There is nothing pretty about Ronald Toppila's story. In 2004, Toppila was declared not guilty by reason of insanity for the murder of his 87-year-old mother.
It was a particularly brutal killing. While he was in a psychotic state, Toppila stabbed her 52 times. Now state psychiatrists who have treated Toppila say he is no longer a threat. He is well enough, they say, to be released into a carefully monitored community treatment program.
A Sacramento judge earlier this week emphatically rejected their recommendations and ordered that Toppila remain confined at Napa State Hospital. Superior Court Judge Kevin J. McCormack called the testimony of the state psychiatrist in the case "horrifying." Even more troubling, he went on to say that the psychiatrist "clearly committed perjury" in his court.
This is a serious accusation that requires a serious examination. Stephen Mayberg, director of the state Department of Mental Health, has already requested the court transcripts and has promised a thorough investigation. It needs to be done as quickly and as transparently as possible.
The judge's statements raise questions not just about the psychiatrist but about a well-respected program for the treatment of mentally ill offenders who are released from state hospitals. The Conditional Release Program, or CONREP, as it is known, provides intensive services to these offenders after release.
At any given time there are some 700 CONREP patients in the community, most of them young males with severe mental disorders who have committed violent felonies. More than 400 have been found, like Toppila, not guilty by reason of insanity and confined to state hospitals as a danger to themselves or others. Of those, 116 were tried for murder or attempted murder.
While in state hospitals, they receive extensive therapy and anti-psychotic drugs, treatment regimens designed to restore them to sanity. Only those who successfully complete rigorous therapeutic programs are released, usually after many years. By law, they have to be evaluated periodically; when they are determined to no longer be a danger to themselves or society, the court must release them. A single psychiatrist does not make the decision to release mentally ill offenders or place them into CONREP. Independent evaluations are done by a number of psychiatrists and other mental health professionals.
When released, most reside in locked facilities, are closely monitored and receive extensive outpatient treatment. If they fail to follow treatment guidelines, take their medications or are caught drinking or taking drugs – in short, anything that violates the terms of their release – they can be recommitted.
Compared to other mentally ill offenders, recidivism rates for CONREP patients are extremely low. About 6 percent re-offend within two years compared to 27 percent of patients from state hospitals who do not go through CONREP.
The success of the program and the safety of the public depend on the skill and judgment of the professionals who treat these offenders. If a mistake was made in the Toppila case, the state needs to understand why and take steps to correct the problem. And if the judge overreacted, that too needs to be examined.
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