New State Program Aims to Help Keep At-Risk Mentally Ill Out of Jail

When Knox County Mayor Tim Burchett was a state senator in Nashville, he learned about New York's Kendra's Law shortly after a shooting at a Knoxville restaurant. The woman the law was named after was killed when a man suffering from untreated mental illness pushed her in front of a bus. The law provided a way for people who are trying to deal with mental illnesses to get treatment without being committed to a hospital or facility full-time. Similarly, it was determined the man involved in the Knoxville shooting suffered from mental illness.

"It's not a sexy issue," Burchett says, but there was a great need to help people with mental illness rather than let them wind up in jail, and he got to work creating a bill patterned after Kendra's Law.

"The prisons now—we're filling them up with drug addicts and mentally ill people," Burchett says. "And the truth is those people need to be sent to another facility to be treated. They don't need to be locked up in a prison. You don't treat somebody [with mental illness] by locking them in a jail cell with a bunch of criminals."

Burchett's mental health bill didn't go anywhere in the Legislature.

But that changed this spring when a similar bill passed the state Legislature and was signed by Gov. Bill Haslam, creating a program similar to the one enacted in New York. The bill was sponsored by Sen. Becky Duncan Massey and Sen. Doug Overbey, who joined Burchett and Commissioner of Mental Health Doug Varney in announcing the new program the legislation created last Friday on the steps of the Helen Ross McNabb Center.

Overbey, who joined Burchett's original effort as a House sponsor of his bill, agrees with the mayor's belief that jail isn't the place for the mentally ill.

"Right now we're treating far too many mental health patients in our jails. Our jails have become the largest place to treat mental health rather than in a facility where they ought to be treated," Overbey says.

The pilot program created by the law will provide two years of funding for 10 people to be treated as outpatients each year through the Helen Ross McNabb Center. In order to get into the treatment program, a court order will have to be issued by a judge. The program is designed to prevent full-time commitment of people with mental illness whose behavior is putting themselves and others at risk for injury and/or jail time. The pilot will start in Knox County, but Massey hinted it could eventually extend to all of Tennessee. It will be the only state-funded outpatient program for mental illness in the state.

Ben Harrington, director of the Mental Health Association of East Tennessee, says that the people who will most likely be using the new resource will be poor and uninsured. They will have probably been in and out of mental-health treatment and stopped following a treatment plan for various reasons. Harrington says when people start to feel better on their treatment plans, they sometimes decide they don't need to continue with it, and fall back into unhealthy patterns.

"For some folks, this is the last resource," Harrington says, adding that people who ignore their mental illness are likely to wind up jail. "Eventually it will lead to something dramatic."

That's where the court order would come in. Under the pilot program, families will be able to present a judge with evidence that a person suffering from mental illness has repeatedly sought treatment, improved with that treatment, and then—for whatever reason—stopped treatment and has become a danger to him- or herself. If the judge decides the outpatient treatment program is suitable, an order will be issued for the person to go into the program.

"It has a coercive element. It's a court order to get them into outpatient treatment," Varney says. "[But] you don't have to wait till a person gets so seriously ill that it's much more difficult [to get help]. It's really to prevent people from getting committed to a hospital."

Harrington says there have been similar programs in Tennessee in the past, but without funding, those programs couldn't accomplish much. Under the new program, $125,000 will be available to use each year for the next two years. Compared to full-time institutional commitment, Harrington says, the outpatient treatment program is much cheaper. Full-time commitment at Lakeshore Mental Health Institute, for example, cost $900 per day.

Massey says the funding for the program will cost less than keeping people who could have used this program in jail. The program, she says, will effectively keep more people out of jail.

"We can't just do the treatment after the fact. We've got to do more preventative care because it really does cost us more dollars afterwards," Massey says. "I think this program will be an important step in helping individuals not go into psychiatric hospitals, not go into the jails, which are a lot more expensive."

The program announcement comes weeks after Lakeshore closed. Harrington says he doesn't know if the program will help bridge the gap left by Lakeshore's closing, but Varney says the program would provide a service the institution did not. Only full-time commitment was hosted at Lakeshore, in addition to screenings, Varney says.

Emily Scheuneman, the public relations coordinator at the Helen Ross McNabb Center, says the center took in 11 of Lakeshore's patients and started a program called Intensive Long-Term Support, which is intended to actually pick up the slack left by Lakeshore's closing. Scheuneman says the program is funded by the state, and the center partnered with the state Department of Mental Health to create the program, as they will again do with the outpatient program.

"We were just approached by the legislators and the Department of Mental Health and asked if we wanted to participate," she says of the new program. "We do want to fill [Lakeshore's] gaps."

Varney says there is no definite timeline for when the outpatient program will begin. He says the Mental Health Department and the Helen Ross McNabb Center are in the process of working out the details of the program—from which judges will be involved in signing the orders, to which doctors will serve patients, to the practical budget. Unfortunately, all that planning takes time.

"There is a considerable amount of work and coordination involved in the planning to ensure that the processes established will be effective and efficient," Varney says.

There are resources, Varney says, through the Helen Ross McNabb Center and the Department of Mental Health that people can access in the meantime.

Burchett says he's glad someone's finally taking a public stand for people living with mental illness.

"Until some big-shot's kid is shot or harmed by somebody like this, you never see legislation. And that's just the truth," Burchett says. "Apparently the leadership is taking another look at this and I'm glad the governor and everybody else found the funding."