FORT WAYNE, Ind. (WANE) — When he was a local attorney, Allen Superior Court Judge Andrew Williams volunteered for the mental health court.
Now he’s the county’s mental health judge, leaning on his 18 years of volunteer experience. He also holds down a full civil docket.
For more than 20 years, Judge David Avery, also a civil court judge, held the position of the county’s mental health judge. In Avery’s court, Williams typically represented mental health treatment facilities, conducted examinations and presented evidence at mental health hearings.
When Williams took the bench three years ago, Avery asked him if he’d be interested in taking over the responsibilities of the mental health judge.
He didn’t have any trouble saying yes, even though it meant being on call 24 hours a day, often getting phone calls in the middle of the night.
In his time as a volunteer, and now as a judge, he’s seen mental health filings increase – from 800 in 2015 to 2200 in 2021 – and state law change for the better.
Williams believes the rise in mental health filings can be attributed to 1) the pandemic and 2) the fading stigma associated with mental illness.
Since July of this year, the state legislature turned initial mental health decisions over to emergency room doctors. That means no more phone calls in the middle of the night, he said.
“That’s helped out tremendously with judges being on call. Now doctors can make a determination as to whether to hold someone for an evaluation up to 48 hours,” Williams said in a wide-ranging sit-down interview with WANE 15.
Untreated mental illness in Indiana costs the state more than $4 billion annually, according to a study published last month by Indiana University Richard M. Fairbanks School of Public Health.
That’s $1 billion more than the state surplus.
The study found that one in five Hoosiers with mental illness do not receive the treatment they need and are more likely to experience chronic health conditions such as diabetes and cardiovascular disease.
One of the heavy costs of untreated mental health comes from incarceration and the state’s criminal justice system. With the loss of many of the state’s psychiatric institutions, mentally ill individuals wind up in county jails.
Ten years ago, a report from the National Institutes of Health estimated that 70% of inmates have symptoms of mental illness “with local jails reflecting the highest prevalence.” Between 16% and 24% are seriously mentally ill. There’s no reason to believe those statistics have changed.
Williams’ role is crucial to an individual who lands in the criminal justice system, often through arrest by the Fort Wayne Police Department or Allen County Sheriff’s Department.
“My focus is to make sure that people are getting the services that they need in order to get to a point to where they can be productive members of the community and to where they can feel like they are productive members of the community as well.”
A mental health petition is filed once a person enters the criminal justice system, normally through an arrest by the police, although it can be made by the individual or his family, he said.
The filings come to Andrews primarily from four treatment centers: Lutheran Hospital, Parkview Behavioral Health, Maple Heights Behavioral Center and the Bowen Center.
There are two types of mental health filings
——-An emergency detention order, which can last up to 14 days
——- an involuntary commitment.
Involuntary commitments come in two different ways: 90 day and indefinite. But the indefinite ones must be approved every year.
“Involuntary commitments are for folks that are probably going to need more assistance for a longer period of time, but it’s not necessary that the person is going to be hospitalized that entire time,” Williams said.
“Hospitalization typically is to get a person to where they’re stable enough to go back into the community and back into their ordinary life.”
Commitments do provide additional supervision of the mentally ill to make sure they’re taking their medications or going to therapy, Williams said.
Williams holds mental health hearings every Wednesday afternoon, which are not open to the public. There are also administrative duties and other duties that relate to the mentally ill individual.
“Sometimes I have to get involved in finding transport for patients from one facility to another,” he said.
What Williams could do, but in this county is left up to the criminal court judges, is force inmates to take their medications while they are incarcerated at the jail.
Those duties are divided in Allen County, the judge said. One of three judges in the criminal division decides whether an inmate must be forced to take his or her medications. Those judges are Fran Gull, David Zent and Steven Godfrey.
Nor does Williams have control over what kind of psychotropic drugs the sheriff’s contract medical provider, Quality Correctional Care, will pay for or administer.
Williams said he realizes there are cost controls over which kind of drugs are offered through the private insurance contractor, based in Carmel.
“Folks who are incarcerated provide kind of unique problem for us when it comes to getting mental health treatment,” Williams said. “If someone is on a commitment and they find themselves incarcerated, every effort is made to continue to get them the medications.”
So many are on Medicaid, the low-income health insurance through the federal government, and that ends once incarceration begins. That means medications must come out of the Sheriff’s taxpayer-supported budget.
“As I understand it, there’s a list of medications that come under that contract and they try to use those medications whenever possible, because it’s part of the contract,” Williams said. Some of the medications that are the most effective are very expensive, like $1,000 per shot.
It is Williams’ job to order civil commitments.
“Civil commitments can be ordered when a petition is filed. Early petition for involuntary commitment can be filed by anybody, however, they generally are filed by the treatment facilities.
“The reason for that is because you have to have a physician statement to go along with it. So I make a decision based upon whether a person is mentally ill, and as a result of the mental illness is either dangerous or gravely disabled. There has to be clear and convincing evidence to meet each one of those elements before commitment can be granted,” Williams said.
Even though Indiana has challenges in treating the mentally ill – the state ranks 43rd in access to mental health services and 39th overall for mental illness, according to Mental Health America, Williams believes positive steps are taking place, a couple of them of his own making.
For the first time ever, Williams hosted the Northeastern Regional Mental Health Summit in September inviting private sector medical providers, non-profit agencies like NAMI (National Association of Mental Illness), drug recovery companies, law enforcement and first responders.
The idea was to “break down the barriers” between different agencies, sometimes unaware of what others are doing.
“Sometimes competition can rear its ugly head. There really is no place for competition when we’re talking about the treatment of mental illness. I think that bringing people together, getting them to talk, made everybody realize that we’re all on the same team.”
Monthly, he holds county-wide Zoom meetings with mental health providers and law enforcement as part of the mental health task force.
“In Allen County, I think it’s better than probably any other county in the state, and a lot of counties throughout our nation. Allen County takes mental health very seriously. We have good resources. We have good mental health providers.”
His frustration is that state-wide not all counties think the same way. “The governor’s office is taking mental health more seriously than ever and Indiana Supreme Court Justice Christopher Goff has been tasked with looking at our mental health care system and figuring out what the trial courts can do better,” Williams said.
“We have statutes that deal with mental health and are supposed to give us direction as to what we should do and what we shouldn’t do,” Williams said. “But all the judges interpret them differently.”
The roll-out of 988, the nationwide mental health line, is still in progress in this state and needs funding from the state legislature.
The judge believes that increasing outpatient services could be a huge part of the answer to treating the mentally ill who so often wind up in jail. Although these services exist, Williams thinks it’s an area where efforts need to be increased.
Outpatient services would include:
- a place where someone could go to get their meds and then go to work.
- supervision to make sure a person goes to counseling sessions,
- administering medications whether pills or injections,
- and; acquiring a case manager who could go to an individual’s home to “make sure they’re doing OK, talk to family’s members, see what conditions the individual lives in, find out the problems they’re experiencing, help them get and maintain jobs –just really provide support for people so they can get to a position where they’re able to do it completely on their own,” the judge said.
Because resources are limited, he foresees Allen County as one of the state’s hubs for mental health treatment.
“We’re going to see that, too, with some of the other large metropolitan areas in the state. It makes sense to do that. If you think about it, if you have a loved one that’s in a mental health crisis, you want them to get the best care they possibly can. You want them to have all the resources available to them that you can possibly get them and Allen County will provide those.”
Where others in the community can help is recognition of the problem. Williams would like to see the community “better recognize that mental illness is not something to be afraid of ” and act collectively.
“Mental illness touches each of our lives, either directly or indirectly. Nobody’s immune from it. Anybody can become mentally ill at any time and I’m not sure that our modern medicine really understands exactly what triggers these mental health crises,” Williams said.
“If you know of someone, a family member or a friend who just doesn’t seem quite right, ask them questions, talk to them, listen to them. Listening is so very, very important. I mean sometimes, sometimes I think that some of these things can be avoided just by having somebody to talk to,” Williams said.
A list of mental health resources can be found on the Indiana Family and Social Services Administration website.