAPHIC] [TIFF OMITTED] 86518.018

        [GRAPHIC] [TIFF OMITTED] 86518.019

        [GRAPHIC] [TIFF OMITTED] 86518.020

        [GRAPHIC] [TIFF OMITTED] 86518.021

        [GRAPHIC] [TIFF OMITTED] 86518.022

        [GRAPHIC] [TIFF OMITTED] 86518.023

        [GRAPHIC] [TIFF OMITTED] 86518.024

        [GRAPHIC] [TIFF OMITTED] 86518.025

        [GRAPHIC] [TIFF OMITTED] 86518.026

        [GRAPHIC] [TIFF OMITTED] 86518.027

        [GRAPHIC] [TIFF OMITTED] 86518.028

        [GRAPHIC] [TIFF OMITTED] 86518.029

        [GRAPHIC] [TIFF OMITTED] 86518.030

        [GRAPHIC] [TIFF OMITTED] 86518.031

        [GRAPHIC] [TIFF OMITTED] 86518.032

        [GRAPHIC] [TIFF OMITTED] 86518.033

        [GRAPHIC] [TIFF OMITTED] 86518.034

        [GRAPHIC] [TIFF OMITTED] 86518.035

        [GRAPHIC] [TIFF OMITTED] 86518.036

        [GRAPHIC] [TIFF OMITTED] 86518.037

        [GRAPHIC] [TIFF OMITTED] 86518.038

        [GRAPHIC] [TIFF OMITTED] 86518.039

        [GRAPHIC] [TIFF OMITTED] 86518.040

        [GRAPHIC] [TIFF OMITTED] 86518.041

        [GRAPHIC] [TIFF OMITTED] 86518.042

        [GRAPHIC] [TIFF OMITTED] 86518.043

        [GRAPHIC] [TIFF OMITTED] 86518.044

        [GRAPHIC] [TIFF OMITTED] 86518.045

        [GRAPHIC] [TIFF OMITTED] 86518.046

        [GRAPHIC] [TIFF OMITTED] 86518.047

        [GRAPHIC] [TIFF OMITTED] 86518.048

        [GRAPHIC] [TIFF OMITTED] 86518.049

        [GRAPHIC] [TIFF OMITTED] 86518.050

        [GRAPHIC] [TIFF OMITTED] 86518.051

        [GRAPHIC] [TIFF OMITTED] 86518.052

        [GRAPHIC] [TIFF OMITTED] 86518.053

        [GRAPHIC] [TIFF OMITTED] 86518.054

        [GRAPHIC] [TIFF OMITTED] 86518.055

        [GRAPHIC] [TIFF OMITTED] 86518.056

        [GRAPHIC] [TIFF OMITTED] 86518.057

        [GRAPHIC] [TIFF OMITTED] 86518.058

        [GRAPHIC] [TIFF OMITTED] 86518.059

        [GRAPHIC] [TIFF OMITTED] 86518.050

        [GRAPHIC] [TIFF OMITTED] 86518.061

        [GRAPHIC] [TIFF OMITTED] 86518.062

        [GRAPHIC] [TIFF OMITTED] 86518.063

                                       -