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a new justice system for the mentally ill

The standard judicial process doesn't always accommodate the mentally ill, so some counties are avoiding it entirely, using a new system focused on treatment rather than punishment. Here is a closer look at the pros and cons of the nation's growing number of mental health courts.

Aaron Wynn was an unlikely savior. Brain-damaged since a motorcycle accident in the 1980s, he often acted out with his fists and suffered schizophrenic episodes. In 1993, while shopping at a Broward County, Fla. grocery store, he had a psychotic break, panicked, and ran outside, knocking down an elderly woman on the sidewalk. She hit her head and died. Wynn, who was charged with manslaughter, was eventually found incompetent to stand trial and sent to a psychiatric hospital, but his case finally brought the issue of criminal justice and the mentally ill to the forefront in Broward County.

Wynn's case prompted a scathing grand jury report on the state of the county's disorganized mental health system. The jury found that the county was virtually ignoring as many as 10,000 people like Wynn. Moreover, a mental health task force that year found that the county was regularly locking up the mentally ill for minor offenses. Unable to make bail, they would find themselves stuck in jail without treatment for weeks until they pled guilty or no contest.

Desperate for a solution, the task force decided to try what it called a "leap of faith:" A court that would deal with mentally ill inmates like Wynn on their own terms, instead of trying to fit them into a justice system that was poorly equipped for their needs. Modeled on drug courts, the new system would have as its goal not so much punishment as treatment -- a different way of serving justice while preventing further crime. "Sentences" would consist not of jail time, but of medical regimens and counseling sessions. After three years of planning, Broward County's mental health court -- the first in the country -- opened for business in 1997. It was too late for Wynn, but for thousands of other mentally ill defendants, it would be a godsend.

As the number of mentally ill defendants has mushroomed in America, so has the number of courts set aside to deal with them. In 2000, Congress passed and President Clinton signed into law the "America's Law Enforcement and Mental Health Project Act," which gave grants to communities interested in setting up mental health courts. Two years later a study by the Judge David L. Bazelon Center for Mental Health Law found only 20 specialized mental health courts nationwide. However, over the next three years, the idea finally caught on, thanks in part to an increase in government grants for the programs -- and also because the Broward County program seemed to be succeeding. Today, over 100 courts around the country offer alternative ways to process cases involving the mentally ill.

Though each court is unique in its operating procedures, all of them have specially trained personnel -- judges, attorneys, and staffers who plan out treatment regimens -- as well as probation officers who make sure the "sentences" of medication and counseling are carried out. Attorneys are often encouraged to use the word "client" instead of "defendant." Some courts accept only misdemeanor cases, usually nonviolent crimes like drug violations, shoplifting, trespassing, and disorderly conduct, which account for about half of the arrests of mentally ill people nationwide, but an increasing number are handling felony cases and violent crimes, too. Others even are beginning to accept young offenders, following the lead of Santa Clara, Calif., which established the first juvenile mental health court in 2001. Eight of the country's mental health courts now deal exclusively with juvenile cases.

A typical court is similar to one opened in Thurston County, Wash. in April 2005. A case begins with a referral from a police officer, a probation officer, a prosecutor, a defense attorney, or even a family member. If the defendant is determined to be mentally ill (according to the DSM-IV, the standards generally used by psychologists to diagnose a mental illness), developmentally disabled, or suffering a traumatic brain injury -- and if that condition can be linked to the crime he is accused of -- he can enter the court's special system. Once he has signed a contract agreeing to comply with the judge's recommendations, he begins a program of regular in-court reviews with the judge and any number of counseling sessions or medications. Although defendants can keep participating for up to 24 months, most are expected to finish their treatments within a year.

Statistics on whether or not mental health courts actually work are scarce, but one study conducted in 2004 did show a dramatic improvement in recividism levels. Portland State University researcher Heidi Herinckx followed 368 cases in the Clark County, Wash. Mental Health Court. Mental health court alumni were 4.1 times less likely to re-offend, and probation violations dropped by 62 percent. The percentage of those in the group with three or more arrests dropped from 26 percent to an astonishing 3 percent. In Broward County, statistics have shown that defendants are twice as likely to get counseling and other forms of psychiatric help -- and no more likely to be re-arrested for another crime -- if they choose mental health court rather than the traditional judicial process, even though they spend far fewer days in jail.

Mental health courts also save money, a point not lost on many counties already strapped for cash. A year and half into their mental health court program, Oklahoma County officials estimated that they were saving $15,000 per year for every defendant who went to treatment instead of a lengthy jail stay.

While mental health courts may offer more support for the ill than the traditional judicial process does, they have plenty of critics -- including, somewhat surprisingly, many mental health advocacy organizations -- and face obstacles that traditional courts don't. Many mental health courts are short on funding and staff, and as a consequence their dockets remain rather sparse. Alabama's five mental health courts typically see fewer than a dozen defendants each per month. Even the pioneering Broward County court, which has seen thousands of defendants since its inception in 1997, is a part-time program.

Mental health courts also face unique legal problems. Some require a guilty plea as a prerequisite for entry, a policy that advocates for the mentally ill are almost universally against. Mental-health judges can also only do so much to ensure that their sentences are carried out. Under involuntary commitment laws, the courts must take special precautions to make sure the rights of their defendants aren't being violated. Defendants often cannot enter mental health court without first agreeing to uphold the judge's sentence, whatever it may be. But if they change their minds post-trial and stop complying with the sentence, judges often have no choice but to find them guilty of violating probation. The defendants then end up in jail, the situation they were trying to avoid in the first place.

Will the problems be surmountable? The Department of Justice seems to think so; it funds about a third of the country's existing mental health courts and is currently sponsoring a major study of the concept. Its Bureau of Justice Assistance distributed scholarships for the Third National Conference on Mental Illness and the Criminal Justice System to judges and coordinators at every mental health court in the country. Mental health courts were literally the first item on the conference agenda -- perhaps a signal that soon, they may be at the top of more counties' agendas as well.


The Role of Mental Health Courts in System Reform
In 2001, the Bazelon Center for Mental Health Law examined procedures in 20 mental health courts around the country. This detailed and comprehensive report explains how the courts work and makes recommendations for how they can improve the services they offer.

Emerging Judicial Strategies for the Mentally Ill in the Criminal Caseload: Mental Health Courts
This 104-page federal report from 2000 provides a detailed description of the origins of mental health courts and a comparison of differing models. [Note: This is a pdf file; Adobe Acrobat required]

National Mental Health Association: Mental Health Courts Policy
Here is NMHA's position paper on mental health courts, which sets out guidelines for making sure defendants' rights are not violated.

Where Justice and Mercy Meet
The Village Voice takes an in-depth look at the functioning of one mental health court program in Brooklyn, New York.

Mental Health Courts: State Links
This list from the National Center for State Courts, organized by state, provides links to existing and planned mental health courts in the U.S., Canada and Australia, as well as a small selection of articles about some local efforts. [Note: This is a pdf file; Adobe Acrobat required]

Bureau of Justice Assistance Mental Health Courts program
This site describes the kinds of mental health court projects the Department of Justice funds, and explains how counties can apply for grants to start their own programs.


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posted may 10, 2005

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