Mental Health Court in the United StatesIndependent studyCJS400

Running Head: MENTAL HEALTH COURT IN THE UNITED STATES 1
Mental Health Court in the United States:
History, Policy, Design, Implementation, Evidence Based Practices, Measurement of
Success and Recommendations for Future
CJS 400: Independent Study
Kelly Haag
Illinois State University
7/31/2013

MENTAL HEALTH COURTS IN THE UNITED STATES 2
MENTAL HEALTH COURTS IN THE UNITED STATES
Introduction to Mental Health Courts
Definition of the Social Problem: Why do we need mental health courts (MHCs)?
Lack of support and community treatment services have led to an increased involvement
of individuals with serious mental illness and/or co-occurring disorders in the criminal justice
system. According to the Council of State and Local Governments (2002) “people with mental
illness are falling through the cracks of this country’s social safety net and are landing in the
criminal justice system at an alarming rate” (p xxi). This phenomenon has been referred to as
“criminalization of mentally disordered behavior” (Wolff, Frueh, Huening, Shi, Eperson,
Morgan & Fisher, 2012, p. 1). It has been estimated that there are over one million adults with
serious mental illness involved in the criminal justice system (Cloud & Davis, 2013; Wolff, et
al., 2012). According to Slate (2003) there was a reported 154% increase in the number of
persons with mental illness in jails from 1980 to 1992 (p. 11). As a result, the criminal justice
system has become the de facto mental health system (Slate and Johnson, 2010). The criminal
justice system is not equipped to adequately meet the needs of persons with mental illness and
thus public safety is threatened and additional expenses are incurred by taxpayers (Abramsky &
Fellner, 2003; MCES QUEST, n.d.; Slate & Johnson, 2010; Waters, Strickland & Gibson, 2009).
Few linkages exist between the criminal justice and mental health care systems (Almquist &
Dodd, 2009; Blanford & Osher, 2012; Slate, 2003). Mentally ill individuals that come into the
criminal justice system may find themselves in circumstances that intensify their problems
(Abramsky & Fellner, 2003; Blanford & Osher, 2012)

The definition of serious mental illness is not steadfast between policymakers, law
enforcement officials or community mental health providers. Serious mental illness (SMI)
includes schizophrenia, major affective disorder, psychotic disorder and borderline personality
disorder (MCES QUEST, n.d.). It may also include PTSD, as the prevalence of this disorder
among the population of individuals coming into contact with the criminal justice system is on
the rise (Slate & Johnson, 2008). One definition of mental illness in court literature refers to
“severe and persistent mental illness” which includes conditions that involve “long term and
profound impairment of functioning” (Council of State Governments Justice Center, 2002, p5).
Schizophrenia, schizoaffective disorder, bipolar, disorder, severe depression and anxiety
disorders are included under this definition. Approximately three out of four people with mental
illness involved in the criminal justice system also suffer from a co-occurring substance use
disorder (COD) (Ax & Fagan, 2007; Slate & Johnson, 2008). Therefore, the co-occurring
disorders must be addressed within the context of the problem of persons with mental illness
coming into contact with the criminal justice system.
The criminal justice system consists of law enforcement, the courts and correctional
services (Council of State and Local Governments, 2002). This includes frontline police
officers, jailers, prison employees, sheriffs, judges, prosecutors and defense attorneys.
Collaboration between these entities is essential to the success of mental health court
interventions.
Definition of a Mental Health Court
Establishment of mental health courts was based on the theory that a solution to the
problem of mentally ill criminal offenders required voluntary participation in a therapeutic
program that would reduce recidivism in this population and also result in greater accessibility to

mental health services for these individuals (Castellano & Anderson, 2012; Goldkamp & Irons-
Guynn, 2000; Slate, 2003)
The growing impact of persons with mental illness in the criminal justice system
prompted judges to seek innovative ways of addressing the issue (Patrilla & Redlich, n.d.)
Mental health court development has resulted from the work of passionate and dedicated judges
who recognized that mentally ill individuals were frequenting the court system and cycling in
and out of that system (Castellano & Anderson, 2012) As of 12/31/2009 there were 288
operational mental health courts in the United States (Huddleston & Marlowe, 2011). Courts
were developed independently and focused on the needs and resources of individual
communities (Lurigio & Snowden, 2009; Redlich, Hoover, Summers & Steadman, 2010). The
diversity of the court processes implemented by MHCs has led to a common adage in the field
that says, “When you’ve seen one mental health court, you’ve seen one mental health court”
(Castellano & Anderson, 2012, p. 70). There has yet to be established a single, common mental
health court model (Slate, 2003). This creates difficulties for implementation, practice and
evaluation of MHC programs. Researchers are examining the differences in mental health court
programs in order to best determine “What Works” in MHC programming.
The Council of State Governments Justice Center Criminal Justice/Mental Health
Consensus Project (2008) offers the following working definition of a Mental Health Court:
“A mental health court is a specialized court docket for certain defendants with
mental illness that substitutes a problem-solving model for traditional criminal
court processing. Participants are identified through mental health screenings and
assessments and voluntarily participate in a judicially supervised treatment plan
developed jointly by a team of court staff and mental health professionals.
Incentives reward adherence to the treatment plan or other court conditions,
nonadherence may be sanctioned, and success is determined according to
predetermined criteria” (p.4).

Although mental health court programs differ significantly from one jurisdiction to
another, research on existing, successful mental health court programs has identified 10 essential
elements for court design and implementation (Thompson, Osher & Tomasini-Joshi, 2008). The
10 essential elements are based on two key principles. First, true cross system collaboration
involving criminal justice, mental health, substance abuse treatment and related system is
essential to successfully implement and operate a mental health court (Thompson, et al.,
2008;;Watson,Hanrahan, Luchins & Lurigio, 2001). Second, mental health courts are not a cure-
all for the problem of individuals with mental illness being overrepresented in the criminal
justice system (Lurigion & Snowden, 2009; Thompson, et al., 2008). Instead, it is one piece in a
comprehensive approach to addressing the problem.
The mental health court intervention occurs after the individual with mental illness has
been arrested and charged with a crime and is therefore defined as a post-booking diversion
program. There are pre-booking diversion programs. However, they are beyond the scope of
this particular policy analysis. One reason for post-booking diversion is that there is greater
possibility for participation in rehabilitative interventions at this stage of the process.
Missionand Goals of Mental Health Court Programs
The very fact that the success of MHCs requires strong collaboration between criminal
justice interests and community mental health providers seems to set the stage for goal conflicts
within the program. The primary concern of criminal justice professionals is public safety.
Mental health care providers focus on the personal well-being and the self-determination of the
client. Mental health court teams and Federal, State and local policymakers have captured the
goals of each practice perspective quite well in policy documents.

A review of mental health court literature and the Policy and Procedures Manuals of
individual mental health court programs identifies a strong agreement on the missions and goals
of these programs. Following are examples of MHC mission statements:
“The mission of the Behavioral Health Court of the Superior Court of California,
County of San Francisco is to enhance public safety and reduce recidivism o
criminal defendants who suffer from serious mental illness by connecting these
defendants with community treatment services and to find appropriate
dispositions to criminal charges by considering the defendant’s mental illness and
the seriousness of the offense” (Superior Court of California, County of San
Francisco, 2008, p.2).
“It is the mission of the Livingston County Behavioral Health Intervention Court
to enhance public safety and reduce recidivism by diverting persons with mental
illness from the Livingston County Judicial System through a cost-effective
collaboration of legal, clinical and community resources” (Livingston County
MHIC Policy and Procedures Manual, 2012,p.2).
“The mission of the BMHC is to address both the treatment needs of defendants
with mental illness and public safety concerns of the community by linking
defendants with mental illness to treatment as an alternative to incarceration”
(O’Keefe, 2006, p.1).
These mission statements strongly support the goals outlined by the Council of State
Governments Justice Center (2008) in- Mental Health Courts: A Primer for Policymakers and
Practitioners. Those goals are as follows:
 Increased public safety for communities by reducing criminal activity
and lowering the high recidivism rates for people with mental illness who
become involved in the criminal justice system (p.8).
 Increased treatment engagement by participants by brokering
comprehensive services and supports and supports, rewarding adherence
to the treatment plan and sanctioning nonadherence (p.8).
 Improved quality of life for participants by ensuring that program
participants are connected to needed community based treatment, housing
and other services that encourage recovery (p.8).
 More effective use of resources for sponsoring jurisdictions by reducing
repeated contacts between people with mental illness and the criminal
justice system and by providing treatment in the community when
appropriate, where it is more effective and less costly than in correctional
institutions (p. 8).

Slate and Johnson (2008) claim the following goals for mental health court programs: (1)
cooperation between criminal justice and mental health systems, (2) identification of the most
effective and least restrictive treatment interventions, (3) effective legal advocacy for the
mentally ill, (4) assessment of mental health delivery and receipt of services, (5) involvement of
consumers and family members in the court process, and finally (6) diversion to community
mental health treatment programs (p. 135). The aforementioned goals were incorporated into
the majority of MHC programs reviewed for this work.
First and Second Generation Mental Health Courts
The original mental health courts, referred to in the literature as first generation courts,
targeted nonviolent, misdemeanor offenders (Castellano & Anderson, 2012). The first
generation courts were developed to address three key issues (Goldkamp & Irons-Guynn, 2000).
These included the public safety risk of mentally ill offenders, the issues involved in placement
of the mentally ill offenders in local jails, and the inadequacy of the traditional criminal process
in dealing with mentally ill individuals (Goldkamp & Irons-Guynn, 2000; Wolff, et al., 2012).
These innovative court programs were designed using strategies that had previously been
incorporated into existing drug court programs (Lurigio & Snowden, 2009). These first
generation courts have been mildly successful in reducing rates of recidivism of offenders with
mental illness, but they have not been successful in reducing the number of mentally ill offenders
involved in the criminal justice system (Canada & Watson, 2012; Odegaard, 2007; Wolff, et al.,
2012

Mental Health Court Policy in the United States
National
National level policy regarding the planning and implementation of mental health courts was
sponsored by Senator Mike DeWyne (R-OH). PL 106-515: America’s Law Enforcement and
Mental Health Project was signed into law on November 13, 2000 (GPO, 2013). This bill
authorized $10 million in grants for programs that provide “continuing judicial supervision” over
misdemeanor and non violent offenders with mental illness, retardation, or co-occurring mental
illness and substance abuse disorders through FY 2004(National Center for State Courts, 2013).
The bill would fund mental health courts modeled after programs already implemented in
Broward Co., FL and King County, WA (NCSC, 2013). This bill also authorized the formation
of the Criminal Justice/Mental Health Consensus Project (Council of State Governments, 2002).
On October 30, 2004 PL 108-414: the Mentally Ill Offender Treatment and Crime
Reduction Act (MIOCRA) became federal law. This law authorized a $50 million grant program
to be administered by the U.S. Department of Justice to help states and counties design and
implement collaborative efforts between criminal justice and the mental health system (NCSC,
2013). Mental health court programs were among those eligible for funding under this
legislation (NCSC, 2013).
In 2008 PL 110-419: Mentally Ill Offender Treatment and Crime Reduction
Reauthorization and Improvement act of 2008 was enacted into law (NCSC, 2013). This law
reauthorized the grant funding for mental health court programs along with a number of other
law enforcement/mental health collaboration projects.
State

I. Mental Health Court Policy in the United States
A. National
B. State
a. Summary
b. Illinois
a. Current Court Programs in IL
II. Mental Health Court Implementation
A. Understanding the Issue
B. Identify Stakeholders
C. Anticipate Stakeholder Questions/Concerns
D. Leverage Resources
E. Resource Mapping
Court Design
Thompson, Osher and Tomasini-Joshi (2008), in their report titled The Essential
Elements of a Mental Health Court, outline the implementation strategy as follows:
1. Planning and administration
a. A broad-based group of stakeholders representing the criminal justice,
mental health, substance abuse treatment, and related systems and the
community guides the planning and administration of the court.
2. Target population
a. Eligibility criteria address public safety and consider a community’s
treatment capacity in addition to the availability of alternatives of pretrial
detention for defendants with mental illness. Eligibility requirements take
into account the relationship between mental illness and a defendant’s
offense, while allowing the individual circumstances of each case to be
considered.
3. Timely participant identification and linkage to services

a. Participants are identified, referred and accepted into mental health courts
and then linked to service providers as quickly as possible
4. Terms of participation
a. Terms of participation are clear, promote public safety, facilitate the
defendant’s engagement in treatment, are individualized to correspond to
the level of risk the defendant presents to the community and provide for
positive legal outcomes for those individuals who successfully complete
the program
5. Informed choice
a. Defendants fully understand the program requirements before agreeing to
participate in a mental health court. They are provided legal counsel to
inform this decision and subsequent decisions about program involvement.
Procedures exist to address, in a timely manner, concerns about the
defendant’s competency whenever they arise.
6. Treatment supports and services
a. Mental health courts connect participants to comprehensive and
individualized treatment supports and services in the community. They
strive to use evidence based practices.
7. Confidentiality
a. Health and legal information should be shared in a way that protects
potential participants’ confidentiality rights as mental health consumers
and their constitutional rights as defendants. Information gathered as part
of the participant’s court ordered treatment program or services should be
safeguarded in the event that participants are returned to traditional court
processing.
8. Court team
a. A team of criminal justice and mental health staff and service treatment
providers receives special, ongoing training and helps mental health court
participants achieve treatment and criminal justice goals by regularly
reviewing and revising the court process.
9. Monitoring adherence to court requirements
a. Criminal justice and mental health staff collaboratively monitor
participant’s adherence to court conditions, offer individualized graduated
incentives and sanctions, and modify treatment as necessary to promote
public safety and participants’ recovery
10. Sustainability
a. Data are collected and analyzed to demonstrate the impact of the mental
health court, its performance is assessed periodically, procedures are
modified accordingly, court processes are institutionalized, and support for
the court in the community is cultivated and expanded.
(p. 1-10).
Other MHC creators have identified components necessary for effective mental
health court design that complement and enhance the strategies of Thompson, et.al,

(2007). Judge Randall Fritzer asserts that labeling and stigmatizing individuals based on
medical diagnosis should not be allowed (Odegaard, 2007). The least restrictive means
of supplying treatment to the individual must be employed, while also taking the factor of
public safety into consideration (Odegaard, 2007). It is also suggested that the technical
rules of the court room be relaxed when operating the mental health court (Odegaard,
2007). This suggestion has been implemented into MHC programs as a way to lessen
the adversarial nature of courtroom proceedings and employ a more empathic, client
based approach as a way to promote therapeutic relationships.
Evidence Based Practices for Individuals involved in Mental Health Court
A. Education for Law Enforcement Professionals
B. Education for Mental Health Professionals
C. Assertive Community Treatment
a. Mental Health Treatment
b. Treatment for Co Occurring Disorders
c. Housing
d. Employment
e. Addressing Criminogenic Needs and Risk Factors
III. Measurement of Success: Performance and Outcomes
A. Performance and Outcome Research on Currently Operating Court
Programs
B. Measuring Performance and Outcomes
a. Implementing measurement into a Mental Health Court Program

b. Outcomes versus Performance Measures
c. Obstacles to adequate data collection
C. Data and Funding
IV. Recommendations for the Future
Appendix A: Mental Health Court Resource Guide
Appendix B: Mental Health Courts in the United States
Appendix C: Resources for Developing Community Collaboration
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