Mental Health Courts

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Mental Health Courts

Definition

The Mental Health Courts Program was established by an act of Congress in 2000 to address the particular needs of mentally ill or mentally retarded defendants.

The general court system is designed to process individuals who have been charged with crimes. It does not account for special considerations, such as mental illness. Mental health courts were created to address the special needs of defendants who are mentally ill or mentally retarded. They operate as part of the federal Mental Health Courts Program, which was established in 2000. These courts provide mentally ill defendants with supervised treatment in order to reduce the number of incarcerated people with mental illness and to prevent those who are mentally ill from continually cycling through the court system. Those who successfully complete the program are eligible for a shortened sentence or a dismissal.

Qualifying mental illness for the Mental Health Program is defined by law as, “a diagnosable mental, behavioral, or emotional disorder—(A) of sufficient duration to meet diagnostic criteria within the most recent edition of the Diagnostic and Statistical Manual of Mental Disorders, published by the American Psychiatric Association; and (B) that has resulted in functional impairment that substantially interferes with or limits 1 or more major life activities.”

History

According to the American Jail Association, between 600,000 and 700,000 mentally ill people end up in jail each year, where they do not receive treatment for their condition. The National Alliance for the Mentally Ill estimates that as many as 40% of mentally ill individuals will come into contact with the criminal justice system at some point in their lives. Research finds that mentally ill inmates are at greater risk for assault and suicide than are other inmates. Judges, attorneys, and jail officials, realizing that there were a large percentage of mentally ill people being processed through the criminal justice system, began in the 1980s to call for more specific court-related treatment programs for these individuals.

The first mental health court opened in Broward County, Florida, in 1997. Mental health courts were modeled after drug courts, which since 1989 have been providing drug treatment to addicts who are convicted of crimes. Individuals who complete drug court–mandated programs are eligible to have their criminal charges reduced or dismissed.

In 2000, Congress passed the America’s Law Enforcement and Mental Health Project Act to relieve the burden on the criminal justice system and on corrective institutions, and to provide individuals with the tools they need to stay out of the criminal justice system. The Bureau of Justice Assistance (BJA) administers the mental health courts, and provided funds in 2002 and 2003 for thirty-seven state and local mental health courts throughout the country. As of 2007, there were nearly 100 mental health courts operating in the United States.

Process

Mental health courts generally take between 15 and 375 cases each year. They try individuals with mental illness separately from other cases. Mental health courts may vary by the kinds of mental health diagnoses and criminal charges they will accept, how the court monitors a defendant’s treatment, and the kinds of pleas an individual can make. In the past, mental health courts would only accept people who were charged with nonviolent offenses, such as trespassing, vandalism, or drug possession. Today, some mental health courts will accept those who have committed more violent crimes, including assault and robbery, but these individuals often require additional supervision.

Although the process can vary from court to court, generally, a defense attorney will refer a defendant to the mental health court. Those individuals who are too violent or disturbed to appear in court may first be referred to a crisis center for stabilization.

In most courts, the defendant will have to plead “guilty” or “no contest” to qualify for treatment. The individual will be evaluated by psychiatrists. If the defendant is deemed stable enough and eligible to stand trial in the mental health court, the judge, assisted by mental health professionals, will determine the correct course of treatment. The treatment will be implemented by mental health professionals under the oversight of the court. The individual may receive inpatient or outpatient counseling, as well as housing placement, education, vocational training, job placement, and health care, as needed. Some participants will simultaneously receive treatment for drug abuse .

An individual will stay in the treatment program and be supervised by the mental health court for up to the maximum sentence for his or her crime. During that time period, the person must return to the court periodically for assessments. When a defendant successfully completes the treatment program, his or her case is resolved. Sometimes the charges will be reduced, and sometimes the case will be dismissed. In cases involving more serious crimes, the defendant may receive credit for the treatment time toward a longer jail sentence. Defendants who do not successfully complete the program are returned to a regular court for another trial, and may have to face jail time if convicted.

Pros and cons

For the individuals and communities they serve, as well as for the criminal justice system in general, mental health courts offer several advantages over traditional courts:

They improve the outcomes for people with mental illness, by helping them get treatment.
They lower recidivism rates for people with mental illness who enter the criminal justice system.
They free up jail cells for more serious offenders.
They are considered a more cost-effective method than correctional institutions to treat defendants with mental illness.

The program has had its critics, however. Some of the arguments against mental health courts are as follows:

They further stigmatize mental illness.
They violate the right of mentally ill individuals to trial by jury.
They provide incentives to mentally ill individuals to commit crimes, so that they can receive treatment.
They force mentally ill individuals into treatment in order to avoid incarceration.
They could lead police to arrest people with mental illness, just to get them treatment.
They often require a guilty plea, about which some individuals with mental illness may not have the ability to make an informed decision.

Research

Although there is little research available to confirm the effectiveness of mental health courts in general, there have been studies conducted on individual mental health courts that suggest positive outcomes. Research overall indicates that participants in mental health courts are less likely to go back to jail and generally spend fewer days in jail than those who are processed through the regular court system.

A study conducted in the Broward County, Florida, mental health court and published in the July 2005 Psychiatric Services found that mentally ill defendants had greater access to treatment than they would have had otherwise, and they spent an average of 75% fewer days in jail compared to those who went through the traditional court system. A 1999 study presented at

KEY TERMS

Drug court —A court that provides defendants with drug treatment programs, in exchange for a reduced or dismissed sentence.

Mental health court —A court that offers treatment to mentally ill defendants, in exchange for a reduced or dismissed sentence.

Recidivism —The likelihood of committing another crime.

the symposium “Mental Health Courts: Promises and Limitations” followed mentally ill offenders who had spent an average of 18 days in mental hospitals and 85 days in jail in one year. The following year, while on Alaska’rsquo;s mental health court program, they spent only 3 days in mental hospitals and 16 days in jail. The August 2006 Harvard Mental Health Letter mentions a study conducted in California that found that offenders processed in a mental health court who did get rearrested were generally caught on technical violations of parole, rather than for new crimes.

However, not all the research has been positive. A study published in the July 2005 Psychiatric Services found a disproportionate balance of gender and ethnic groups represented in the mental health courts. Women and Caucasians in the study were more likely to be referred to mental health courts than were men and ethnic groups, even though the majority of prison inmates are male (90–94%) and minorities (63%). That study also found that participants in one mental health court had no significant improvement in clinical symptoms compared to those who went through the general court system.

Resources

BOOKS

Fagan, Thomas J. and Robert K. Ax, eds. Correctional Mental Health Handbook. Thousand Oaks, CA: Sage

Publications, 2002. Rogers, Richard and Daniel W. Shuman. Fundamentals of Forensic Practice: Mental Health and Criminal Law. New York, NY: Springer, 2005.

Slovenko, Ralph, ed. Law in Psychiatry. Vol. 2. East Sussex, United Kingdom: Brunner-Routledge, 2002.

Tonry, Michael, ed. The Future of Imprisonment. New York: Oxford University Press, 2004.