The man was still hearing voices, but they were not telling him what to do, she testified. He denied having delusional thoughts. He knew what day it was and that he was standing in a courtroom.
Now Lewis had a decision to make, the kind that made her pray she was right and worry she was wrong and which she made a dozen times each day: not whether the man was guilty or innocent, but whether he was stable enough to be released from the psychiatric hospital in suburban Maryland where he had been confined since his arrest.
With the support of medication, counselors, a caseworker and a judge’s monitoring, could he be trusted to deal with his own mental health? And at a moment of public concern about the link between mental illness and violence, there was another consideration: Was he dangerous?
It was a Tuesday in mental health court in Upper Marlboro, one of a growing number of such courts being established across the nation because the criminal-justice system is swollen with the mentally ill. More than half of all inmates in U.S. jails and prisons — more than 1.2 million people — reported symptoms of mental illness, according to a 2006 federal study, the most recent national study available. That number had quadrupled since a similar federal study in 1998, and some state and local studies suggest that the number has continued to rise in more recent years.
State and local court systems are adjusting to this reality, with about 300 jurisdictions setting up specialized dockets for judges who use the power of the legal system to impose mental health treatment on some of society’s most troubled residents. They are people charged with assault, theft, arson, trespassing, harassment, stalking and other crimes short of homicide. They are also people whose mental illness is often part of a tapestry of problems that might include drug addiction or other issues that increase their risk of violence.
The courts operate in different ways from state to state. The one in Upper Marlboro handles only misdemeanor cases. Defendants must agree to participate, and after that, the judge can make mental health treatment a condition of pretrial release or probation. The goal is to restore healthier, more stable people to a community that is ultimately safer for the time, tax dollars and energy spent.
The reality, however, is that challenges are inherent in trying to impose the order of the judicial system on the most disordered of minds — in asking someone with a serious mental illness to handle court dates, therapy appointments, medication and other logistics of a decentralized and often inadequate mental-health-care system.
As Lewis said one day in her chambers after a particularly difficult session: “Sometimes I don’t know who can solve all of these problems. Maybe no one can.”