Tag: mental illness

Mental Health Advocates Raise Concerns About Psychiatric Commitment Bill

Eastern State Hospital
Eastern State Hospital. Photo by T85cr1ft19m1n, via Wikimedia Commons

By Paul Kiefer

As Washington lawmakers grapple with the shortcomings of the state’s behavioral health system, Sen. Manka Dhingra (D-45, Redmond) is sponsoring a bill that aims to open beds in the two state-run psychiatric hospitals, Eastern and Western State, to provide short-term mental health treatment beds for people with serious behavioral health disorders to stabilize so that a court can decide whether they need to be hospitalized long-term, a process called civil commitment. Neither hospital currently provides any short-term beds; instead, they provide long-term treatment, mostly to people accused of crimes who have been deemed incompetent to stand trial.

The bill would require the state hospitals to admit patients who need to undergo the two weeks of mental health evaluations and treatment needed for a civil court to decide whether they belong in long-term care. It does not set aside a specific number of beds for this purpose.

Across Washington, short-term psychiatric beds are hard to come by, especially for people with a record of violent crime. To fill the gap, Washington courts send hundreds of people each year to regular hospitals, which usually aren’t equipped to provide the level of mental health care that a psychiatric hospital can; some patients with severe behavioral health disorders even end up in emergency room beds, and others are turned away, often into homelessness. In September 2021 alone, King County courts committed 361 people to non-psychiatric hospitals.

Dhingra’s bill would prioritize opening beds at state hospitals for people whose criminal records would make it difficult to place them elsewhere.

“The hospitals are already seeing this group of people. We should take them in when they first come into contact with the civil system instead of waiting for them to commit a felony.”—State Sen. Manka Dhingra

The proposal sparked pushback from mental health advocates, who argue that the bill would only make it more difficult for the state’s Department of Social and Health Services (DSHS)—the agency that runs the two state hospitals—to manage its backlog of patients who either need to get into the hospitals for long-term, court-ordered treatment or who are sitting in the hospitals waiting for housing after their treatment ends. Advocates also say that hospitalizing people who need short-term treatment in large institutions far away from where they live works against the state’s larger goal of treating people with behavioral health disorders in their own communities.

In Dhingra’s view, Eastern and Western State Hospitals should help meet the demand for short-term treatment—especially for people that other hospitals refused to treat because of their criminal record. “The hospitals are already seeing this group of people,” she said. “They don’t get the treatment they need in the civil system; they then commit felonies and wind up at Western State. We should take them in when they first come into contact with the civil system instead of waiting for them to commit a felony.” Using the state hospitals may be a temporary solution, Dhingra added, until more local psychiatric beds open; since 2016, DSHS has been investing in small, community-based treatment facilities across the state, but that effort hasn’t met the demand for beds.

Some mental health advocates and DSHS itself, however, say Eastern and Western State Hospitals stopped handling short-term treatment for a reason. During a hearing on the bill last week, DSHS Assistant Secretary Kevin Bovenkamp told lawmakers that opening the hospitals to short-term patients again “moves us in the wrong direction.”

“We worked for years to shift the focus towards getting people places to recover in their own communities,” said Laura Van Tosh, an advocate who previously spent time as a patient at Western State Hospital. “If this plan goes through, it will upturn all those efforts. The last thing we want to do is put more people in the state hospitals.”

From Van Tosh’s perspective, while the bill might get people into psychiatric beds faster, a short stay in a large state hospital is far less useful in a patient’s recovery than treatment in their own community. “From where I stand, this doesn’t seem patient-centered, and it doesn’t seem focused on recovery,” she said. “It just seems like a mechanism to get homeless people off the streets and keep them in hospital beds for who knows how long.” People experiencing homelessness are more likely to be civilly committed, and people who have been civilly committed are more likely to become homeless after they are released Continue reading “Mental Health Advocates Raise Concerns About Psychiatric Commitment Bill”

Appeals Court Rules State Must Pay When People With Disabilities Wait in Jail for Services

A “rubber room” at the Snohomish County Jail in 2013, used to hold people with serious mental illnesses in isolation.

By Paul Kiefer

The Washington State Department of Social and Health Services (DSHS) won’t appeal a ruling by state Court of Appeals that could enable people held in jails for weeks while awaiting mental health evaluations to receive financial compensation for their lengthy, and possibly unconstitutional, confinement.

The ruling signals a possible turning point in a push by public defenders and disability rights advocates to overhaul how Washington’s criminal legal system treats jailed people with serious mental illnesses.

When someone’s mental health during and after an alleged crime comes into question, the state gives them a “competency evaluation” to determine whether they are competent to stand trial. If they’re not competent, their case can be paused while they are treated at a state facility, where staff can “restore” them to competency by using medication and therapy to treat their mental illness. The goal of restoration is to return people to a point where they can understand the charges against them, return to jail or the community, and eventually go to trial.

The ruling, which the Court of Appeals issued at the end of November, centered on Shymila Luvert, who spent four months languishing in a jail cell last year while awaiting a mental health evaluation that never came. Luvert, charged with a second-degree assault and booked into King County’s Maleng Regional Justice Center in Kent last spring, didn’t appear to understand what was happening to her.

The push to force DSHS to compensate individuals with disabilities for long wait times is new, but the underlying problem is not. The number of people with mental disabilities and illnesses left waiting for mental health services in jails across Washington has risen steadily for years.

A King County judge ordered that Luvert receive a competency evaluation in her jail cell. When she refused to engage with the evaluators from DSHS, the court changed strategies, directing the department to move her to Western State Hospital in Lakewood for an inpatient evaluation within a week.

As Luvert waited for a bed to open, she sank deeper into her mental health crisis. “It was clear that she was not understanding what I was doing there, or what I was talking about,” said Ramona Brandes, the King County public defender who represented Luvert. “She was just sitting in jail, and she didn’t understand why. It was doubly sad because I couldn’t move her case forward in any way and I couldn’t get her the services she needed.”

As weeks turned to months, the court gave the department an ultimatum at the end of July: Find a bed for Luvert in less than a week or temporarily release her. When DSHS didn’t comply, the court ordered the department to pay Luvert $250 for each day she spent in jail beyond the first two weeks of her stay.

The push to force DSHS to compensate individuals with disabilities for long wait times is new, but the underlying problem is not. The number of people with mental disabilities and illnesses left waiting for mental health services in jails across Washington has risen steadily for years. Many spend their time in isolation cells with only occasional visits from mental health care providers, and their mental and physical health often deteriorates as time drags on. Some people spend more time in jail waiting for evaluation than they would have if they were simply convicted of the crime and sentenced to jail time.

In 2014, a group of public defenders and mental health advocates sued DSHS and its two major hospitals in federal court on behalf of more than 100 defendants statewide who had languished in jail while waiting weeks or months for evaluation or to have their competency “restored.” That case, known as Trueblood—named for one of the public defenders who filed the lawsuit—appeared to mark a turning point.

“Jails are not hospitals, they are not designed as therapeutic environments, and they are not equipped to manage mental illness or keep those with mental illness from being victimized by the general population of inmates,” US District Judge Marsha Pechman wrote in her ruling in April 2015. The court ordered the state to complete initial in-jail mental health evaluations within two weeks, and to transfer anyone who does not appear mentally competent to a state psychiatric hospital within seven days.

But in the years since the case, DSHS hasn’t been able to consistently reduce wait times for people in need of competency evaluations or restoration. “[Trueblood] gave us all this hope that there is going to be a change, that things were going to get better,” Brandes said, “and that DSHS was going to start transporting people in a timely fashion. And then they didn’t.”

Instead, the department has paid more than $85 million in contempt fines to the federal court, along with millions to county courts. Those dollars were set aside to pay for new mental health services, staff and facilities, both in county jails and in DSHS hospitals. In 2018, DSHS reached an agreement with disability rights advocates in federal court to take a new approach. Rather than paying contempt fines, the state agreed to devote more resources not only to meeting the court’s intake timelines, but to scaling up diversion and crisis intervention programs. The court didn’t fully waive contempt fines; instead, DSHS has accrued another $100 million in fines that it will need to pay if it can’t meet its promises to improve wait times and diversion programs.

“[Trueblood] gave us all this hope that there is going to be a change, that things were going to get better, and that DSHS was going to start transporting people in a timely fashion. And then they didn’t.” —King County public defender Ramona Brandes

Kim Mosolf, the director of the treatment facilities program at Disability Rights Washington—the nonprofit that negotiated the settlement with DSHS in 2018—said the new emphasis on diversion, which keeps people out of both jails and hospitals, is a way to stem the flow of people with disabilities into jail and psychiatric hospitals. DSHS, she said, “had been trying to build their way out of the Trueblood contempt fines for several years without luck,” opening hospital beds slower than the demand for them rose.

The number of people who need in-patient evaluation or restoration outpaced the department’s ability to open new hospital beds and hire staff, keeping wait times long for people awaiting transfers from jails. The COVID-19 pandemic, which forced Western State Hospital to temporarily pause intake to contain an outbreak, only exacerbated delays.

Mosolf added that adding beds to speed up the process of competency restoration isn’t a long-term fix. “Restoration is not treatment in the way that most people consider treatment,” she said—the purpose of restoration is to make a patient competent enough to stand trial, even if their improvement is temporary. “The state’s own data shows that experiencing restoration does not lead to longer-term stability and health for people—so investing in more inpatient restoration beds is actually a very bad investment in terms of the returns.” Continue reading “Appeals Court Rules State Must Pay When People With Disabilities Wait in Jail for Services”

Sinclair-Owned KOMO’s Latest Exploitation Film Ignores Causes of Homelessness—and Solutions

By Ashley Archibald

A 90-minute KOMO special, “The Fight for the Soul of Seattle” debuted on Dec. 13, prompting alarm among homeless advocates. The program, a sequel to the infamous (and viral) “Seattle is Dying” special, presents Seattle as a seedy den of iniquity fostered by elected officials with lenient policies toward drugs and crime.

Since 2013, KOMO has been owned by the right-leaning Sinclair media conglomerate. Much of its recent programming, including “Seattle Is Dying,” seems aimed at painting a misleading portrait of a city in chaos for a national audience primed to believe the worst about progressive West Coast cities.

“The Fight for the Soul of Seattle” aims to reveal a city held hostage by a few thousand people experiencing homelessness caught in the thrall of addiction, propped up by lenient harm reduction policies, and never facing the consequences of their actions—unlike the upstanding (housed) citizens who suffer at their hands. It throws in references to the uprising against police brutality sparked by the death of George Floyd at the knee of a Minneapolis police officer as further evidence of social unraveling.

In reality, it is 90 minutes of tape exploiting the most vulnerable people in Seattle, shoved through a sepia filter and tailor-made to confirm the preexisting beliefs of people who wish they never had to see a poor person again.

To be clear, Seattle has issues. Homelessness and drug use are real. The human suffering on the streets cannot be swept away. But the weakness in “The Fight for the Soul of Seattle” stem from the fact that it fails to grapple with root causes, instead using homelessness as a wedge issue.

Much like its prequel “Seattle is Dying,” “The Fight for the Soul of Seattle” takes real problems — homelessness, drug addiction and the ensuing impacts on the city — and magnifies them into a force that is destroying the Emerald City without engaging with solutions

“I’m going to start by saying this,” reporter Eric Johnson intones at the top of the piece. “Seattle no longer feels the need to stop anyone from doing anything for any reason at any time.” The words land over images of homeless people asleep on the ground, exposed to the elements, evidence of the city’s culture of permissiveness.

Much like its prequel “Seattle is Dying,” which ran in March 2019, “The Fight for the Soul of Seattle” takes real problems — homelessness, drug addiction and the ensuing impacts on the city — and magnifies them into a force that is destroying the Emerald City without engaging with solutions like affordable housing, access to mental health services, provision of appropriate shelter space and the ability to raise funds through equitable taxation.

As though housed people do not commit crimes. As though they do not suffer from addiction. As though homelessness was some kind of moral failing.

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If there is any kind of failing here, it is one of journalism.

“The Fight for the Soul of Seattle” is replete with long-distance shots of people experiencing homelessness at the nadir of their lives, including some who Johnson alleges are using drugs right on camera. But there is no evidence that Johnson spoke to the people whose lives he trots out on screen as proof of Seattle’s decline. This is bad practice, but it’s also perilous. In Johnson’s previous work, “Seattle is Dying,” he included long-distance shots of a man rolling on the ground, insinuating that he was homeless.

Crosscut reporter David Kroman found Robert Champagne, who hadn’t been homeless in more than three years by the time “Seattle is Dying” aired.

And, while he insinuates that the block in front of the Morrison Hotel—site of the Downtown Emergency Service Center’s main shelter—is the most dangerous area of Seattle, Johnson did not bother to contact the shelter itself.

I know this because I did.

Daniel Malone is the executive director of DESC, Seattle’s largest shelter provider. In the nine months since the coronavirus pandemic began, DESC decamped from its main shelter to the Red Lion hotel in Renton, although it still offers housing at the Morrison and behavioral health services in the vicinity.

“It’s not like we picked up and left,” Malone said.

Had KOMO contacted him for the piece, Malone said, he would have shared the stark reality. He would have explained the efforts that DESC goes through to provide help to people dealing with serious mental health challenges. He would have explained the limitations of what they are able to provide.

“But I didn’t have that opportunity,” Malone said.

Scott Lindsay, the former public safety advisor to Mayor Ed Murray, did.

“Let’s be super clear,” Lindsay says. “It is the drugs.”

In a follow-up interview via email, Lindsay clarified that he objects to the way that the city handles homelessness and crime. Continue reading “Sinclair-Owned KOMO’s Latest Exploitation Film Ignores Causes of Homelessness—and Solutions”

Involuntary Treatment Bill, Modeled on California Law, to be Resurrected Next Session

Rep. Steve O’Ban, R-28

This story originally appeared in the South Seattle Emerald.

A state senate bill aimed at taking people with severe behavioral health issues off the street and putting them into involuntary treatment is off the table for this year, but its sponsor, Tacoma Republican Steve O’Ban (R-28) says he plans to resurrect it next session, because the problem of untreated mental illness and addiction isn’t going away.

“The reason for this bill is really the parents who have these kids … who devolve into a worse and worse condition and by the nature of their condition, they don’t think they need care,” O’Ban says. Under current law, people can only be detained and put under guardianship if a court determines that they’re incapacitated by a “mental disorder” and pose an imminent threat to themselves or others.

O’Ban’s proposal would allow judges in three counties—King, Pierce, and Snohomish—to appoint executors for people who have been involuntarily held for psychiatric evaluation five or more times in a 12-month period under the state Involuntary Treatment Act. That law allows people to be held in psychiatric hospitals (or emergency rooms if no psychiatric beds are available) for up to 180 days if a judge determines that they are incapacitated by mental illness. The proposed new involuntary guardianship, or “executorship,” would last one year unless the executor filed for an extension.

The program is modeled on a similar set of bills that passed in California in 2018 and 2019, which authorized three counties—San Francisco, San Diego, and Los Angeles—to create a new “conservatorship” program for people with both severe mental illness and addiction. California state senator Scott Wiener (D-San Francisco), who sponsored both bills, says his legislation is intended to address “a very small percentage of homeless people … who are severely debilitated and not capable of accepting voluntary services.”

“One of the areas that’s been a particular concern is the lack of structure and necessary accountability for these patients who come out of involuntary treatment, or they’re in jail, where they should not be, and by the nature of their condition they don’t think they need care and they refuse the needed services.” – State Sen. Steve O’Ban (R-28)

Wiener says the new California laws create a “very narrow conservatorship to reach this small population so that we can save their lives. It is incredibly inhumane, and certainly not progressive, to allow people to die on the streets.” He estimates that the legislation would apply to as many as 100 people in San Francisco, but advocates who opposed the bill say the number is probably much smaller.

O’Ban’s bill, in contrast, would initially be limited to 10 people in each county.  Patients placed under executorship would cede most of their legal rights to a “court appointed resource officer,” or CARE officer, including the right to refuse treatment or choose their own medical providers, the right to decide where to live, and the right “to make decisions regarding social aspects of life,” according to a staff analysis of the legislation.

“One of the areas that’s been a particular concern is the lack of structure and necessary accountability for these patients who come out of involuntary treatment, or they’re in jail, where they should not be, and by the nature of their condition they don’t think they need care and they refuse the needed services,” O’Ban says.

At a hearing on the bill earlier this month, parents whose kids had died on the streets due to lack of housing and treatment testified that if the law had been in place when they were trying to get help for their children, they might still be alive today. Jerri Clark, the founder of Mothers of the Mentally Ill, told the committee that her son, who died last year at the age of 23, “cycled through hospitals that kept him just long enough that he wasn’t dangerous anymore” before releasing him.

“If you look at the big picture, we’ve completely divested from mental health care and we’ve put people out on the streets where they’re completely disintegrating… and then the only care that they’re getting is in the back of police cars.” – Jen Flory, Western Center on Law and Poverty

But critics of the legislation, including advocates for people with disabilities and people who have struggled with mental illness themselves, say that taking away people’s civil rights is inhumane and doesn’t solve the underlying issues: An acute lack of funding for treatment, housing, and intensive case management.

“We do have concerns that adding another layer of legal process to compel people into care, rather than adding new treatment or housing resources, will mainly restrict civil liberties while not actually getting to the desired outcomes,” the Department of Community and Health Services said in a statement about the bill. “Instead of adding another layer of court involvement, we think a middle of the road approach – focusing on expanding flexible, community-based intensive services and added supportive housing resources – will more effectively meet the needs of this population.”

Laura Van Tosh, a behavioral health care advocate who testified against the bill, says the fact that people are involuntarily committed again and again “points to a problem that has nothing to do with people’s mental health. How can people be committed that many times in one year and nobody has ever talked about why the system didn’t work well enough the first time?” She says the current involuntary commitment system “is like going to a restaurant and getting E. coli over and over again, and never figuring out that you should go to a different restaurant.”

California’s conservatorship law requires treatment and housing to be available before people can be placed under conservatorship, although opponents say cities may meet this requirement by simply putting people in the new program at the front of the line for scarce treatment and services. “San Francisco will not conserve people unless they have somewhere to place them,” Wiener says. “In San Francisco, we’re expanding our mental health bed capacity and our shelter bed capacity, we’re building more supportive housing, but it’s definitely a challenge.”

Similarly, O’Ban’s bill says that a county could only implement the program if there are sufficient resources, including mental health treatment and housing, to serve potential clients. The loopholes will likely be the same, if a version of O’Ban’s bill passes in the future, as those in places like San Francisco. There are always beds in Seattle for some people—the question is who gets priority.

Jen Flory, a policy analyst at the Western Center on Law and Poverty, says that by putting people in involuntary treatment and stripping them of their rights, “we’re kind of skipping from A to Z. If you look at the big picture, we’ve completely divested from mental health care and we’ve put people out on the streets where they’re completely disintegrating… and then the only care that they’re getting is in the back of police cars being brought to psych emergency [wards]. And at the end of this journey, they’re like, ‘Okay, there’s something wrong with you and we need to force this care on you.’”

David Lord, the public policy director for Disability Rights Washington, says that before the state authorizes counties to appoint guardians for people struggling with mental illness and addiction, they should actually fund the services O’Ban’s bill enumerates, which include supportive community housing, outpatient counseling and treatment, peer support services, and substance use treatment.

“If you provide services, make them available, and do it in a way that is attractive to people, they’re much more likely to accept those services than if you try to force them,” Lord says.

Neither California’s law, nor O’Ban’s proposal, specifically focuses on people experiencing homelessness. But the subtext of both bills is that they will help put people exhibiting visible symptoms of severe mental illness and addiction—shouting, acting out, and behaving in ways that make other people uncomfortable—out of sight.

In our conversation, O’Ban referred to the 100 “prolific offenders” identified in a report by former Seattle City Attorney candidate Scott Lindsay as a group that might be eligible for executorships under his proposal. And he acknowledged that while his bill is “not exclusively for those who are homeless, I think many of the people who are eligible would be” homeless.

“I can tell you that there are familiar faces, frequent flyers, people who are well-known to the law enforcement community and in emergency rooms,” O’Ban says. “If you start focusing on that population, by identifying the top 100 who are heavily utilizing all those …. you would save the system literally hundreds of thousands of dollars a year.” And “clean up” downtown streets in the process.

Morning Crank: The Council Takes a Closer Look at the “Prolific Offenders” Report

1. Six of the seven District 2 city council candidates participated in a forum at the Georgetown Ballroom last night, and I livetweeted the whole thing. Check out the thread to find out what committee Ari Hoffman wants to chair, when Tammy Morales last called 911, why socialist Henry Dennison won’t answer yes/no questions… and also a lot of information about the candidates’ plans are for addressing homelessness, environmental racism, and how they would counter displacement in South Seattle.

2. City council members Lisa Herbold and Lorena Gonzalez invited leaders of several of the business groups that funded a recent report on so-called “prolific offenders” Wednesday, and raised questions about the methodology behind the report and some of its conclusions.

Mike Stewart, the head of the Ballard Alliance, said he and other business leaders got the idea for the report after they “started to realize that things are changing a lot” for business owners, who he said are dealing with a level of crime they’ve never experienced before. “It feels like  many of the instances of the criminal behavior that happens seems to be coming from many of the same people—so an individual might commit a crime in a business district one day and the next week, they’re back again,” Stewart said.  Erin Goodman, the head of the SODO Business Improvement Area, added, “One individual in our sample is quite simply terrorizing the Ballard business district. … In a single day in 2018, he shoplifted from five stores in a two-hour period, brazenly pushing a shopping cart full of the stolen items from store to store.”

These bookings include charges for failure to appear or comply with terms of release, which made up 41% of the charges in a King County assessment of its “Familiar Faces” program, which deals with a similar population.

The report, “System Failure,” was put together by former mayor Ed Murray’s public safety advisor, Scott Lindsay. It highlights the booking histories of 100 individuals, hand-picked by Lindsay and characterized in the report as “roughly representative of a larger population of individuals who are frequently involved in criminal activity in Seattle’s busiest neighborhoods.” Every person on Lindsay’s list had four or more bookings into King County Jail over a 12-month period and had “indicators” that they were chronically homeless and had a substance use disorder.

The criteria Lindsay used for his list are similar to those used in King County’s Familiar Faces initiative, which, in 2014, identified 1,252 people with four or more annual bookings (94 percent of them with a substance use disorder or behavioral health issue, or both), except that Lindsay chose to zero in specifically on frequent offenders who are homeless, which Familiar Faces does not. Just 58 percent of the people on the 2013 Familiar Faces list had indicators that they were homeless. By hand-picking a list of offenders who are homeless (and by choosing to highlight the stories of mostly people who moved to Seattle from elsewhere), Lindsay’s report feeds into the common, but unsupported, belief that most people who commit property crimes are homeless and that homeless people from across the country come to Seattle to mooch off the city’s generosity.

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Gonzalez and Herbold pressed the “System Failure” funders on some of the methodology in their report, including the fact that Lindsay determined the number of crimes each person had committed using police reports, complaints, and charging documents, without looking at anything the person said in their own defense or tracking whether they were ultimately found guilty. Goodman, from the SODO BIA, acknowledged that “some of these folks could have gone through the criminal system and been found innocent,” but added, “This is simply a snapshot based on bookings. [Lindsay] clearly states that it does not say how the case was adjudicated.”

Goodman expressed frustration that so many people were let out of jail within hours or days of being arrested; that so few of the people found incompetent to stand trial because of mental illness were subject to involuntary commitment; and that “there was zero accountability in the system for consequences for failure to comply with court-ordered release conditions.” Those conditions, according to the report, included things like appearing at every court date; abstaining from drugs and alcohol; submitting to random drug tests; and going to abstinence-based inpatient or outpatient treatment.

Underfunding services and then complaining that they aren’t working “is like sprinkling a little bit of salt over a giant bowl of soup and then [saying], ‘Oh, salt doesn’t work,'” Public Defender Association director Lisa Daugaard said.

One issue with these kinds of conditions is that there simply isn’t enough available capacity—in other words, funding—for the services that do exist to serve clients with mental health and substance abuse challenges. The Law Enforcement Diversion Program, for example, recently expanded with funding from the recent Trueblood court settlement to provide a vastly expanded suite of services (including mental health care, transitional housing, and intensive case management) to people whose competency to stand trial has been called into question. That funding will serve about 150 people who would not have previously been eligible for the program. But, as Public Defender Association director Lisa Daugaard, who was also at the table, pointed out, there are likely thousands of people who could benefit from similar services, while the total capacity for all such programs is in the hundreds. Underfunding services and then complaining that they aren’t working “is like sprinkling a little bit of salt over a giant bowl of soup and then [saying], ‘Oh, salt doesn’t work,'” Daugaard said. “We are not right-sizing the things that are effective.”

The other, related, issue with expecting people to comply with court conditions is that those conditions are often unreasonable. As long as the underlying issues that are causing someone to shoplift or act aggressively or loiter in the doorway of a business aren’t addressed, telling people to show up to day reporting or abstain from their drug of choice is a losing strategy. It’s little wonder that 100 percent of the people Lindsay chose for his report  failed to comply with the conditions imposed by the court.

Goodman’s frustration is understandable: Her group represents businesses in an area of the city with the highest concentration of people living in RVs, many of them with substance use disorders, untreated mental illness, or both. But there’s little point, experts say, in trying to force people into treatment when they aren’t ready. “If the clients aren’t ready, they aren’t ready, and therein lies the challenge,” Heather Aman, a deputy prosecutor at the city attorney’s office who works with LEAD clients, told me recently. “Anyone who isn’t addressing their substance use or mental health issues has an impact on their community, because there’s not an ability to force individuals to [get help or treatment] until they’re ready. And what do you do with the person that needs to be ready? That’s the million-dollar question.”