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
A
Successful Reintegration into the Community: One NGRI Acquittee's
Story
By Randy Starr
randy.starr@worldnet.att.net
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.
Randy
Starr,
[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.
The
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.
My
case was monitored by a prestigious internationally acclaimed outpatient
forensic-oriented facility located on the near west side of
The
trust given to me by the
He
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.
Late
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.
During
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.
All
of the insight and coping skills I'd learned while in the hospital were being
reinforced by my outpatient treatment with the
While
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
shores of
I
didn't have but on what I did have.
Once,
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
The
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.
All
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!
As
I've stated earlier, there are fifty-one ways of approaching the topic at hand.
In
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.
I
completed treatment with the
Initially,
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!
Randy
Starr
Staff
Training & Development Instructor