March/April 2016 Issue
Mental Health Monitor: Mental Health Courts — Improving Outcomes for Defendants With Mental Illness
Advocates for criminal justice reform often refer to America's jails and prisons as "de facto mental institutions," and cite a constellation of problems associated with confining individuals in a system not designed for their care and treatment. While estimates of the percentage of incarcerated individuals with mental illness vary, there is general consensus that significant overrepresentation of people with mental illnesses in the criminal justice system leads to a variety of complex problems, including the following: consequences for public safety, undue distress to individuals and families, and ineffective use of resources, as untreated mental illness often results in problems from prison overcrowding to high rates of recidivism. One possible solution to these problems is the expansion of mental health courts (MHCs).
Philosophy and Structure of Mental Health Courts
From a philosophical standpoint, an MHC assumes the perspective that the neurobiological basis of mental disorders is outside the willful control of individuals. According to a report by the Council of State Governments Justice Center, "People with mental illness cannot simply decide to change the functioning of their brain. As with physical illnesses, it is believed that mental disorders are caused by the interplay of biological, psychological, and social factors." Therefore, MHCs offer participants a model that involves accountability for the actions that led to court involvement along with opportunities to engage in treatment of underlying mental health disorders.
An MHC team typically includes the judge, prosecutor, defense attorney, case manager, court staff, criminal justice staff (probation, police, jail representatives), and mental health or treatment staff. In contrast to a traditional court where a judge hears a case, renders a verdict and imposes and punishment, the judge in an MHC is more involved in monitoring the treatment plan, including participation in time-intensive team reviews of each case on the docket. While high-volume jurisdictions may administer stand-alone MHCs, an MHC can also refer to a specialized docket handled by a judge and team that also handle traditional cases.
The active engagement of the defendant is paramount, beginning with the decision to accept the terms of participation in the program. Karen Blackburn, program administrator for Problem Solving Courts with the Administrative Office of Pennsylvania Courts, says, "Clients always have defense counsel advising them on their participation and the requirements for successful completion. While a defendant has to be accepted into a mental health court, in Pennsylvania his or her entry into the program is entirely voluntary, and the individual must consent to participate with the treatment plan."
A client's progress through the plan is carefully monitored. Blackburn says, "These are matters of the court, and there is a constant need to maintain balance between the expectations of the program, as in the conditions of sentencing and participation, and accountability for treatment."
This research is similar to other findings summarized by the Council of State Governments Justice Center that showed promising findings on MHCs, including the following:
However, another recent report by the Urban Institute that summarized research on MHCs "concluded that they seemed to be modestly effective at reducing recidivism, but it was unclear whether they had a positive effect on participants' mental health" (National Public Radio, 2015).
The mixed findings could have various explanations. As noted earlier, the diversity of implementation of MHCs leads to difficulty in interpreting and comparing research findings, especially regarding gaining a deeper understanding of the specific variables that may account for positive effects.
Also, the goals for MHCs outlined by the Council of State Governments Justice Center are sufficiently broad that it is conceivable that individual MHCs may devise programs that prioritize goals differently, consequently promoting differing outcomes. The goals are as follows:
In an attempt to standardize data collection and facilitate research on MHCs, the National Center for State Courts developed 14 performance measures on effectiveness, both in process and outcome. The core measures include participant accountability (e.g., in-program reoffending, attendance at scheduled therapeutic sessions), social functioning (e.g., living arrangements), case processing, collaboration, individualized and appropriate treatment, participant perceived fairness, and aftercare/postexit transition.
An Evolving Solution
While in traditional circumstances an individual's involvement with various systems is likely to be fragmented and uncoordinated, the sequential intercept model outlines a linear trajectory.
The model envisions a series of points of "interception" at which an intervention can be made to prevent individuals from entering or penetrating deeper into the criminal justice system. Ideally, most people will be intercepted at early points, with decreasing numbers at each subsequent point (Munetz & Griffin, 2006, p. 544).
The five "intercepts" are the following: law enforcement and emergency services; initial hearings and initial detention; jails and courts; reentry from jails, prisons, and hospitals; and community corrections and support services. Utilizing this model, often counties or jurisdictions develop "forensic task forces" with representation from these intercepts to assess the interface between the criminal justice system and the mental health system with the intention of developing interventions that seek to engage individuals in treatment, prevent initial involvement with the criminal justice system, and facilitate re-entry after incarceration.
Complex problems often demand complex solutions, and mental health courts are an evolving response, growing increasingly sophisticated in order to most effectively target limited resources to maximum effect. Blackburn sums up the challenge, illuminating the fundamentally pragmatic dimension: "Problem-solving courts, in general, are devised in order to target the highest-need, highest-risk populations. They target people who fail at the traditional way of doing things and employ a problem-solving approach."
— Liza Greville, MA, LCSW, is in full-time clinical practice in rural Pennsylvania and a contributor to Social Work Today.
Munetz, M. R., & Griffin, P. A. (2006). Use of the sequential intercept model as an approach to decriminalization of people with serious mental illness. Psychiatric Services, 57(4), 544-549.
National Center for State Courts. (2007). Mental health court performance measures: Introduction & overview. Retrieved from http://cdm16501.contentdm.oclc.org/cdm/ref/collection/spcts/id/221.
National Public Radio. (2015, December 17). Mental health courts are popular, but are they effective? Retrieved from http://www.npr.org/sections/health-shots/2015/12/16/459823010/mental-health-courts-are-popular-but-are-they-effective.North Carolina State University. (2015, December 3). Study: Mental health courts significantly reduce repeat offenses, jail time. Retrieved from https://news.ncsu.edu/2015/12/desmarais-mhc-2015/