Wednesday, September 03, 2014




Pepper's case spotlights gaps in mental-health care

By Jessica Priest
April 26, 2014 at 4:26 a.m.
Updated April 27, 2014 at 4:27 a.m.

Pepper appeared on the stage and sang with microphone in hand late at night at the Downtown Bar and Grill on Aug. 19, 2009.

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Mental health cases rising

The number of emergency mental hearings in justice courts in Victoria County increased from 108 in 2012 to 183 in 2013, according to the Texas Office of Court Administration.

On the county-court level in Victoria, temporary mental health service hearings and orders authorizing psychoactive medications almost doubled during that same period.

There were 73 temporary mental health service hearings in 2013, up from 43 in 2012. Judges issued 67 orders for psychoactive medications, up from 33 in 2012, according to the state database.

Almost everyone in Victoria has a Pepper story.

"My daughter, who is in fourth grade, even talks about him," District Attorney Stephen Tyler said. "He's more famous than you or I or anybody in town."

So it surprised some when the man often seen roaming Victoria streets in search of a few bucks or delighting bar patrons with his singing was arrested on suspicion of beating a man unconscious April 17. However, Pepper, whose real name is Marlin Adams, has a criminal history in Victoria that spans more than 20 years.

Pepper's arrest prompted a debate about the dangers posed by people diagnosed with a mental illness and whether the community was adequately equipped to treat them. Gulf Bend Center and law enforcement officials warn stereotyping doesn't help them walk the tightrope between treating these individuals and protecting the public.

"A majority of the people with mental illness are actually victims of crimes rather than the perpetrator of crimes, and a lot of that we don't see in the news," said Lane Johnson, the nonprofit's associate executive director of clinical services.

Johnson pointed to a number of studies, including a 2009 report that found the mentally ill are more prone to violence when dealing with substance abuse or other stresses, such as getting a divorce or losing a job.

Law enforcement and the Gulf Bend Center officials agree it's worthwhile and less costly to treat individuals before they are incarcerated, but few have concrete solutions on how best to accomplish this.

The cost is much simpler to determine: $55 a day to house, feed and supervise an inmate in the Victoria County jail. That figure does not include transportation, medication or hospitalization.

After entering the jail, inmates normally covered by Medicaid or Medicare lose access to it. A deputy must accompany them at a hospital 24/7.

Ninety-five of the 392 inmates, or about a fourth of the population, in the jail in January received psychological medication. That medication costs about $5,780, about half of the total medical bill for the month.

"It's kind of like that old saying, 'Pay me now or pay me later,'" Sheriff T. Michael O'Connor said.

Current policies

Law enforcement and Gulf Bend Center officials fine-tune their jail diversion program periodically.

Ten years ago, law enforcement was forced to take the mentally ill to overcrowded emergency rooms not equipped to deal with unpredictable, emotional outbursts, O'Connor said.

Now, deputies call the Gulf Bend Center's mobile crisis unit for backup, reducing the amount of time they spend on the call and doubling expertise.

The Gulf Bend Center, which receives about $50,000 from the county annually, in January began leasing space at Citizens Medical Center.

It's called the extended observation unit, and it's where a person is monitored by a physician for 24 to 48 hours. From there, he or she is referred to additional treatment or released back into the community if it's determined the stressful situation is under control.

So far, the community hasn't needed more than the six beds inside, Johnson said.

The Gulf Bend Center or law enforcement requests a judge issue an emergency detention warrant when dealing with those who refuse help.

If an individual with a mental illness lands in a jail in Victoria, Cuero or Port Lavaca, televideo conferencing software is set up for an evaluation by a physician, Johnson said.

Prescribed medication is found in a few hours or shipped overnight and administered by an on-site nurse, O'Connor said.

Challenges

Those in the courtroom navigate mental health issues by turning to a lengthy article of the Texas Code of Criminal Procedure, which stipulates people cannot be held liable for a crime if found incompetent by a judge or a jury.

Incompetency means the suspects do not understand the charges they face and cannot consult with their attorney.

If incompetent, the person is sent to a treatment facility to help regain competency for no longer than the maximum sentence for the crime committed.

When that time is up and he or she regains competency, the suspect goes back to a jail to await trial. If his or her condition is stagnant or worsens, the hospital stay lengthens.

The 79th Legislature passed Senate Bill 679 in 2005, amending the article to say if both parties agree a defendant is incompetent, no hearing is necessary.

Victoria attorney Jerry Clark represented a man almost a decade ago in San Patricio County who was eating his own feces.

While the prosecutor also agreed the man was incompetent, both parties had to ask a jury to find him so, too. Two days later, it ended in a hung jury.

"I'm sure I'm not the only person that's happened to, but it was bizarre, I'll tell you that much," Clark said. "I can without hesitation say the changes to the law have immensely improved how to deal with these cases."

The burden of proof shifts to a prosecutor when the suspect has a record of mental illness, Tyler said.

In March 2000, Pepper was charged with aggravated assault causing bodily injury when he picked up a woman and threw her to the ground.

His then-lawyer, Stephen Cihal, reminded the court that a judge already found Pepper incompetent in a 1991 criminal trespass case, so Pepper was ultimately sent to San Antonio State Hospital, according to court records.

It wasn't until April 2001, about a month after a doctor wrote a judge, confident of Pepper's improved psyche, that Pepper pleaded no contest in exchange for 90 days in jail and a $500 fine.

Notoriety also may exacerbate the issues a mentally ill person faces.

"A lot of times, people with mental illness want to isolate themselves. Popularity might raise their anxiety or paranoia," Johnson said.

But Victoria is not unique in its fondness for Pepper or those like him.

In 2012, the Austin American-Statesman wrote an obituary for Leslie Cochran, a man described as an icon who spawned the oft-heard slogan, "Keep Austin Weird."

Like Pepper, Cochran was thought to have suffered a brain or head injury earlier in life and be homeless.

With a few arrests under his belt, Cochran, like Pepper, was both adored and abhorred, according to the Statesman article.

Solutions

O'Connor wants to mimic Brazos County, but so far, his idea hasn't stuck.

The Brazos County Sheriff's Office has a crisis intervention team - a group of deputies whose sole job is to diffuse mental health crises. Its forward-thinking netted it about $1 million in jail cost savings, O'Connor said.

"We've had hostage situations; we've had individuals who do harm to themselves to the point of it being fatal and harm others to the point of it being fatal. ... It's very complicated, and it's not like we can just throw them in jail and be done with it. That would break the county; that would break the taxpayers," he said.

Tyler said he hesitated to support such a plan without seeing data showing it's necessary. Victoria County is smaller than Brazos County.

Insane asylums have a stigma attached to them because in the past, they were thought to be abusive, Tyler said, but "leaving people to live alone under overpasses isn't better."

Voters must indicate to legislators mental health is a priority so they'll allocate funds and resources to combat the problem.

"Maybe we can do better by ourselves and them with just a little better planning and being a little more proactive," Tyler said. "Whatever laws they pass, we'll do our best to work by."

In the meantime, Victoria Police Chief J.J. Craig and Gulf Bend Center officials said they try to empower Victoria residents to inform and protect themselves.

The Gulf Bend Center is offering mental health first aid classes from 8:30 a.m. to 4:30 p.m. May 8 and 9 for those who regularly interact with youth.

The nonprofit urges residents to call its hotline at 1-877-723-3422 if they suspect something is awry.

Craig has an even shorter number for people to dial: 911.

"You'd be surprised how often people will remain in an unsafe location," he said, noting people are inclined to help, and Victoria has no laws against panhandling. "I would prefer you don't be a victim and be a really good witness to what's happening."

Johnson added, "Just because they have a mental illness doesn't mean they should be absolved of the crime. People need to learn and be responsible for their behaviors. One of the gaps right now in our community is a better system once someone is incarcerated to get treatment as quickly as possible."

Bianca Montes contributed to this story.

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