State program connects those found incompetent to stand trial with mental health services

NINA MOINI: Well, a few years ago, state lawmakers established what's called a competency attainment board and a program of forensic navigators. The program has now been in effect for a year. They discovered the need for this following a KARE 11 news investigation that revealed thousands of people charged with crimes were found mentally incompetent to stand trial but didn't receive mental health treatment.

Many of these people would go on to commit more violent crimes. Joining us now to talk about the impact of these resources so far are Ryan Flynn, the chair of the Competency Attainment Board, and Kim Larson, who oversees the Forensic Navigator program. Thank you both so much for joining us this afternoon.

RYAN FLYNN: Thank you for having me.

KIM LARSON: Yes. Thank you. It's nice to be here.

NINA MOINI: Absolutely. Kim, I think a lot of people may not understand the term "forensic navigator." Could you tell us a little bit about what that means?

KIM LARSON: Yeah, I'd be happy to. So forensic navigators are appointed by the court in a case when the competency of the defendant is in question. And they are there specifically to help the defendant navigate the systems that they need to access while they are attempting to attain competency. So we connect the individuals, the defendants, with services-- whether that's mental health substance use or other services-- housing, basic needs-- to try to help them gain stability and then attain competency so that they can resolve their case.

NINA MOINI: And, Ryan, I mentioned the KARE 11 investigation, but I'm sure that people in the justice system or people close to this had seen some of these warnings and kind of seen how things were working or not working. Can you talk a little bit more, Ryan, about what prompted the need for the board that you're on? And what were you seeing?

RYAN FLYNN: Absolutely. So, in addition to being on the board, I'm actually a prosecutor for Ramsey County Attorney's Office. Prior to that, I was a prosecutor in Chisago County. And this was a statewide problem where we would see people coming in with very serious cases.

They had a history, often, of having low level cases such as misdemeanors, trespassing, minor thefts. And we noticed that every time that they would come in to face criminal charges, they wouldn't be competent to be able to understand their rights, understand the process, or communicate with their defense attorney.

And we would try to get them services, but, really, the only way to get them services is wait for them to have significant mental health crises to make them a good candidate for civil commitment. And so, if they didn't get civilly committed--

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And when DHS, the Department of Human Services in Minnesota, oftentimes takes custody of people who are civilly committed and facing serious cases, however, they haven't had a major expansion in their bed capacity for decades. And so they also had to start restricting the services that they were giving for people who were not competent.

And that created additional pressure on the criminal courts. And what was happening is we were left sometimes even with homicides, repeat offenders who just weren't being able to get any services. And there were times where we had very serious cases, and the judges, strangely enough, would have to just tell the defendant, we're releasing you, and we're ordering you to go get yourself competent, because there was nobody who was going to be able to help them get through that process.

NINA MOINI: Is there ever the perspective, Ryan, and maybe this is silly, but that people wouldn't want to reach the point of competency because they wouldn't want to stand trial?

RYAN FLYNN: Well, of course. And there's also a diagnostic of malingering, where some people actually exacerbate their symptoms to try to avoid accountability for criminal charges. But a lot of times, these cases are not ones where we're even looking to send somebody to prison or be particularly punitive.

NINA MOINI: Right.

RYAN FLYNN: Many times, these are low level cases-- sometimes drug possession, sometimes trespassing-- where the community interest is just getting this person stable, getting them housing, getting them access to services that exist, but that they don't know how to get access to those services. And that was the real idea behind the Forensic Navigator program. It was this sort of pushback against this idea of brochure advocacy.

And everyone who's gone into a doctor's office has sort of sat in that lobby, and they've looked at the wall of brochures that tells them about available resources. Well, this is a high needs population. And the idea that we would expect them to go into that lobby and go through these brochures themselves to find housing assistance programs, medication assistance programs, and therapy programs really was just not based in reality, which is what the forensic navigators are here to do.

NINA MOINI: And, Ryan, the KARE 11 investigation found numerous examples where, in these cases, people would become more violent and more serious things-- one of the worst examples being, of course, the mass shooting at a medical clinic in Buffalo, Minnesota back in 2021. Can you talk a little bit about that specific instance and how that was an example?

RYAN FLYNN: Absolutely. So that was an example of somebody who had multiple misdemeanor cases that would be presented to the court. And under the old rule, misdemeanor cases, even if they were violent misdemeanors, would be automatically dismissed if somebody was incompetent. So it's not just that case, but other cases.

There's known cases in which somebody has misdemeanor domestic assault against family members. There's trespassing, misdemeanor threats, disorderly conducts. And what's happening is because they're not getting services, their behavior is becoming worse and worse. They're becoming more paranoid, often.

And they don't finally get that sort of significant intervention until they've become so dangerous that now they are a good candidate for being civilly committed as mentally ill and dangerous. Whereas, by putting the resources in early, we can try and off ramp those individuals so that they get services early to avoid these really tragic cases.

NINA MOINI: Yeah. And, Kim, that's where you all really come in, right? And I know it's only been a year. I don't know if that's a long enough time to know how things are going. But how are things going? What are the impacts that you're seeing so far with this greater attention?

KIM LARSON: Yeah. A year isn't very long, but we have seen, I think, some really positive impacts in different areas around the state. A couple of the immediate things that we've been able to bring to the system and help with are, just, one, at the very beginning, the court is also ordering those individuals to participate in what's called a court ordered examination.

And that's conducted by a forensic examiner to determine what's going on with the individual and what services they need. Our forensic navigators have been able to work with those court examiners and the defendants, and, in some instances, ensure that those court ordered examinations are happening in a more timely manner.

And so that's just a tiny piece. Something that we're seeing now that we have a few months of experience with our forensic navigators, is they're starting to be able to put together proposed programs and recommendations for descendants and presenting that information to the court. And then the court is looking at that and deciding where it's appropriate to send that defendant, what programs they should participate in. And, in many instances, we're now seeing that that is leading to a release from custody for the defendant so they can participate in programming, get the services they need, and start moving towards that stability and competency status that we're looking for.

NINA MOINI: Got it.

KIM LARSON: And that's just been, just in the recent months, a really exciting development for us that feels really great to see positive movement.

NINA MOINI: Absolutely. And, Ryan, I'll kick the last question over to you, because I understand the Forensic Navigator program is only able right now to cover about 20% of the cases they receive. With the need being so great, what else has to happen to be able to tackle this board?

RYAN FLYNN: Well, the first thing is we need an expansion of our services. So we do have a plan in place on the board side to significantly expand the number of forensic navigators so that we can address a greater percentage of the cases that are referred to us. The second thing that needs to happen is we have to identify more crisis beds in the state of Minnesota.

As I'm sure many are, unfortunately, aware, Minnesota ranks at the bottom in the nation for mental health crisis beds available. So we have to identify more beds. And we have to come up with some best practices so that we can get people into those beds and get people into stable housing, with stable services, with stable medication, because that's really what they need to be able to become competent.

NINA MOINI: All right. Ryan and Kim, appreciate your work and stopping by so much. Thank you both.

KIM LARSON: Thank you.

RYAN FLYNN: Thank you.

NINA MOINI: That was Ryan Flynn, the chair of the Minnesota Competency Attainment Board, and Kim Larson, the Forensic Navigator program administrator.