Unsuccessful and ongoing efforts to treat a female robbery defendant for her bipolar disorder and drug addiction are highlighting deficiencies in Cayman’s ability to deal with people with mental health issues, a court has heard.
Justice Charles Quin described the increasing number of court cases involving defendants with mental health issues as a “chronic problem” that had to be dealt with as a matter of urgency. The defendant’s lawyer also pointed out what she described as failures on the part of the police and health services to help her client, when she appeared before court last week.
The woman, who pleaded guilty to robbery last year, received what Justice Quin acknowledged was a “slightly unorthodox” order for her detention. The defendant was made the joint responsibility of the women’s prison at Fairbanks and the Mental Health Unit of the Health Services Authority for 30 days.
She was in court twice in four days because she had broken conditions of her “house arrest” by going out after her curfew to an area she was specifically forbidden to visit, and then consuming cocaine.
She had received a sentence of one year after admitting that she wielded a machete and caused damage while demanding a piece of carrot cake at a restaurant. After 205 days in custody, the house arrest was imposed as part of an Assisted Outpatient Treatment Order, which provides for supervision during a suspended sentence.
The woman had been allowed to leave her home to attend programs such as intensive outpatient, early recovery and relapse prevention. She was also being tested for illegal substances three times per week.
On Monday, March 23, she was brought to court for curfew violation. Defense attorney Fiona Robertson said police had seen her client in an area where she shouldn’t have been; rather than arresting her or taking her home, they simply told her to go home.
Reading from reports, Justice Quin said it was shocking that the woman continued to interact with drug dealers. “They will come to her home and drive her to places where drugs can be found … These people should be arrested for supplying drugs,” he said.
Hearing from her supervising officer that the woman did not have the strength to fight the influence of the drug dealers who came to her home, Justice Quin said that was outrageous and evil.
The defendant begged for “one more last chance.” She said she knew she broke the law, “but you’ll never see me in front of you again if I was given a chance.”
Justice Quin reminded her that he could send her back to prison “and that’s what many people think I should do.” He released her with the provision that she wear an electronic monitor and return to court for a review in two weeks.
However, she was back in court three days later. This time, Ms. Robertson said, she could not contain her frustration. The police had seen her out in violation of her house arrest conditions, but did not keep her in custody as they were obliged to do under the Assisted Outpatient Treatment Order. As Ms. Robertson understood it, there were no cells available, so the defendant was simply released again. The attorney found it bizarre that police could have cells in West Bay, George Town and Bodden Town and yet, on the night of March 31, not have one cell available.
Then, the woman, after remaining at home for some time, recognized that she was in crisis and went to the hospital, but was not admitted to the mental health unit.
Ms. Robertson said she was furious about the situation. The police were not living up to their duty, she asserted, “and, unfortunately, the health service authorities equally are not rising to their duty of care.”
She said the defendant had asked in the past to be sent overseas for treatment. Justice Quin said efforts had been made to send her overseas, but there were problems, some due to the defendant’s criminal record.
He said, “The criminal justice system is faced with a marked increase of defendants with serious mental issues and they must be addressed as a matter of urgency. It can’t go on. It’s a chronic problem … We can’t be sending people to Trinidad or Jamaica or Cuba. It should be dealt with in Grand Cayman.”
The judge called this a “chronic situation that needs urgent attention and urgent resources.”
The defendant’s supervision officer pointed out that when there are highly vulnerable clients at the mental health unit, volatile clients are not mixed in. Given the defendant’s history, there may have been hesitation to admit her. The alternative, she said, was lockup or a place of safety. “The only place of safety for individuals with behavioral instability is the prison system,” she said.
Deputy Director of Public Prosecutions Patrick Moran noted the supervision officer’s recommendation that the defendant be placed on a 30-day remand to address her cocaine cravings. He said he was conscious of the difficulties faced in relation to mental health disposals.
He read from a letter by one of the hospital psychiatrists – prior to going to the hospital the woman had broken her curfew, used cocaine, had done nothing to harm herself, and was found not to be manic or depressive, she was simply issuing threats of self-harm. She spoke with two doctors and both agreed there was no need for further treatment other than medication.
The judge ordered that the woman be taken to the mental health unit immediately and treated as an in-patient as long as was required for her drug addiction and mental health issues. When released, she is to be taken to Fairbanks Prison and the mental health unit must treat her medically during her 30 days in custody. The mental health unit is to have an officer in court on May 1 to report on the treatment and the progress of the defendant.
Justice Quin said he would write to police to ask for an explanation as to why the defendant was not kept in custody when officers found her violating her house arrest conditions.