A Hospital Without Walls

Denver’s Court to Community program is showing promise.

Thursday afternoons in courtroom 151P tend to be less formal than other proceedings in Denver county courts. Judge Larry Bohning still hands out an occasional scolding ("Time's running out, Mr. Finn; you need to stay away from that alcohol"), and every once in a while somebody gets their probation revoked and heads to jail. But most of the defendants on Bohning's once-a-week mental-health docket are here to give a brief progress report, share any problems they might be having with their treatment plan or job situation — and pick up a free snack or toothbrush on the way out.

"This morning I got on methadone," says one young woman, rubbing her right arm nervously. "They've been giving me motel vouchers until I can get into housing. I try to check in once a day. I move around a lot."

"I'm coming down from being manic," says another woman in a hoodie. "The good news is that my new meds are working good."

"I'm coming out of my depression," announces an older man sporting a leather jacket and a gap-toothed grin.

Bohning nods, congratulates, asks an occasional question. "You had a job interview last week," he says to one dreadlocked visitor. "How did that go?"

The man beams back. "I'm starting at ten dollars an hour," he says.

The people who gather in 151P on Thursday afternoons are part of Denver's Court to Community program, a three-year pilot project to help low-level, mentally ill offenders connect with a range of community resources — and to keep them out of jail. Funded by a combination of grants, the effort isn't cheap; in its first year, it's enlisted 38 out of what will eventually be 75 clients, at an average annual cost of $12,000 per person. But its backers say it's a lot less expensive than having its target population of homeless, addicted and severely mentally ill residents spend much of their time in jails or hospital emergency rooms.

"This is basically a hospital without walls," says Regina Heuter, executive director of the Denver Crime Prevention and Control Commission, one of the chief sponsors of the project. "We know it takes fifteen months, on average, to get someone stabilized. But we have a year's worth of data now, and it shows that people are generally not coming back to jail, not showing up in detox. That means a decrease in those costly services."

In his three decades on the bench, Bohning has seen waves of failed initiatives to deal with the homeless and mentally ill. But this latest effort is different. "I was skeptical at first because I didn't think there would be enough funding," the judge admits. "If you don't have some short-term bed space, so these people can have a more stable environment, they're not going to stay on their meds."

The partners in the program, the Colorado Coalition for the Homeless and the Mental Health Corporation of Denver, work to ensure that the participants have access to adequate medication as well as reliable shelter. "I'm convinced we're doing some good," Bohning says. "We could use 300 more slots."

At present, the program is limited to people charged with city ordinance violations, such as trespassing or public urination — no misdemeanors or felonies. Many of the participants are familiar figures at the county jail and local hospitals. The "therapeutic jurisprudence" doled out in Bohning's court is designed to keep them out of trouble by closely monitoring their situation; failure to report back, in many cases on a weekly basis, can result in a probation violation. "They're not dropping out anywhere," Heuter says. "There's not a crack to fall between. If they don't work with us, they get prosecuted."

Since its launch, the Court to Community program has had three "graduates" and eight revocations, usually for alcohol or drug use. But there's also been an 83 percent drop in the total number of days the group has spent behind bars. One man who was in the county lockup on a weekly basis prior to joining the program — sometimes released and re-arrested on the same day — hasn't had a single arrest in more than six months. "He's not using, he's stable in his meds, and he can actually carry on a conversation," reports Shari Lewinski, the court coordinator. "This is tough stuff to treat. People start to slide back, but there are so many eyes watching, and the caseworkers are on top of things."

Modest in size but intensive, the court program may be joined by the end of the year by the first of three mental-health "triage" centers planned for the metro area. That project, backed by local hospitals and Mental Health America of Colorado, is supposed to further ease the burden on emergency rooms by offering an alternative that's more specifically geared to the needs of mentally ill clients in crisis.

Heather Cameron, the project's director at MHAC, calls hospitals "the most costly access point" for people with mental illness seeking help. Of the estimated 40,000 ER visits in the Denver area each year by people with mental-health issues, roughly half don't result in a hospital admission, she says. That population might be better served by going to a crisis center staffed by specially trained clinicians, who can do a more thorough assessment and stabilization of the patient than most hectic hospital ERs can offer.

"Seventy percent of the transports [to the ER] are by law enforcement," Cameron notes. "If you're lucky, you get a trained officer to come to your house and de-escalate a crisis situation. But the only place the officers had to take someone was the hospital emergency room." The "triage" label for her program is somewhat misleading, Cameron says — as with the court program, the overall goal is to provide links to a wider community of resources and make the critical followup and aftercare more feasible.

Lewinski expects to see the approach expand as its cost-effectiveness is demonstrated. "The good news is that the quality of life for these folks is improving," she says. "It's no picnic to cycle in and out of jail and live on the streets."

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