730. 740. Whatever it takes.

Another in our ongoing series¹ of Doing the Right Thing Gets Very Expensive (Local Government Edition):²

We can all³ agree that a person who may have broken the law has the right to a fair trial, which includes access to a lawyer who can walk the accused through the process and mount some kind of defense, if that is the best course of action, which is something a lawyer would know.⁴

Sometimes, folks who are accused of breaking the law aren’t capable of understanding that they’ve broken it, either because the law is really complicated and/or because their mental state is not reality based.

New York State⁵ has a whole section of its Mental Health and Hygiene law devoted to these cases. It’s referred to as section 730 and was adopted in 1970, which makes it barely older than me. Parts have been declared unconstitutional, yet 730 as a whole still controls what happens in many cases where the defendant is not capable of understanding a trial.

Hang onto that idea for a minute. I’ll come back.

The language in these laws does not match what we’d use today, which shouldn’t be a surprise because a lot of what we said in 1970 is not okay now. Every time I read about hygiene law I think about the filmstrips we saw in 4th grade.

The folks who are covered under section 730 are deemed incompetent because of “mental disease or defect [who] lack capacity to understand the proceedings against him or to assist in his own defense.” We really wouldn’t describe mental illness or a developmental disability as a “disease” or “defect” anymore but these are the words used when the law was drafted and in current conversations about the law.⁶

Which might give you one huge clue that it’s time to rewrite and/or nullify and come up with something better. However. We press on.

The goal of 730 is to get the accused to a place where he/she/they can understand what is happening in their case and the charges against them. In court speak, this is called “restoration to competency.”

Sometimes, it’s pretty easy to restore a person to competency. They need some meds, maybe, and some courtroom training. Most defendants can be restored in a couple of months.

Of course, there are outliers. And that’s where it gets messy.

A judge can order a defendant into a state-run competency restoration service at a state-operated Forensic Psychiatric Center, which costs (on average) $1,300 per day. Judges do this with the best of intentions. They want the accused to get the help they need to understand what’s happening in their case. Cost is not the primary concern.

Nor should it be. One of the functions of government (despite what the current regime would have you believe) is to care for the most marginalized members of our society. If this is what that care costs, then that is what is costs.

The problem in New York State is that we are not sure that is actually what it costs. These centers are informational black holes from which no data can emerge. The county the client resided in is liable for the entire expense of treatment.⁷

Which would be okay, I guess, if counties had some kind of control over or visibility into the process. Instead, we are just sent invoices with a patient’s name on it and a very large number at the bottom. What we know is that we have to pay it.

What we don’t know is what kind of treatment is being given, how long a stay might be, or if the client is on-board with the treatment plan. Additionally, we don’t know when one of our residents might be ordered into restoration. There also seems to be no time limit on when we can be billed for services. We’ve had invoices show up years after the client has been released from care—and our payment is due in 30 days.⁸

For example: last year⁹ our small county was sent a $100,000+ bill for a resident who’d been assigned to a state center. We had no idea it was coming, nor how many of them we’d be getting, or what sort of treatment plan existed. What we knew is that we had to find the money to pay it, which we had because we always leave a cushion in the budget for a 730.

I mean hooray for us, I guess, but that’s not how you want to handle taxpayer dollars.¹⁰ We’re putting aside funds that could be spent on any number of other things in the mental health and hygiene realm just in case this relatively rare event happens. One year, we had two of them, which was a different sort of crisis.

To be clear: a 730 is not intensive psychiatric treatment, even if judges might believe that it is. The only goal is to get the accused to a place where they can understand the legal process. It is not to improve their quality of life or mental health.

Again, tho: restoring a defendant to competency is the right thing to do. No one in the courtroom should be unsure of what’s going on.

But how do we pay for it? And how do we know we’re getting what we’re paying for?

The oversight into the 730 process is enough of a problem that the New York State Association of Counties has drafted a resolution setting some avenues for sharing information in the future. I sit on the subcommittee that drafted it, btw. It’s hard to say if our state assembly and senate members will care enough about the problem to, you know, do something.

At least one smaller county¹¹ has decided to just stop paying the bills the state sends until they get more information about what is happening inside these centers. I wonder how long it will take before other counties do the same. This isn’t the preferred method of getting someone to pay attention—but is becoming the only avenue we have.

And is an avenue worth thinking about as the federal government strips services out of its budget. Why bother paying for something we don’t have or is forced on us without our consent?

Some links:

• This story made my blood boil.¹²

• If you don’t already know her story, you really should read about Madame C.J. Walker. And even if you do know who she is, you should refresh your memory.

• You should also know about Alice Ramsey.¹³

• My economist friend Karl¹⁴ is writing again. And he hit the nail on the head with this post about rural economies.

• Related to the above: you likely don’t know who really uses Medicaid.¹⁵

• You are meant to feel powerless. You aren’t.

1. First installment is here.

2. I’m work-shopping better titled, btw. Add your own!

3. The word “all” is doing some heavy lifting here but let’s proceed as if “protecting everyone equally” was an actual American value as opposed to something we trot out during eleciton season

4. My whole rant on how this system doesn’t always do what it is designed to do will be held for another day, if there are no objections

5. All states have these sorts of laws, mind. New York isn’t special, even though we want to be because we’re the EMPIRE STATE, yo.

6. For a big yikes, click here. This was the norm, tho, not an outlier.

7. The cost used to be split 50/50 with the state. In 2019, the state balanced their budget by dumping it all on counties. Coincidentally, cost has increased “over 6,000 13 percent in some smaller counties, such as Warren County (10,926 percent) and 14 Livingston County (6,549 percent).” You can’t blame that rate of rise on COVID alone.

8. Know that this is an imperfect analogy: Imagine that one day you find a bill in the mail for your car. You are no longer allowed to drive it but you have to pay $100,000 in order to have the possibility of driving it again. The agency can’t tell you when you can get back on the road. It won’t tell you what it’s doing to make it driveable in the forseeable future. In fact, you may never drive it again but it is impossible to know if that’s going to be the outcome. They are working on it, they say, but some things are impossible to predict.

9. maybe the year before? it all blurs together

10. Remember: a government isn’t a business or your personal finances. In an ideal world, a government will only collect what they need to provide services and no more. But you can’t do that when you can’t predict when the state will send you a large invoice that it decides is your problem.

11. Jefferson, for those scoring at home

12. and generally? I can stay pretty chill about news stories. But this one? Fury.

13. I very much want to write about her, Marvel Crosson, and Emily Post.

14. (mostly not dismal)

15. Hint: it’s the middle class and the elderly in nursing homes, not poor people who don’t want to work, which is what the ruling class want you to believe.