OFFICE OF THE PUBLIC DEFENDER
WICHITA COUNTY, TEXAS
MENTAL HEALTH CASE MANAGER PROGRAM
POLICIES AND PROCEDURES MANUAL
Table of Contents
Introduction ..................................................................................... 1
Mission Statement ........................................................................... 3
Glossary ........................................................................................... 6
Indigence Criteria and Indigence Proceedings ............................. 12
Caseload Criteria ........................................................................... 18
Duties and Responsibilities ........................................................... 23
Training and Education................................................................. 28
Workload and Caseload Standards ............................................... 31
Data Collection and Reporting ...................................................... 32
Confidentiality Standards ............................................................. 33
Endnotes ........................................................................................ 35
Appendices ...........................................................................Attached
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Introduction
In 2012, the Wichita County Public Defender’s Office
(“PDO”) sought to address the needs of indigent clients with
mental health issues and attorneys representing those clients. The
PDO applied for a grant from the Texas Indigent Defense
Commission (“TIDC”) seeking a permanent “Mental Health Case
Manager” position1 and in the Summer of 2012, the TIDC
awarded Wichita County and the PDO a Multi-Year Discretionary
Grant beginning in Fiscal Year 2013 establishing the position of a
Mental Health Case Manager. Wichita County envisions this
position as a permanent resource for the indigent accused.
The Mental Health Case Manager Program intends to
facilitate diversion of indigent mentally ill and intellectual
development disability (“IDD”) clients from the criminal justice
system to the mental health system, monitor competency and
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competency restoration, and find and present available mental
health and IDD resources to counsel. If necessary, the Mental
Health Case Manager may assist attorneys in developing an
insanity defense or presenting mental health matters on behalf of
the accused for trial or plea negotiation.
The Mental Health Case Manager also develops and
investigates other creative measures that specifically help the
indigent defense bar effectively represent mentally ill or IDD
clients. The Mental Health Case Manager is available to educate
the local bar about the program and the process for utilization of
the Mental Health Case Manager as a resource.
In November 2012, the Mental Health Case Manager began
accepting referrals, screening indigent clients and assisting
attorneys. The creation of this manual is an effort to accomplish
the overall mission of providing assistance of counsel to all
indigent individuals.
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Mission Statement
The Sixth Amendment to the United States Constitution
guarantees that—In all criminal prosecutions, the accused shall
enjoy the right … to have the Assistance of Counsel for his defence.
See U.S. Const. Amend VI.
Individuals suffering from mental illness or an Intellectual
Developmental Disability (“IDD”) are frequently in and out of jail
due to their illness or condition. A myriad of difficulties confront
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attorneys representing these clients. Attorneys frequently are
unprepared to handle clients with mental health issues and often
lack the time or the ability to recognize the needs of such clients
and link them with available resources. These difficulties prolong
incarceration, delay trial and disposition, prevent needed mentalhealth treatment and unnecessarily burden the criminal justice
system with the management of these individuals.
The right to the assistance of counsel for the defense—a
basic and fundamental right of all civilized societies—must
include as a part of its adversary process the right to seek and
employ experts, investigators and individuals schooled in the
principles of mental health. Meaningful access to the criminal
justice system requires nothing less than full assistance by
learned counsel with help from such qualified professionals.
It is the mission of the Office of the Public Defender of
Wichita County, through the creation of the Mental Health Case
Manager position, to promote full access to the criminal justice
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system for those suffering from mental illness or an intellectual
disability.
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Glossary
In this Manual the following terms, phrases, definitions and
explanations apply:
“Assigned counsel” means an attorney licensed to practice
law in the State of Texas and listed on the Wichita County Court
Appointment List as maintained by the Wichita County Court
Administrator.2
“Axis I” denotes those clinical syndromes psychiatrically
classified as such in the Diagnostic and Statistical Manual
(“DSM”) multi-axial system.3
“Axis II” denotes those developmental and personality
disorders psychiatrically classified as such in the Diagnostic and
Statistical Manual (“DSM”) multi-axial system.
“Continuity of Care Query or CCQ” represents a database of
individual and confidential mental health information maintained
by the State of Texas for use by local jail and detention facilities.
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“Counsel” means the Chief Public Defender of Wichita
County, Texas, and his assistants or counsel appointed by the
District or County Courts of Wichita County, Texas to represent
an indigent client.
“County” means Wichita County, Texas as represented by
the Constitutional County Judge and Commissioners’ Court of
Wichita County, Texas.
“Criminal District Attorney or DA” means the elected or
appointed Criminal District Attorney of Wichita County, Texas
including assistants, investigators and staff.
“Diagnostic and Statistical Manual of Mental Disorders
(“DSM”) represents the official system of classifying psychological
and
psychiatric
disorders
as
published
by
the
American
Psychiatric Association. Mental health professionals currently
utilize various versions of the DSM.
“Household”
means
all
individuals
who
are
actually
dependent on the accused for financial support.
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“Indigent Client” means a person who is not financially able
to employ counsel according to the Wichita County and District
Courts Indigence Defense Plan. A full explanation of the criteria is
included as a part of this manual.
"Intellectual Developmental Disability or (“IDD”)" means
significantly
sub-average
general
intellectual
functioning
concurrently existing with deficits in adaptive behavior and
originating during the developmental period of life.4
"Mental illness" means an illness, disease, or condition,
other than epilepsy, senility, alcoholism, or mental deficiency,
that:
(A) Substantially impairs a person's thought, perception of
reality, emotional process, or judgment; or
(B) Grossly impairs behavior as demonstrated by recent
disturbed behavior.5
"Mental retardation" means Intellectual Developmental
Disability.
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“Net household income” as applied to the Indigence Defense
Plan means all income of the accused and spousal income actually
available to the accused.
Net Household Income includes: take-home wages and
salary (gross income earned minus those deductions required by
law or as a condition of employment); net self-employment income
(gross income minus business expenses, and those deductions
required by law or as a condition of operating the business);
regular payments from a governmental income maintenance
program, alimony, child support, public or private pensions, or
annuities; and income from dividends, interest, rents, royalties, or
periodic receipts from estates or trusts. Seasonal or temporary
income shall be considered on an annualized basis, averaged
together with periods in which the accused has no income or lesser
income.
“Public Defenders Office or PDO” means the Office of the
Public Defender of Wichita County, Texas and incudes the Chief
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Public Defender, assistant public defenders, investigators and
staff.
“Screened or Confidential Screen” (sometimes known as a
“Chinese Wall or Screen”) refers in this manual to a method of
separating files and material maintained by the Mental Health
Case Manager for the benefit of indigent clients represented by
lawyers with the PDO from those files and materials maintained
for the benefit of indigent clients represented by assigned counsel.
The
Screening
system
guards
against
conflict-of-interest
situations and violations of the Texas Rules of Disciplinary
Conduct.
“Sheriff’s Office” means the Wichita County Sheriff’s Office
(“WCSO”), its elected or appointed Sheriff, deputies, jailers and
staff.
“Texas Indigent Defense Commission or TIDC” means the
Texas Indigent Defense Commission, the official grant authority
and supervising agency.
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“The
Cost
of
Obtaining
Competent
Private
Legal
Representation” is a phrase that includes the reasonable cost of
support services such as investigators and expert witnesses as
necessary and appropriate given the nature of the case.
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Indigence Criteria and Proceedings
The Mental Health Case Manager’s services are reserved for
indigent defendants who have been assigned attorneys by the
Wichita
County
Indigent
Defense
Coordinator.
Indigent
defendants include those represented by the Office of the Public
Defender of Wichita County and/or the assigned counsel (or,
appointed counsel) system of Wichita County.
Defendants
applying for appointed counsel must meet the following criteria.
Indigence Criteria.
In Wichita County, Texas, an accused is presumed indigent
if any of the following conditions or factors are present:
1.
At the time of requesting appointed counsel,
the accused or accused’s dependents are eligible to
receive food stamps, Medicaid, Temporary Assistance
for Needy Families, Supplemental Security Income, or
public housing;
2.
The accused’s net household income does
not exceed 100% of the Poverty Guidelines as revised
annually by the United States Department of Health
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and Human Services and published in the Federal
Register; or
3. The accused is currently serving a sentence in
a correctional institution, is currently residing in a
public mental health facility, or is subject to a
proceeding in which admission or commitment to such
a mental health facility is sought.
An accused who does not meet any of the standards above
shall nevertheless be considered indigent if the accused is unable
to retain private counsel without substantial hardship to the
accused or the accused’s dependents. In considering if obtaining
private counsel will create a substantial hardship, the appointing
authority shall take into account:
1.
The nature of the criminal charge(s),
2.
Anticipated complexity of the defense,
3.
The estimated cost of obtaining competent
private legal representation for the matter(s) charged,
4.
The amount needed for the support of the
accused and the accused’s dependents,
5.
Accused’s income,
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6.
Source of income,
7.
Assets and property owned,
8.
Outstanding obligations,
9.
Necessary expenses,
10.
The number and ages of dependents, and
11.
Spousal income that is available to the
accused.
Factors NOT to be considered in determining indigence:
1. The accused’s posting of bail or ability to post
bail may not be considered in determining whether the
accused is indigent.
2. The resources available to friends or relatives
of the accused may not be considered in determining
whether the accused is indigent.
Only the accused's financial circumstances as measured by
the financial standards stated in this rule shall be used as the
basis for determining indigence.
Indigence Proceedings:
The appointing authority (i.e., the Wichita County Indigent
Defense Coordinator) can require the accused to respond to
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questions
about
the
accused’s
financial
status,
produce
documentation supporting financial information provided, and/or
order a court official to verify financial information provided.
Information gathered for determining indigence, both in the
affidavit of indigence and through oral examination, may not be
for any purpose other than:
1.
Determining if accused is (or is not)
indigent; or
2.
Impeaching direct testimony of accused
regarding the accused’s indigence.
A request by the appointing authority for additional
information, documentation, and/or verification cannot delay
appointment of counsel beyond the timelines specified in Parts I
and IV of these rules and contained in Code of Criminal Procedure
article 1.051.6
An accused determined to be indigent is presumed to remain
indigent for the remainder of the case unless a material change in
the accused’s financial circumstances occurs.
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An accused’s status as indigent or not indigent may be
reviewed in a formal hearing at any stage of court proceedings, on
a motion for reconsideration by the accused, the accused’s
attorney, or the attorney representing the state. The accused’s
indigent status will be presumed not to have changed. The
presumption can be rebutted in the review proceedings based on
the following:
1.
Evidence of a material change in the
accused’s financial circumstances, as a result of which
the accused does not meet any of the standards for
indigence contained in these rules; or
2.
Additional
information
regarding
the
accused’s financial circumstances that shows that the
accused does not meet any of the standards for
indigence contained in these rules.
If an accused previously determined to be indigent is
subsequently determined not to be indigent, the attorney shall be
compensated by the county according to the fee schedule for hours
reasonably expended on the case.
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If the court determines that an indigent client has financial
resources enabling him to offset in part or in whole the costs of the
legal services provided, including expenses and costs, the court
shall order the indigent client to pay during the pendency of the
charges, or, if convicted, court costs in the amount that it finds the
indigent client is able to pay.
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Caseload Criteria
To be eligible for the Mental Health Case Manager program,
a client must be indigent as determined by the criteria explained
in this Manual and must currently have or must have had in the
past (1) an Axis I diagnosis or (2) an Axis II diagnosis of an
Intellectual Developmental Disability as defined by the DSM.
Axis I Clients
This is the top tier of the DSM Multi-Axial format. The most
common and widely recognized clinical diagnoses are Bipolar
Disorder, Schizophrenia and Depressive Disorder, but any Axis I
or IDD condition will permit the opening of a mental health file.
Psychotic behavior is not required and may or may not accompany
any qualifying Axis I clinical diagnosis.
The Mental Health Case Manager will obtain verification of
previously diagnosed Axis I and IDD disorders, if possible, or work
with counsel to arrange an evaluation if an Axis I or IDD
diagnosis is suspected and continue to research resource options
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available to the client in line with a proper outcome of their legal
case.
Intellectual Developmental Disability (IDD) Clients
Formerly
known
as
Mental
Retardation,
Intellectual
Developmental Disability or IDD is generally recognized as having
a Full Scale IQ of 70 or below and includes requisite adaptive
deficits that manifested before the age of 18 to 21. The Mental
Health Case Manager will research community resources for
which the indigent client may qualify. The Mental Health Case
Manager will communicate between community agencies, the
indigent client, and assigned counsel to coordinate efforts to
secure resources for the indigent client that will achieve the best
outcome for their legal case.
Referral and Assessment
To apply for admission to the program, a referral form must
be completed for the indigent client detailing contact information,
criminal charges, qualification for the program, and what services
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are needed from the program.
Appointed counsel, a PDO
attorney, court personnel such as the Wichita County Court
Administrator’s Office, Sheriff’s Office or jail staff, or any person
with knowledge of an accused’s mental health history may
complete the referral form. See Appendix 2.
CCQ and Referral
The Wichita County Public Defender’s Office has a working
relationship with the Wichita County Sheriff’s Office and the
Wichita County Court Administrator’s Office. The WCSO has
access to the Continuity of Care Query (CCQ) identifying
individuals arrested but who have received State or local mental
health services. While the WCSO is not allowed to provide any
detailed information regarding the information found in the CCQ,
The WCSO will notify the Mental Health Case Manager that an
indigent client who is currently incarcerated may need to be
assessed.
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The Wichita County Court Administrator’s Office is often one
of the first entities to become aware of an indigent client’s mental
health issues through the form known as the Declaration of
Inability to Hire Counsel and Request for Court-Appointed
Counsel.
After receiving the referral, the Mental Health Case Manager
will informally assess the accused for mental illness and/or IDD by
interviewing the accused, seeking prior determinations of
incompetency/ mental illness/ IDD, interviewing family members
or other social service providers to determine whether the accused
likely suffers from mental illness or IDD. If the indigent client
meets caseload criteria counsel will be notified (in writing, if
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necessary). Counsel will be notified of any denial from the
program and the reasons for the denial.
Once the Mental Health Case Manager identifies a client
suffering from mental illness or IDD, the indigent client will
become part of the mental health caseload.
After a client is
admitted to the program, the Mental Health Case Manager will
coordinate with the appointed counsel regarding the role of the
Mental Health Case Manager and the services that are desired.
The Mental Health Case Manager will meet with the indigent
client face-to-face for an intake assessment within 14 days of
admission to the program. (See Appendix 3). The indigent client
will be asked to sign Release of Information forms during this
assessment, which will allow release of information to counsel and
to the Mental Health Case Manager. The Mental Health Case
Manager will then discuss with the counsel any identified needs or
services that the Mental Health Case Manager can assist with or
attempt to resolve.
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Duties and Responsibilities
The Mental Health Case Manager assists PDO attorneys,
investigators and assigned counsel to screen and identify indigent
clients
suffering
from
mental
illness
and/or
Intellectual
Developmental Disability so these individuals may be:
(1) Promptly diverted from jail to a suitable mental health
care facility or program outside the criminal justice system;
(2) Appropriately helped while awaiting trial or disposition,
if necessary; and/or,
(3) Successfully treated within the community supervision
system in order to avoid revocation and recidivism.
The Mental Health Case Manager will work with PDO
attorneys and assigned counsel to achieve appropriate dispositions
of cases that take into account the mental health needs of the
client. To that end, the Mental Health Case Manager may
facilitate services and recommend programs based on a client’s
diagnosis, level of need and ability to access services.
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If released from incarceration prior to disposition, the
Mental Health Case Manager may act as a liaison between
indigent clients and attorneys ensuring that the client is aware of
court appearances and attorney appointments.
The Wichita
County Court Administrator’s Office has access to a database and
is able to report appearance dates to the Mental Health Case
Manager. Depending on the client’s circumstances, the Mental
Health Case Manager may provide traditional social services such
as arranging transportation, applying for housing, and referring
the client to appropriate medical and/or psychiatric treatment
providers when such services are justified. These efforts, however,
should directly assist attorneys in providing legal services for the
indigent client.
When an indigent accused remains incarcerated during the
pendency of his/her case, the Mental Health Case Manager shall
work with jail officials and local behavioral health and social
service providers in order to coordinate and monitor services.
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Competency Evaluations
After an initial assessment of indigent clients who appear to
suffer from mental illness or an intellectual disability the Mental
Health Case Manager will discuss with counsel and consider shall
the need for a competency examination. If the evidence warrants
it and counsel agrees, the Mental Health Case Manager will
complete a Motion for a Competency Evaluation and obtain an
Order for a Competency Examination.7
The
Mental
Health
Case
Manager
will
schedule
a
competency examination and monitor the completion of the
examination. If the indigent client is ultimately determined
incompetent the Mental Health Case Manager will provide the
necessary court order or orders and completed competency
evaluations to the North Texas State Hospital or a Local or
Regional Mental Health Authority or entity or licensed mental
health professional for commitment or treatment to regain
competency.
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The Mental Health Case Manager will follow-up and
communicate with the psychiatric facility, authority or entity for
updates on the indigent client’s progress in regaining competency.
The Mental Health Case Manager also works closely with the
Wichita
County
Court
Administrator’s
Office
regarding
competency examinations and commitments for competency
restoration for the purpose of ensuring the Courts are aware of
competency restoration commitments and to avoid delays as a
case moves through the court system to final disposition.
Insanity Defense
It is an affirmative defense to a prosecution that at the time
of the conduct charged, the actor (the accused), resulting from
severe mental disease or defect, did not know that his conduct was
wrong.
The Mental Health Case Manager will assist counsel with
gathering records and evidence and the development and
presentation of an insanity defense at trial, if warranted by the
evidence.8
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Counsel Involvement
All interaction on a mental health case will be with the
express consent and at the direction of counsel. Before beginning
work on a case, the Mental Health Case Manager will consult
counsel regarding the accusations and case direction, as well as
any specific requests of counsel. In this regard, the Texas Rules of
Evidence and the Texas Rules of Disciplinary Conduct govern all
discussions with counsel and the client.
The Mental Health Case Manager maintains separate files
in locked cabinets for indigent clients of the Public Defender’s
Office for those indigent clients of private appointed counsel. See
Confidentiality, infra.
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Training and Education
The Mental Health Case Manager will reach out to the local
indigent defense bar and provide both training and education in
an effort to link resources available to the needs of the indigent
mental health client and attend and participate in mental health
educational opportunities.
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In-House Training
The Mental Health Case Manager will provide training to
PDO lawyers regarding the importance of meeting the mental
health needs of clients as part of resolving their legal issues and
will attend all in-house staff meetings and provide regular
training on current and developing resources for indigent clients
with mental illness or Intellectual Developmental Disability. The
Mental Health Case Manager will also coordinate with community
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providers to assist with in-house training regarding resources
available in the community.
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Workload and Caseload Standards
It is difficult to establish a strict caseload or workload
standard for mental health cases because of the breadth and
depth of illness and conditions as well as the diversity of clients
demonstrating a need for services. As a general guideline,
however, there seems to be a rough consensus that a single
caseworker (in this case the Mental Health Case Manager) should
be such that their caseload does not exceed 20 to 30 open cases at
any given time, with a caseload of about 80 to 100 cases over the
course of a year.9
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Data Collection and Reporting
The TIDC monitors the program and collects data and sets
standards.
The Mental Health Case Manager maintains records of cases
in the program, which includes dates of the following: arrest,
bond, appointment to PDO or assigned counsel, initial contact,
case filling, disposition and outcome, referral to Mental Health
Case Manager Program, and the Mental Health Case Manager
assessment. Data reflects the number of referrals made on each
case and whether the case is a felony or misdemeanor. The Mental
Health Case Manager also tracks the case name and attorney
assigned. See Appendix 4.
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Confidentiality Standards
The Mental Health Case Manager will establish and
maintain a confidential screen between two sets of files and
materials—one set of files and materials for PDO lawyers and one
set of files and materials for assigned counsel. The Mental Health
Case Manager will separate and segregate the files and materials
of assigned counsel from all other files especially PDO files. The
Mental Health Case Manager will have sole care, custody and
control of assigned counsel files and materials. Assigned counsel
files and materials will be locked in a separate filing cabinet and
screened from PDO lawyers and staff and only the Mental Health
Case Manager will possess the key to the filing cabinet.
The Senior PDO Investigator shall have limited access to the
assigned counsel filing cabinet key. Access by the Senior PDO
Investigator shall be exercised only for the purpose of obtaining
assigned counsel files and materials and delivering them to
assigned counsel in the event that the Mental Health Case
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Manager is absent, incapacitated or if the position of Mental
Health Case Manager is vacant.
The files and materials of the Mental Health Case Manager
are privileged legal materials subject to the attorney-client
privilege of the lead counsel handling the indigent client and will
be maintained in strict confidence at all times by the Mental
Health Case Manager. For purposes of this manual and in
practice, the Mental Health Case Manager position constitutes a
“representative of lawyer” as defined by Texas Rules of Evidence,
Rule 503.
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Endnotes
Although originally designated as “Mental Health/Social
Worker” the position was later denominated as “Mental Health
Case Manager.”
1
2
TEX. CODE CRIM. PRO. ART. 26.051.
Several revisions of the DSM exist. This manual does not
distinguish between DSM versions. Clients’ diagnoses may be
consistent with earlier versions of the DSM. This fact will not
affect a decision to open a caseload file or provide services.
3
4
TEX. HEALTH & SAFETY CODE § 591.003 et. seq.
5
TEX. HEALTH & SAFETY CODE § 571.003 et. seq.
6
TEX. CODE CRIM. PRO. ART. 1.051.
7
TEX. CODE CRIM. PRO. ART. 46B.001 et. seq.
8
Tex. Rules of Evid. Rule 503.
See A Better Model: Ensuring Equal Justice for Persons with
Mental Illness & Mental Retardation, Texas Appleseed, Pamphlet.
9
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Appendix
Appendices not included in this report.
{ This space reserved for expansion}
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