A balancing act: Guam searches for a way to protect the rights of the mentally ill while protecting citizens from harm by them

August 3, 2017

 

“Baby attacker” screamed the Guam media in 2015, after a New Year’s Day incident at Micronesia Mall in which 10-month-old Alexya Esser, in the arms of her parents, was punched in the face by an unknown woman.

 

Surveillance video captured the incident and was shortly a hot click item on local social media. Police soon located and arrested Yu Hua Han, a former mental patient, whose previous contact with the law had been a 2009 incident in Tamuning, during which a two-year-old girl and her father had been stabbed.

 

Initially, the new case proceeded like a normal criminal case. Han was jailed and arraigned on two counts of aggravated assault as a third-degree felony, two counts of assault as a misdemeanor, and two counts of child abuse as a misdemeanor.

 

A Superior Court grand jury handed down a ‘true bill’ indicting Han on the charges. But given her history, instead of setting a trial date, a judge ordered a forensic evaluation by a psychiatrist to determine her competence to understand her offense and ability to aid in her own defense in court.

 

In May, according to media reports, Dr. Kirk Bellis testified in court that Han was probably not able to differentiate between right and wrong at the time of the ‘baby punching’ incident. He diagnosed her as schizophrenic. Dr. Bellis recommended that Han be watched and taken care of at all times, noting her ‘fragility.’

 

 

According to Guam Deputy Attorney General Carol Hinkle-Sanchez, whose responsibilities include mental health cases involving both adults and juveniles, handling these cases requires a delicate balance between protecting the rights of persons who suffer mental illness, yet can live a normal life if they follow instructions for taking psychiatric medicine and protecting the public, should the patient fail to do so and re-offend.

 

The 2009 case was eventually closed and expunged from the record and Han was released back into the community in 2014 after a lengthy hospitalization at the Guam Behavioral and Health and Wellness Center, formerly known as the Department of Mental Health and Substance Abuse.  She was given instructions on how to maintain herself, but with no official supervision to ensure she did.

 

 

  Guam Deputy Attorney General Carol Hinkle-Sanchez

 

“They’re expecting that you will continue on voluntary treatment, which is what was expected of her the first time,” Hinkle-Sanchez said of Han, “but she fell off.”

 

Yu Hua Han’s case made clear the shortcomings of existing procedures. That and the attention generated by media coverage of the case led to Guam Senator Dennis Rodriguez’ bill, now known as the Baby Alexya Law, which establishes an assisted outpatient treatment service under Behavioral Health.

 

The law reads in part, “I Liheslaturan Guåhan finds that [AOT] is practiced in forty-five states as an extension of inpatient treatment, while allowing the qualified patient with a treatable mental illness or condition to receive court ordered treatment on an outpatient basis.”

 

 “We have a lot of people right now, with mental illnesses, who really don’t need to be in the criminal justice system,” Hinkle-Sanchez says.

 

Yu Hua Han continues to be considered not competent to face trial on the criminal charges, but she has been transferred to the Department of Corrections and will be tried, whenever she is found competent.

 

Since the 1970s, a combination of new and effective psychiatric drugs has allowed for the release of patients who were formerly locked up, often for decades. On the down side, in the absence of effective supervision, these former patients often get in trouble.

 

Public officials, seeing the potential for savings to the taxpayers, have slashed budgets for treatment facilities to the bone and closed many of what were formerly huge psychiatric facilities which had cared for the long term patients.

Many states and jurisdictions are looking to Assisted Outpatient Treatment as a means to deal with a problem that presents huge costs to governments, while posing dangers to members of the public and threats to the rights of the treatable mentally ill persons.

 

Recently, a nine member delegation from Guam was part of a workshop in Detroit, Michigan intended to provide training in how to set up AOT programs and share experiences and knowledge from other jurisdictions.

 

The Guam group included Deputy AG Hinkle-Sanchez, as well as a psychiatrist, a psychologist, a Superior Court judge, Guam’s Public Guardian, a psychiatric nurse and psychiatric social worker, among others. There was also a Guam fire captain. The broad composition of the group provides a picture of the breadth of the problem being addressed.

 

Brian Stettin, Policy Director of the Treatment Advocacy Center in Arlington, Virginia, threw some cold water on the idea that just passing laws authorizing AOT would solve the multiple problems.

 

“While we’ve been patting ourselves on the back for some of those achievements,” Stettin said, “we’ve also had to recognize now that we have not done well in getting some of these laws to be used much.”

   

Stettin said that during a national speaking tour, he met former Judge Oscar Kazen in San Antonio, Texas.

The former probate judge handled the local mental health docket as well in his county for nine years, until his abrupt dismissal from the rough and tumble Texas court system, for no stated reason.

 Judge Oscar Kazen

 

Said the San Antonio News-Express:  “The move has stunned courthouse observers, who credit Kazen, 53, for his diligence and judgment on the mental-health docket, particularly his work in helping to create an assisted outpatient treatment court widely seen as a model for courts around the nation.”

 

But Kazen remains active in the field, drawing on his experience with drug courts, which have become an established part of many American judicial systems and have facilities, staff and funding, based on the results they’ve achieved in redirecting addicts.

 

AOT is much newer and far from achieving such recognition, Kazen says.

 

He wants to keep released mentally ill persons on their treatment track, in part, through what is widely known as “the black robe effect,” in which a judge pressures former patients to stay on track and on medications.

 

“If I’m an individual who is a paranoid schizophrenic and I have decided that I am not going to take my meds and this is my seventeenth time and we know that each and every time, I do go off and wind up shooting at the black helicopters,” there’s a need for more attention, Kazen said.

 

“You’re not going to fix anyone, any large numbers of people in your community or cure the fact that you have people going to jail because they’re mentally ill. This is not the magic bullet,” Kazen told the participants.

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