Note: This article was published in the December of 2002 edition of the Federal Probation, Volume 66, Number 3; Administrative Office of the United States Courts; Washington, D.C. 20544
Successful Reintegration into the Community: One NGRI Acquittee's
By Randy Starr
I would like to dedicate this article to James L. Cavanaugh Jr., M.D. and the staff at the Isaac Ray Center of Chicago, IL and to the memory of my mother. I would also like to thank Migdalia Baerga, MSW, Mental Health Administrator with the Office of Probation and Pretrial Services, Administrative Office of the U.S. Courts, for her encouragement and suggestions for this article, Ellen Fielding for her editorial support, and my wife "Sweetie" for her ongoing support and belief through over fifteen years of marriage.
[Editor's Note: Randy Starr's reentry story is unusual because of the circumstances of his crime, the court verdict of Not Guilty by Reason of Insanity, and the journey he has traveled since then. In 1979, Randy Starr was charged with the murder of his mother. Found not guilty by reason of insanity, he was hospitalized for five years, during which his condition was treated with psychiatric medications and intensive counseling. "I cannot remember when I have last seen a person use a period of enforced hospitalization as effectively for his own benefit as you have done," the director of his inpatient unit wrote him after his release.
Though Mr. Starr's path within the criminal justice system was uncommon, he faced many of the standard issues on reentry into the community under conditional release: finding a job and suitable housing, establishing responsible habits and a healthy lifestyle, dealing with loneliness, judging whom to confide in, etc. Released in 1984, Mr. Starr is employed as a staff training & development instructor, and has been married for over 15 years.]
REINTEGRATION INTO the community, as a "Not Guilty by Reason of Insanity (NGRI) "conditional-releasee" is a particularly challenging procedure. Most of those in this classification make it, but there are many that don't. This article is written with the intention of lending insight into some of the components that helped me successfully run this gauntlet of reentry.
fifty states in the
best to deal with their forensic populations. The legal and political atmosphere constantly
changes. The pendulum swings back and forth from the left to the right. Counting the Federal system, imagine 51 pendulums in motion, at different points, regarding how strict or liberally the laws deal with these forensic individuals. A friend of mine who works as an administrator in the mental health field compared this dynamic to a helix. We need to consider these constantly changing times and political and legal climates, and their accompanying philosophies on treatment and release. The Federal Court System has its own related trials and tribulations. Thus, what might appear to be a single theme of how to best contend with the delicate issue of appropriately monitoring the conditional-release of the Not Guilty By Reason of Insanity (NGRI) acquittee has 51 opportunities for variation. Presumably, the similarities will predominate over the numerous and distinct differences. There are specific desired ingredients required to make a successful conditional release, though, and I'll try to list some of those that worked for me. But first, let me briefly describe the unfortunate details of my case history.
In the latter part of 1979, while in a demented rage, I murdered my mother. My mental illness led me to believe that she was an evil person and that she was going to somehow hurt me.
At the time I thought my attack on her was self-defense. I was wrong. In fact, she was a good
person and innocent of any wrong-doing toward me. Both my paranoia and my twisted
thinking had become overwhelming. Nearly five years earlier I had been diagnosed as being schizophrenic of an undifferentiated type. Retrospectively, however, there were clearly a host of other behavioral maladjustments figuring in here, including, but not limited to: 1). My inclination toward mania, 2). My growing paranoia. 3). My poor impulse control and growing tendency toward violent outbursts. 4). My inability to appropriately deal with stress. And, 5). My life-learned pattern of seeing the world with an anti-social slant. After a brief hospitalization on a psychiatric ward in a general hospital, during those years I had received very unsuccessful and sporadic outpatient treatment. My maladjustments had merely worsened as my abuse of alcohol, prescription medications and street drugs increased. My mother's trust of me, her ignorance of mental illness and the innate vulnerability of being alone with a mentally ill person prone toward outbursts of violence all combined to put her in harm's way.
After a three-month stay in a horrendous county jail, I was found Not Guilty by Reason of
Insanity. Both a psychiatrist and a psychologist had examined me and agreed that I was, in fact,
insane at the time of the crime. At a bench trial, all parties in the
courtroom agreed on this insanity ruling. I was quickly sent to our maximum
security psychiatric facility in
For over a year I didn't realize the wrongness of what I had done. With the appropriate psychiatric drugs (which were to lessen my problems with anxiety, agitation and distorted thinking) and both excellent one-to-one counseling and group therapy, I started responding to treatment. One day the reality of my mother's murder fully set in, and I broke down in tears. We had finally reached a major turning point in the course of my inpatient treatment. Much challenging work, of course, remained, but at this point I quit nagging at the staff about when I might be discharged and started actively participating in the treatment plan being formulated for me.
I'd grown up in a family that didn't trust authority figures. We had warped family values and put too much focus on the merit of the big-eat-the-little mentality. Alcohol abuse was the norm, not the exception. When mental illness struck me a few years before my NGRI crime, I was ill-prepared to cope appropriately with anything remotely challenging in life. My recovery started with my hesitant steps at trusting others--a select few staff members to begin with. Later, I gained insight into my mental illness, and later still started better understanding the nature of my alcohol and drug abuse. This was a difficult process, requiring a lot of hard work on my part and on the part of many supportive staff members. Initially, I resisted the notion that I had both a mental illness and a serious alcohol and substance abuse problem. They call it being dually-diagnosed and that's what I was. As time passed, I was to gain much appreciation of the merits of Alcoholic's Anonymous.
case was monitored by a prestigious internationally acclaimed outpatient
forensic-oriented facility located on the near west side of
trust given to me by the
reminded me of Sergeant Friday off the old Dragnet TV Series. It was
clear that he was a no-nonsense interviewer and certainly not there to cater to
any nurturing needs that I might have. He talked a lot about the legalities
involved in the conditional-release process, the legal accountability all
parties were subject to. Dr. Cavanaugh explained that the
The only things remaining between me and court-mandated outpatient treatment by Dr. Cavanaugh and his staff were the judge presiding over my case, the state's attorney, a court-appointed psychologist, angry family members of my mother, community protest and the local TV media shoving their camera into my face and the local reporters writing less than accurate accounts of the procedure in the newspaper. My first attempt to gain conditional-release was denied by the court. At my second such attempt, about a year and a half later, I received the sought after approval.
in 1984, I once again hit the street. Although my ex-wife had been relatively
supportive during this challenging ordeal, she had divorced me about a year and
a half before I was conditionally-released. That was after five years as an
inpatient NGRI patient in the state of
The ease of the transition from inpatient to outpatient was largely the result of effort
and good planning on the part of the inpatient facility I'd been at, the outpatient facility I'd be
linked to and, my willingness to cooperate with those efforts. While I was
hospitalized, we'd followed some solid aftercare plans had been put together,
but for them to have any value I would have to use good old common sense and
follow these plans. First, my living situation. I'd
found a little studio apartment a couple of weeks before my conditional
release. The court had given its okay for the conditional release and now I had
to find a suitable place to live before the hospital staff could okay the
discharge. I quickly hit the bricks in search of an affordable and acceptable,
which posed a challenge because of my limited funds. There was also the reality
of how and where I was going to find anyone who would rent to someone with a
several year gap in their life history. The standards I set for my apartment
were marginal at best. It couldn't be a flophouse, but I couldn't afford
anything nice either. I walked the streets of north side Chicago, in an area
known for affordable and plentiful lodging
It was a rat hole and roach infested but it was a starting point for my new life. Though I could tell it wasn't going to be the safest place to live, it was marginally acceptable. I could tolerate its shortcomings by seeing it honestly, as just another stepping stone toward better times and better things. With the benefit of liberal pass privileges, a sincere drive to do well, and some street smarts, I'd managed to land myself a pretty good job at a large natural history museum as a cashier-clerk about six months before my actual release. It paid just a few cents above minimum wage, but the money allowed me to scrape by. I was proud of the place I was working at, and having my freedom counted for a whole lot to me.
the first year of my outpatient treatment I was required to attend a minimum of
one weekly session with a therapist at the
case. During that first year that I also was required to go twice monthly to an alcohol and
substance abuse counselor. I was also committed to attend a minimum of three A.A.
meetings per week for at least the first three months of my reintegration period. In addition, for those first three months I was required to show up at least once weekly at a neighborhood drop-in
center. The first two stipulations the weekly therapy session and the twice monthly visit to the substance abuse counselor were strictly monitored. The latter requirement of attending the three A.A. meeting per week and the once-a-week drop-in center participation, however, were monitored far more casually, though there was always the chance that I'd be given a spot-check analysis which would catch any alcohol or other substance abuse. I was never given such a spot-
check, but I was doing what I was supposed to with those requirements. Quite
frankly, a lot of good faith and trust were given to me by the
The challenges facing me during those first few months of my conditional release were plentiful. I was 34 years old and living independently. You need to understand that I'd left home and gotten married when I was just 16 years old. After 12 years of marriage to an often well-intentioned yet enabling spouse, I'd been hospitalized because of my NGRI crime. Here I was, however, living independently earning my wages, paying my bills, buying and cooking my own food, cleaning my own home and clothing, furnishing my apartment the best I could, keeping my appointments, figuring out my transportation needs, staying away from bad people, booze and street-drugs, and potentially compromising situations, and, perhaps, most stressful of all trying to keep the roach infestation problem under control. (The bugs were driving me nuts!) My frequent solitude and loneliness were also challenges. The stress level after just the first few weeks had me feeling as if my eyes were starting to bulge and my hair stand on end. I became far more understanding (even sympathetic) about other recently discharged patients I'd seen over the years, who had failed shortly after their return to the community. In the past I had reacted with some arrogance to their failure. I was no longer so arrogant now.
of the insight and coping skills I'd learned while in the hospital were being
reinforced by my outpatient treatment with the
hospitalized, I'd learned the importance of focusing more on what I had and
less on what I didn't have. Once out I had my freedom to focus on and the pride
of having done all that it takes to gain a conditional release. I learned to
accept and expect that I'd be doing without a lot of the simple pleasures of
life, while at the same time appreciating and savoring that which I did have in
life. A genuine positive attitude adjustment had been achieved over the years.
It's true that I was barely making enough money to pay my expenses. It's true
that I was living in an impoverished setting. It's true that at times I barely
had enough to eat. It's also true, however, that I was
a very fortunate individual who had gone through some extremely challenging
times and weathered them. Sure, my little studio apartment was a real dump. On
the other hand, I lived just a half mile or so from a nice public beach on the
I didn't have but on what I did have.
one of my museum co-workers paid a brief visit to my apartment. (I rarely had
any company over.) She was clearly aghast at the dirty and barren look it had,
and said so: "What are you, a Buddhist monk or something like that? Hey
guy, don't you have any furniture?" With a smile I responded, "Come
back in five years and I'll be doing much better." It was that confidence (which
grew from my newfound belief in God, my fellow-man and myself) and
willingness to be patient at achieving my goals that kept me in the winning
track. My goals were both realistic and attainable. At the same time, my
standards had become high. I was "sick and tired of being sick and
tired!" There was no longer any room in my life for self-destructive
losers. I figured that associating with negative people would be worse than
just being by myself at times. This proved to be a
valuable perspective, although I also avoided merely isolating. With
therapeutic help, I'd established a sufficient support network to get me by. My
support network had some significant strengths and weaknesses. For example, as
a part of my conditional release, I'd relocated to
NGRI element of my background was never discussed at the Substance Abuse
Center. Their staff never specifically mentioned it nor did I. We dealt with
issues directly associated with my staying away from alcohol or other substance
abuse. That was okay with me. In A.A. I shared freely
of my alcohol and other substance abuse-related problems, but always stayed
away from sharing information about my history of mental illness or any of the
NGRI stuff. Again, it was a choice I'd made, and no, I never got close enough
to any other A.A. member for them to be my sponsor or vice versa. The
about this element of my life. I always figured we've all got our secrets and crosses to bear. On
the other hand, if the response was more liberal and upbeat, I'd be more likely to get closer to
him or her. At work, I was even stricter with what I would share. I got along fine with my superiors and co-workers, and even received a couple of significant promotions over the five years I worked at my first "reintegration period" job. Still, I kept my cards close to my chest.
the while, I kept the content and quality of my interactions with the
say that I'm very proud to have received my five years plus court-mandated outpatient treatment
from such a high caliber facility!
I've stated earlier, there are fifty-one ways of approaching the topic at hand.
Both the overseeing psychiatric administrative staff (and the therapist responsible for the individual case) are held to a very high degree of responsibility to the legal system regarding closely monitoring the individual's continued behavior and mental status. As is the case for the NGRI inpatient in Illinois, mandatory supervisory reports continue to be sent to the court on a regular and frequent basis, and are often required as regularly as every sixty days.
House visits weren't ever initiated by the staff accountable for my continued compliance with their outpatient program. They at all times, however, could have easily showed up at my door steps, my place of employment, etc., and with no questions asked by me either. Had I been in violation on any level and in any manner, they could have had me cited with contempt of court, sending me, perhaps, first to the local county jail, then, back into the forensic psychiatric facility. Psychiatric decomposition would have likely quickly had me appropriately routed back into an inpatient status, too.
completed treatment with the
I worked with inpatient alcoholics and drug addicts, after that, I went on to
work as a field worker with an internationally based mental health
organization. Next, in 1996, and, perhaps, most significant in my continued
pursuit to "give back," I was hired as a consumer specialist working
with primarily with forensic patients at the largest psychiatric facility in
After working as their consumer specialist for over three years, I applied for the position I have currently had (for over three years now), that of a staff training and development instructor. I got this job not because of my extensive psychiatric history, but in spite of it. There was much competition for this position and many excellent candidates applied for it. I was the one hired, though. In this current position my history isn t too much of a focal point, although it is a commonly known reference point.
When I m not working I do a lot of networking throughout the mental health community and all the United States and even with some of my Canadian friends working in the field of forensics. I find this exchanging of information and experiences and insights gained very rewarding and my efforts seem to be appreciated by a host of mental health administrators and clinicians across the country. In my continued pursuit to give back to the society that has been so good to me over the years, these past five year, in particular, I ve presented at mental health conference, mostly of a forensic nature, and I ve written a lot, thus far mostly of a narrative nature. A couple of years ago, via an opportunity offered to me by Dr. Pat Corrigan, Robert Lundin and their staff at the Psychiatric Rehabilitation Center of the University of Chicago, I wrote and published a book, Not Guilty by Reason of Insanity: One Man s Recovery.
Years ago I first heard a particular quote that really grabbed my attention, although I have no idea of its origin, "You alone can do it, but you can t do it alone!" Partnership my friends, and reaching out to one another in the spirit of bettering that which has already been achieved in the arena of mental health services is our worthy goal. Together, let s keep the faith in both the merit of our own lives and the continued betterment of the lives of our fellow human beings. Life continues to go well for me and I m a contributing member of society. God bless you all!
Staff Training & Development Instructor