A short article in today's Inquirer reminded me that the problem of mentally ill criminals is not limited to the New York subway system. Notwithstanding all their protection and security measures, even the courts aren't safe:

YORK, Pa. - The county sheriff has apologized for what he called an "embarrassing and egregious" security breakdown after court security workers missed a knife later thrown at a judge in a courtroom.

Terry Lee Rehm, 58, was arrested Thursday after authorities said he threw a 13-inch butcher knife at Judge Michael J. Brillhart, who was seated on the bench. The knife went over the heads of several county employees and a defendant and sank into a wall to the judge's left, authorities said. No one was injured.

The man charged with hurling a butcher knife at a county judge Thursday was also arrested 2½ years ago, accused of threatening to blow up the courthouse and demanding to talk to Satan.

On Feb. 24, 2004, Rehm walked into the office of Karla Forbes, a court reporter, and told her he was the author of "The Invisible Line," according to the arrest affidavit from the incident.

He told Forbes and Beth Ness, another court reporter, that he wanted to talk to Satan, Jesus Christ and Mr. York County, the document states, and that he wanted justice. It also states Rehm told the women he was a terrorist and wanted to blow up the courthouse.

When the women asked him to leave, he refused. When sheriff's deputies intervened, Rehm sat down on courthouse steps and repeated that he was terrorist and that they would have to carry him out.

When deputies picked him up, he started screaming, according to the document.

Rehm was handcuffed and taken to York Hospital.

Rehm was charged with disorderly conduct and making terroristic threats. In a request to determine Rehm's competency to stand trial, his attorney, T. Korey Leslie, wrote that the man "appears to suffer from a mental disorder and has at least one known prior commitment to a mental hospital."

Rehm also "demonstrated bizarre and inappropriate behavior in the presence of counsel," Leslie wrote, and he was unable to "communicate with counsel coherently or logically."

Following a psychological examination to determine whether he was fit to stand trial, the misdemeanor charges were dropped in October 2004, court records show. However, court records available do not indicate why the charges were dropped. The prosecutor and defense lawyer in the case couldn't be reached for comment.

In last week's incident, detectives said, Rehm smuggled the knife and a number of other potential weapons past courthouse security: bullets, a wrench, two screwdrivers, two knives and a hammer.

I'm wondering about the cracks. Is there a pattern in which an accused suspect's mental illness, while not being a defense to a crime (it isn't), becomes a de facto opportunity for buck passing by everyone concerned?

As a practical matter, incarcerating the mentally ill poses problems -- one being that there is no way to force criminals into treatment:

"It's kind of like a revolving door," Mr. McHugh said. "When they need room at the forensic hospital, the inmates come back, and they may take their medication or they may not. Our department does not have the legal authority to medicate someone against their will."

Mr. McHugh acknowledged that in the prisons, opportunities to consult a psychiatrist are "relatively limited," an impression confirmed by a former inmate, George Jones, who was held in administrative segregation in Rahway from 1992 until his release in 1995.

Mr. Jones, who has a diagnosis of bipolar disorder and antisocial tendencies but is not one of the five plaintiffs in the suit, said that the only way to get an appointment with a psychiatrist at Rahway was to do something wrong.

"If I wanted to see a psychiatrist, I flooded my cell," he said. "On the bottom tier, somebody was always either burning themselves up or burning their cells or eating feces or trying to kill themselves to get medical attention."

When an inmate did see a therapist, Mr. Jones said, the average session lasted two or three minutes. "Basically," he said, "it was just: 'Are you taking your medication? Are you sleeping O.K.? Would you like to increase your medication?' That and 'Do you feel like hurting yourself today?' "

Dr. Grassian, citing court decisions in New York, California and Texas limiting or blocking the solitary confinement of mentally ill prisoners, said policy makers were gradually being forced to recognize that subjecting the mentally ill to harsh punishment rather than therapy exacted a high price, both in prison and out in society.

"It's like beating a dog and leaving it in a cage and making it as violent as you can, and then taking it to the middle of Manhattan," Dr. Grassian said. "What do you think is going to happen when you open the cage?"

When I served as a Berkeley Police Review Commissioner, I used to hear laments from officers who just didn't know what to do with crazy people when they were the subjects of complaints. Some -- not all -- were called "homeless," and this was reflected on police cititions with the word "NOMAD" appearing as the "address." The cops knew they'd never show up for court, and they didn't want them to. They didn't want crazy filthy homeless people urinating in their nice clean police cars either.

Do I blame them? Hardly.

One time, a homeless man broke into my car, tore open a bag of dog food I'd left inside, ate some dog food, washed it down with engine coolant I had in the back seat, then passed out. I know this because the next morning when I saw a man sitting in my car and angrily told him to get out, he promptly puked all over himself and the front seat -- and after he staggered away I saw the open coolant container and dog food bag along with the mess he'd made. I say this not to engage in mindless homeless-bashing, but to illustrate a simple fact of life: no one wants to deal with mentally ill, dysfunctional people. I'm not sure the problem is that they slip through the cracks so much as it is society's game to ignore them in the hope they'll just go away. Only when they finally do something really serious do they get attention. Until then, there really is no system.

From Congressional Quarterly, 2002:

Beginning in the 1960s, deinstitutionalization, a policy of hospital closures, developed in response to advocates who argued that Americans were being warehoused in state mental institutions and would receive better care in their communities. Furthermore, the development of more effective psychotropic medications promised better symptom control, and a greater chance that some patients could eventually care for themselves. In response, state governments dramatically accelerated the release of patients and the downsizing of state mental hospitals. In 1955, state mental hospital populations peaked at 559,000 persons. Today, 70,000 individuals with severe mental illnesses are housed in public psychiatric hospitals. In the past decade, 40 state mental hospitals have closed, while more than 400 new prisons have opened. "I'm very suspect of deinstitutionalization," Dion says. "It just cost-defected from the state mental hospitals to the jails. Now the state can say they have a more caring, loving system in their hospitals."

Many promises underlying the closures have not been kept. Community-based programs haven't taken care of the released hospital populations. "Deinstitutionalization happened pretty quickly, and the government has become pretty hesitant to provide funding for the services," Mauer says. "The community programs just fell through the cracks, so the criminal justice system became the default."

It is also not enough to expect the state to shoulder the entire burden, says Lynn Duby, commissioner for the Maine Department of Behavioral and Developmental Services. "Medicaid cannot be the main funder. When you have to fund something 100 percent through state funds, of course it's not enough."

State governments have traditionally been the major source of money for public mental health services, and remain so today. But according to the Bazelon Center for Mental Health Law, total state spending for treatment of the seriously mentally ill is one-third less now than in the 1950s. According to a 1998 study by the Center for Mental Health Services of the Substance Abuse and Mental Health Services Administration, the growth of spending for the treatment of mental illness and substance abuse nationwide has been lower than for health care generally. It is clear that the costs for caring for the mentally ill have shifted from the health care system to jails and prisons.

Legal advocacy groups, of course, make lots of trouble for the police and prison system, as mentally ill criminals are in a never-never land (as well as a special category against which discrimination is forbidden). It is considered unfair that they be treated like prisoners, but of course in many cases there are no viable treatment options (closed state hospitals, no compulsory treatment, no halfway houses, no money, etc.)

Ignoring a problem in the hope that it will go away has a poor track record.

It's not a crack that mentally ill criminals are falling through. It's a huge, de facto gap.