How one legal team is building support for people with cognitive disabilities : NPR

A few years ago, Noah Cox noticed something about some of the people he represented in court. They had difficulty communicating, thinking logically, or solving problems.

“I wanted to know their version of what happened and asked them questions. And many of them had a hard time finding a basic explanation,” says Cox, a lawyer with the Los Angeles County Public Defender's Office. “They seemed to have problems related to some kind of intellectual ability.”

What Cox saw pointed to a broader trend: Research shows that people with mental and developmental disabilities are overrepresented in the country's jails and prisons.

He set out to break that pattern by forming a team within the public defender's office known as the Neurocognitive Disorders Team. This is a pioneering effort based on the premise that prison is not always an appropriate place for people with these types of disabilities.

“Cycle of participation in the system”

There are many reasons why someone may have cognitive impairment, including conditions such as fetal alcohol syndrome, Down syndrome, traumatic brain injury or intellectual disability, which can limit learning and daily tasks.

But many of Cox's clients were never diagnosed with any disabilities. This doesn't surprise Leigh Ann McKingsley, senior director of disability and justice initiatives at The Arc, a nonprofit that advocates for people with intellectual and developmental disabilities.

“Disability often goes undetected,” McKingsley says. “They could have gone through their school system without even taking many exams, but it was never documented.”

She says it's easy for such people to become overwhelmed. This could lead to trouble. Compared to the general population, people with intellectual and developmental disabilities more likely to be victims of violent crime.

But it could go in the other direction.

“People with intellectual disabilities are often misunderstood, and that can lead to this cycle of inclusion in the system,” McKingsley says.

A person with this type of disorder may not understand the consequences or be unable to differentiate between who is his friend and who is not. They can be highly suggestible and easier to guide during police questioning, McKingsley said.

“They end up in a system that doesn’t care about their disability. They probably come out much worse off and are more likely to commit more crimes or get involved with people who do,” she says.

“I didn't know”

Jimmy is 56 years old and a native of East Los Angeles. He is wiry, with tattoos on his neck and glasses that are a little too big for his face. NPR is not using his last name because he and his family are concerned about the stigma of his criminal record.

For as long as he can remember, he had problems – with his family, with teachers, with the police.

“I was unaware that anything was wrong,” he says. “It took me a while to understand the situation.”

Jimmy was homeless, struggled with substance abuse, and was in and out of jail most of his life. He came to Cox's office on a burglary charge. This was a third strike, meaning he already had two violent crimes on his record and now faces a harsher sentence.

“I remember meeting Jimmy,” Cox says. “He tried very hard to tell me something that was very important to him. But I couldn't understand what he was trying to say.”

Cox asked the judge to appoint a neuropsychologist to evaluate Jimmy. His initial testing showed poor cognitive abilities and an IQ low enough to indicate impairment.

“It became apparent that this was a person with developmental disabilities that had not been identified in his youth,” Cox says.

“They were actually trying to help.”

Cox, along with a small team of lawyers, interns and social workers, wanted to prove that a diversion program, an alternative to prison, would be more suitable for Jimmy.

If diagnosed with a childhood-onset developmental disorder, Jimmy will be eligible for California Regional Centers, a network that provides support for people with these conditions. Access to such support could improve his chances of becoming distracted.

So the team collected as many records as possible and interviewed Jimmy's family to gain insight into his childhood.

“They actually tried to help him. And it was very new for us,” says his sister Sylvia.

Sylvia always knew something was wrong with her brother. He was late crawling and talking. He couldn't remember how to adjust the temperature of the bath water. He struggled in school. She says he started getting into trouble with the police before he reached his teens.

“I think it was a self-fulfilling prophecy for him. The more he was called bad, I think the more bad he became,” she says.

After all the interviews and tests, Jimmy was diagnosed with mild mental retardation, which he had since childhood. He was 54 years old.

“I'm not upset anymore”

Diversion skeptics say it may be too lenient on offenders. But Ricardo Garcia, a public defender who heads the Los Angeles County office, says that if done right, it can address a person's underlying problems, whether they involve mental health, substance abuse or cognitive impairment.

Los Angeles County Public Defender Ricardo Garcia says distraction can solve a person's underlying problems if done correctly.

Philip Chung for NPR

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“You give them a purpose and teach them self-determination skills,” Garcia says. “He doesn't tell people how to live their lives better. “He shows them the options so they are aware and can decide for themselves, using all the information available, to live the life that most people want to live.”

Jimmy has now completed a third of his two-year diversion plan. He lives in a group home, attends therapy and travels most of the time to Ladera Park in Los Angeles as part of a day program that works with adults with disabilities. His days look completely different than before.

Jimmy now views his life as a blank slate.

Philip Chung for NPR

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“I go to therapy. I come to this program. I'm busy all the time,” says Jimmy. “All I can say is that it offers more than prison can offer me because I have just completely turned my life around. I don't even do drugs anymore. I'm no longer homeless. I'm not disappointed anymore. I exchanged my life for a new one.”