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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

PDO - MH Case Manager Policy and Procedure Manual ii

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

PDO - MH Case Manager Policy and Procedure Manual 1

competency and 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.


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 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 mental-health

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 system for those suffering from mental illness or an

intellectual disability.

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.

“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.

“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.


“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 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.


“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.


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 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, 6. Source of income, 7. Assets and property owned, 8. Outstanding obligations, 9. Necessary expenses, 10. The number and ages of dependents,

and11. 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 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.

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.

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.


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 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 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.


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

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.

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.

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.

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.

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

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.

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.

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 providers to assist with

in-house training regarding resources available in the

community.


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


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.

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 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.


1Endnotes

Although originally designated as “Mental Health/Social Worker” the position was later denominated as “Mental Health Case Manager.”2 TEX. CODE CRIM. PRO. ART. 26.051.3 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.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 503.9 See A Better Model: Ensuring Equal Justice for Persons with Mental Illness & Mental Retardation, Texas Appleseed, Pamphlet.

Appendix

Appendices not included in this report.

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