July | August 2017


Judges Find Hope In Different Approach For People
With Mental Illness

By Mikel Chavers
If a mental health court were a college, people with illnesses like bipolar disorder, schizophrenia and major depression would graduate and move on to a better life—a life where they are able to manage their illness. And most importantly, they’d avoid jail.
That’s all based on the principle that if the justice system could just get at the underlying issues that cause a person to commit crimes, it could stop the behaviors and help the person become a productive and safe member of society.
Mental illness is one of those underlying issues.
Lifelong struggles with mental health issues can often contribute to crimes. Crimes lead to arrests, court appearances, jail time and often more court appearances and jail time. Over and over the cycle repeats, as judges grow increasingly frustrated at the justice system’s inability to fix the problem.
“We’re living the same day over and over again with these people,” said Judge Stephen Goss, presiding judge of the Dougherty Superior Court Mental Health and Substance Abuse Division in Georgia. “It’s like being stuck in a revolving door in a hotel lobby.”

Untying Judges’ Hands

He’s not alone in his early frustrations. Before mental health courts, it’s like judges’ hands were tied.
“I was a trial judge for seven years before I became a justice and I had a lot of people on my docket who had drug and alcohol and mental health issues, but our system was very fragmented,” said Ohio Supreme Court Justice Evelyn Lundberg Stratton. “The reality is these people had co-occurring disorders and so I often had to lock them up because I had no place to put them. And I was very frustrated by the process and so I kind of wanted to do something.”
That’s the reason Goss, Stratton and other state officials are looking to mental health courts for help. Mental health courts aren’t buildings, specifically, they are special times set aside in regular criminal courtrooms across the country where judges hear only cases involving people with serious mental illnesses. These programs are catching on because judges can take a different approach with these people and often they get better results.
When it is business as usual in a courtroom under a regular docket, offenders with mental illnesses committing a low-level crime could be sentenced to jail or could be put on probation or on community control, Stratton said. They would be ordered to get mental health treatment and drug and alcohol treatment, and are also told, ‘oh by the way, you need housing and a job.’
“And the person’s never actually been diagnosed properly, so they don’t even know what mental illness they have. They never even make the first place. They walk out that door and the probation officer never sees them again, so they’re arrested a next time,” Stratton said.
They become frequent users of the system.
But a mental health court is a different approach. With a targeted group of clients and cases to handle, judges ask various community agencies to come to the court and bring all the mental health expertise and services together in one afternoon—because there are economies of scale to do that, Stratton said.
Mental health courts are said to work because caseworkers, judges and other personnel are experienced in dealing with mental health issues and when the mental health courts meet, special treatment services are made available for those defendants. The benefit is the focus these folks receive. It’s a dedicated time for a dedicated purpose to solve very specific underlying issues.

Use of Courts Growing

With that kind of thinking, mental health courts are sprouting up all over the country. There are now more than 200 mental health courts nationwide.
The Council of State Governments Justice Center helped spread the movement, said Patricia Tobias, Idaho’s administrative director of the courts. With its Mental Health Criminal Justice Consensus Project, the CSG Justice Center helps states adopt the strategy using federal grants from the Bureau of Justice Assistance.
In Ohio, Stratton formed a commission to help the legal community collaborate with other state agencies to foster mental health courts. She created the Advisory Committee on Mental Illness and the Courts in 2001—the first such Supreme Court committee in the country—and through that was able to grow Ohio’s mental health courts from two 10 years ago to more than 30 today, and more are coming.
“Because I got involved in a statewide level, it really encouraged judges at the local level to get involved as well because we had state buy-in,” Stratton said.
Ohio isn’t alone. Out West, Nevada also has a statewide effort. Every Friday in Reno, a mental health court is held at 9:30 a.m. and noon, and 200 people typically participate in the program, all seeing the judge at varying times, according to Nevada Assemblywoman Sheila Leslie. She’s an administrator who runs the mental health court, the state’s first located in the Second Judicial District Court.
The legislature was able to fund the state’s three mental health courts as a line item in the budget, signaling the importance placed on the strategy. That line item provides for 65 subsidized housing slots for the mentally ill, six case service coordinators and a supervisor that only works with mental health court clients.
“Because in order to get into mental health court, you have to be a person with a severe mental illness,” Leslie said. “So all of those people would qualify for state services anyway, but by targeting the resources to those involved in the criminal justice system, it gives us the resources we need to stop them from recidivating.”
The mental health court is saving the state money. In 2009, the mental health court saved Leslie’s district more than $250,000 in avoided jail time for its 63 individuals who successfully completed the mental health court program, she said. The year before they entered the mental health court, the group cost the district more than $300,000 for 2,820 days in jail. But after entering the mental health court, the group spent only 569 days in jail—a whopping 80 percent decrease in time behind bars.
“Even though Nevada is one of the worst states in terms of the percent of revenue we’ve lost during the recession, so far, the mental health court item has not been cut because the legislators really understand—and the governor as well—that by cutting the mental health court budget, you’re increasing costs exponentially in the other budgets,” Leslie said.

Budget Cuts Threaten Courts’ Funding

But some experts say budget cuts can’t be avoided in this economic recession. And when cuts are made to the mental health treatment services and mental health housing options, for example, judges are limited on where they can send mental health court clients.
After all, the mental health courts only work if the right treatment options are available to give to these people.
Goss in Georgia said the single biggest problem is just the lack of resources and the lack of treatment professionals in his part of the state. Goss hears a dozen or more cases every Friday during his mental health court.
In New York with its 23 mental health courts, Judge Judy Harris Kluger, chief of policy and planning for New York state’s unified court system, said when the state suffers from budget cuts, everything is affected.
“Everybody’s being cut in New York state,” Kluger said. “Like anything else, it may take us longer to place someone (and) there may not be as many choices in terms of where to place someone. It’s not as if the treatments don’t exist, but it’s just everybody’s cutting back so it’s going to have an impact on timing and also the variety of options that may be available.”
Idaho is going through something similar. “Our greatest challenge today is in light of the budget declines at the department of health and welfare, the behavioral health department is being cut dramatically, which will likely limit the amount of teams that are available in the communities to provide successful treatment to mental health court offenders,” Tobias said.
That has Tobias and her counterparts examining what adjustments need to be made. They’ll likely have to decide if they will need to limit number of offenders that can be admitted into mental health court, she said.
“We either have to find efficiencies in treatment delivery (to treat more people with the same resources) or limit offenders that can go into mental health courts,” Tobias said.



By Hallie Fader-Towe
Mental health courts are only one of many options for reducing the prevalence of mental illness in the criminal justice system. Considering a mental health court in your state or community? The CSG Justice Center provides training and technical assistance through the Justice and Mental Health Collaboration Program and its predecessor, the Mental Health Court Program, both funded by the Bureau of Justice Assistance in the U.S. Department of Justice.
Based on experience, here are five key things to do before setting up a mental health court:
Convene stakeholders early to discuss the issue and identify potential interventions and resources. Those stakeholders include representatives from the criminal justice system, including law enforcement, corrections, court and community corrections practitioners; behavioral health systems, including mental health and substance use; and local government and mental health consumers.
Spend time understanding your current system: What is the process flow for individuals in your criminal justice system? Are people screened for mental illness or a substance use disorder in the jail? What behavioral health resources are available in your community for individuals involved with the criminal justice system?
Use interviews and available data to describe the population of individuals with mental illnesses in your criminal justice system. Recent research has found 17.9 percent of individuals entering jail have a serious mental illness. How is this reflected in your jurisdiction? How many of these people are eligible for benefits upon release into the community?
Use your stakeholders to define a potential “target population” for your mental health court or other initiative. Consider the level of charges, residency, clinical criteria and risk assessment to determine who can get help from the program.
Consider the total number of individuals who would be in the target population based on the jail population and the target population you are focusing on: Is this enough to fill a court calendar for a mental health court? Does the size of the population served by the mental health court justify the time of the stakeholders and team members in planning?