Prosecutor fights to do right by mentally ill
In commitment cases, Travis Co. attorney helps families seeking care
Sixth in a continuing series
AUSTIN — The morning started like any other for Barb MisleFreund, Travis County’s chief mental health prosecutor. She drove the 25 miles from her home in Jonestown, where she lives by a lake, to Central Market on North Lamar Boulevard. She ordered a small coffee, filled to the brim.
The grocery store backs up against Austin State Hospital, where Misle-Freund spends several days a week in a courtroom, and where she expected to be for hearings one recent Monday. She dressed for it with a distinct sense of style: a black vest, layered over a white button-down and black tank, plus a knee-length skirt and shiny heels. Her eyes hid behind a pair of Ray-Ban aviators. She snapped a lid on her coffee and poked in a straw.
The hospital was also where a Houston-area mother recently hoped her son would be admitted for care. Warren Muldrow, 23, bipolar and drug abusing, had been in and out of local psychiatric wards and jails for years.
Those involved in Warren’s case agreed he shouldn’t stay in the Fort Bend County jail, where he landed
after violating a probation sentence he received for calling 911 and making threats. But they struggled to find a suitable place to send him in the state’s woe-fully underfunded mental health system, where few community alternatives exist to treat those with serious mental illnesses before there is “a substantial risk of serious harm to the person or to others” — the legal standard for an emergency detention.
In late August, a mental health professional concluded Warren met that standard, and District Judge Chad Bridges in Fort Bend approved his transport to the Austin State Hospital, one of nine state adult psychiatric institutions. How long he would be hospitalized became a question to be answered, at least in part, by a team that includes Misle-Freund.
She is the first to admit it’s not a perfect system, but this is not for want of effort by those involved. The state hospitals are essentially full and, consequently, face pressure to move patients in and out as quickly as possible. State law allows those who are involuntarily committed to remain forupto 120days for treatment, with the possibility for extensions beyond that. But the current average stay for a civil patient in Austin is much shorter.
The hospitals divide their available beds between civil, for those like Warren who do not have pending criminal cases, and forensic, for thosewho have been committed by the courts to be sufficiently rehabilitated so they can stand trial. There is so much demand for forensic beds that they tend to crowd out civil beds, which only increases the pressure tomove those patients.
Sipping her coffee on the grocery store patio, her blond hair pulled back from her tan face, Misle-Freund consulted a spreadsheet on her iPhone for what might be coming that afternoon at so-called probable cause hearings.
The commitment process goes like this: If a police officer takes a mentally ill person to a hospital, believing that person is a threat to self or others, the hospital can hold him or her for 48 hours. Once a decision is made that a longer stay is necessary, a probable cause hearing must be held before a judge within 72 hours.
Misle-Freund would see those who wanted to get out of the hospital at their hearings later in the day. Or they could ask Melissa Ferrell, the Travis County mental health public defender, to go on their behalf. Warren’s mother, Shelia Muldrow, had attended his hearing two weeks before.
Coffee in hand, Misle- Freund figured Ferrell was still visiting the clients to determine who was and was not willing to stay. “This is actually a small Monday,” Misle-Freund said, looking through the list of about adozen names. “The thing is, you never know what we’re going to get.”
A Dallas native, MisleFreund developed an early interest in law. Anincident her sophomore year at the University of Texas, where she studied political science, focused that even further. Aman known as “the choker” raped more than 10women, including her.
Misle-Freund felt lucky to be alive. She decided to pursue a career in which she could help others. A few years into her first job at the county attorney’s office, a transfer into the nascent mental health division proved to be just that. She could help people like Shelia, who sought to get her son the care he needed. The task was rarely straightforward, but over 20 years, with countless individuals, she’d given it her utmost. “We have the responsibility to try,” she said.
A few minutes before the scheduled 1p.m. start of the hearings, Misle-Freund arrived at the courtroom on the hospital’s campus. The room, located in a mazelike building, stood adjacent to a seating area with furniture fit for a doctor’s office. The first time she visited, Shelia had trouble finding it.
Misle-Freund greeted the sheriff’s deputy and sat down at a long table in the courtroom. Positioned at the head, John McCormick called out the docket: 12 people had waived hearings. One had been released. Two wanted to argue their case.
A private attorney, McCormick serves among a rotation of “special masters” who preside in monthlong stints over the probable cause docket. McCormick wore suspenders and a shirt embroidered on the cuffs with his initials, but no judge’s robe.
The first client entered the room and sat across the table from Misle-Freund, next to Ferrell, the defense attorney. The client wore street clothes, with the exception of shoes, which were removed because of the laces. (Confidentiality requires that no identifying detail be revealed about clients, even whether they are male or female).
Misle-Freund began, as she usually does, by questioning the client. She asked about the person’s living situation. The reply sounded reasonable. Then she wanted to know how the person provided for himself or herself, and the conversation grew nonsensical. Misle-Freund asked about the client’s diagnosis.
Here the discussion rambled with a description of a life plagued by controlling, supernatural forces. It had been a struggle to combat them. “I feel like you’re a part of my problem, too,” the person told Misle-Freund at one point. She didn’t mean to be.
Misle-Freund’s aim was to present all of the information she could so the court could fairly decide in the person’s best interest. She took the client’s assertions seriously, no matter how strange, preferring to give the client the benefit of the doubt.
Misle-Freund questioned a social worker about observations of the person. The client slouched quietly, head shaking. Ferrell, whose job is to advocate for what the client wishes, countered that the person had not been evaluated recently. The client tapped a sock-covered foot under the table.
For the defendants who seem dangerous, MisleFreund feels the pressure of winning the case, meaning the clients remain in custody. She knows consequences can be horrific if they’re let out prematurely. She often becomes the ally of family members like Shelia, who are fighting to get their children clinical care. But the decision is ultimately out of her hands.
At 1:55 p.m., the special master-determined theperson needed to be detained longer. He sent them out with well wishes.
The next person entered and sat in the same gray armchair. “How are you?” Misle-Freund asked. The special master read the case number. The witnesses were sworn in. Questioning began.
The client spoke animatedly, using broad hand gestures. Then, almost immediately, the client broke down into heaving sobs. Misle-Freund slid a box of tissues across the table. Thiswas nothing unusual. She’d seen people scream or strip naked or lunge across the table. Once, someone tossed a cup of spit at her.
“Do you need a moment?” the special master asked. The conversation continued, almost ina rant. Ferrell, as she had the previous client, reminded the person that only the questions asked needed to be answered.
The client agreed to stay a little longer at the hospital. The hearing would not continue.
It was like the outcome in Warren’s case. He, too, had changed his mind and said he would remain. Later, he waived his commitment hearing, meaning he wouldn’t contest it or attend. But his mother had been there for both, just in case her input was needed. She spent $39.25 after the second one to buy more clothes for Warren towear. She’d hoped he would be staying a little while.
After court, MisleFreund returned to her office downtown. A man from the state hospital waited in the lobby with new requests to continue holding patients who recently arrived.
Misle-Freund took the stack from him and dropped it off with the paralegal, who would comb through it for mistakes that might inadvertently lead to a person’s release.
The attorney walked downthe hall and knocked on the door of Ruben Baeza, with whom she shares the civil mental health docket. A criminal prosecutor, Jason Steans, sat with him inside. He was wondering about the civil commitment process.
As the conversation progressed, Steans lamented that the system was overburdened. Inparticular, he bemoaned the lack of residential facilities for “medium level” clients, people who don’t do well in the community but also don’t qualify to be hospitalized long term — people like Warren. And who could forget that the state ranked near last in per capita mental health spending?
Misle-Freund, who hadn’t yet had lunch, tried to cheer him up.
“Think about where we started, and where we are,” she said, perched on Baeza’s desk. “It’s a hell of a lot better.”
Returning to her office, Misle-Freund explained they do the best with what they have. She noted how people now also explore more creative approaches to treatment, like taking up yoga, or ceasing to drink alcohol, along with taking their medications.
Still, for Misle-Freund, there remained a certain harsh reality faced by families like the Muldrows everyday. The state doesn’t do enough to keep people out of hospitals. Instead it lets people rotate in and out of a place that should be a last resort.
“If it was my child,” she said, “Iwould get out of the state of Texas.”
Five days later, on Sept. 16, Warren was released. His stay had lasted 24 days.
Specially trained Fort Bend County sheriff’s deputies picked him up, and he was back by 2 p.m. to the place where officials had been so eager to remove him, the Fort Bend County Jail.
Coming next: Out of the hospital, Warren awaits a space in a drug rehabilitation program. emily.foxhall@chron.com twitter.com/emfoxhall