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Mhc essential elements

  1. 1. Improving Responses toPeople with Mental Illnesses The Essential Elements of a Mental Health Court
  2. 2. Improving Responses toPeople with Mental IllnessesThe Essential Elements of aMental Health CourtA report prepared by theCouncil of State Governments Justice CenterCriminal Justice/Mental Health Consensus Projectfor theBureau of Justice AssistanceOffice of Justice ProgramsU.S. Department of JusticeMichael ThompsonDr. Fred OsherDenise Tomasini-Joshi
  3. 3. This report was prepared by the Council of State Governments Justice Center, which coordinates the Criminal Justice/MentalHealth Consensus Project. It was completed under cooperative agreement 2005-MU-BX-K007 awarded by the Bureau of JusticeAssistance (BJA), Office of Justice Programs, U.S. Department of Justice. The opinions and findings in this document do notnecessarily represent the official position or policies of the U.S. Department of Justice or the members of the Council of StateGovernments. While every effort was made to reach consensus and represent advisory group members’ and other reviewers’recommendations, individual opinions may differ from the statements made in the document.The Bureau of Justice Assistance reserves the right to reproduce, publish, translate, or otherwise use and to authorize others topublish and use all or any part of the copyrighted material contained in this publication.Council of State Governments Justice Center, New York 10005© 2007 by the Council of State Governments Justice CenterAll rights reserved. Published 2007.Cover design by Nancy Kapp & Company. Interior design by David Williams.
  4. 4. Contents Acknowledgments v Introduction vii Ten Essential Elements 1 | Planning and Administration 1 2 | Target Population 2 3 | Timely Participant Identification and Linkage to Services 3 4 | Terms of Participation 4 5 | Informed Choice 5 6 | Treatment Supports and Services 6 7 | Confidentiality 7 8 | Court Team 8 9 | Monitoring Adherence to Court Requirements 9 10 | Sustainability 10 Conclusion 11
  5. 5. iv Improving Responses to People with Mental Illnesses
  6. 6. AcknowledgmentsMany thanks are due to all those at the Bureau of Governments Justice Center thanks them, as well asJustice Assistance (BJA), a component of the Office a group of leading mental health court experts whoof Justice Programs, U.S. Department of Justice, spent a full day at BJA’s conference Mental Healthwho supported the development of this publication, Courts and Beyond in 2005 in Los Angeles to provideparticularly Domingo S. Herraiz, Director; A. Eliza- extensive comments on a subsequent draft of thebeth Griffith, Deputy Director for Planning; Robert document. In addition, representatives of BJA’s Men- tal Health Court Learning Sites added importantHendricks, former Acting Senior Policy Advisor for information throughout the review process.Mental Health; Michael Guerriere, former Senior A number of current and former JusticePolicy Advisor for Substance Abuse and Mental Center staff members were key contributors toHealth; Ruby Qazilbash, Senior Policy Advisor for the document, including director of communica-Substance Abuse and Mental Health; and Rebecca tions Martha Plotkin, research associate LaurenRose, Policy Advisor for Substance Abuse and Men- Almquist, and project coordinator Danieltal Health. Souweine. The project also benefited greatly from Special thanks must also be given to the the advice of Justice Center consultants Barry Ma-National Drug Court Institute (NDCI), particularly honey, President Emeritus of the Justice Manage-Karen Freeman-Wilson, West Huddleston, and Car- ment Institute, D. Alan Henry, Director Emeritus ofson Fox, for their guidance on how this publication the Pretrial Justice Institute, and Timothy Murray,could benefit from, and integrate, their experiences Executive Director of the Pretrial Justice Institute.developing the seminal publication Defining Drug Finally, Justice Center staff express their grati-Courts: The Key Components. tude to the hundreds of contributors who reviewed Representatives of the sites awarded grants online drafts. Through a web forum, these respon-under BJA’s Mental Health Court Grant Program dents provided valuable comments and offeredspent considerable time at a national conference insights and suggestions that made Essential Ele-in Cincinnati in 2004 providing valuable feedback to ments a stronger, more practical resource.a draft of Essential Elements. The Council of State The Essential Elements of a Mental Health Cour t v
  7. 7. vi Improving Responses to People with Mental Illnesses
  8. 8. IntroductionMental health courts are a recent and rapidly with mental illnesses charged with crimes, andexpanding phenomenon. In the late 1990s only a make more effective use of limited criminal justicefew such courts were accepting cases. Since then, and mental health resources.more than 150 others have been established, and As the commonalities among mental healthdozens more are being planned. Although early courts begin to emerge, practitioners, policymakers,commentary on these courts emphasized their dif- researchers, and others have become interested inferences—and their diversity is undeniable— developing consensus not only on what a mentalthe similarities across mental health courts are health court is, but on what a mental health courtbecoming increasingly apparent. In fact, the vast should be. The purpose of this document is to articulatemajority of mental health courts share the following such consensus in the form of 10 essential elements.characteristics:• A specialized court docket, which employs a problem-solving approach to court processing in About the Elements lieu of more traditional court procedures for cer- This publication identifies 10 essential elements of tain defendants with mental illnesses mental health court design and implementation.1• Judicially supervised, community-based treat- Each element contains a short statement describing ment plans for each defendant participating in criteria mental health courts should meet, followed the court, which a team of court staff and mental by several paragraphs explaining why the element is health professionals design and implement important and how courts can adhere to it. Ulti- mately, benchmarks will be added, enabling courts• Regular status hearings at which treatment to better assess their fidelity to each element. plans and other conditions are periodically Although both adult and juvenile mental reviewed for appropriateness, incentives are health courts have emerged in recent years, this offered to reward adherence to court conditions, publication pertains only to adult mental health and sanctions are imposed on participants who courts. There are two primary reasons for this do not adhere to the conditions of participation focus. First, as of this writing, there are only a hand-• Criteria defining a participant’s completion of ful of mental health courts targeting juveniles. Sec- (sometimes called graduation from) the program ond, the significant differences between the provision of mental health and criminal justice The reasons communities give for establishing services for juveniles and that for adults makes itmental health courts are also remarkably consis- difficult to develop a document that encompassestent: to increase public safety, facilitate participation both effective mental health and substance abuse Just as the success of local drug courtstreatment, improve the quality of life for people prompted the development of many mental health1. Essential Elements was developed as part of a technical assistance development of mental health courts in 23 jurisdictions in FY 2002 program provided by the Council of State Governments (CSG) Jus- and 14 jurisdictions in FY 2003. The Justice Center currently pro- tice Center through the Bureau of Justice Assistance (BJA) Mental vides technical assistance to the grantees of BJA’s Justice and Men- Health Courts Program. The BJA Mental Health Courts Program, tal Health Collaboration Program, the successor to the Mental which was authorized by America’s Law Enforcement and Mental Health Courts Program. Health Project (Public Law 106-515), provided grants to support the The Essential Elements of a Mental Health Cour t vii
  9. 9. courts, Defining Drug Courts: The Key Components, a the elements are present, they will manifest differ-1997 publication of the U.S. Department of Justice, ently across jurisdictions. In addition, some mentalinspired this document. Although there are signifi- health court practitioners may disagree with somecant differences between drug courts and mental of the statements below, identify elements that mayhealth courts, the Key Components document pro- be missing, or argue that some of these elementsvided the foundation in format and content for are unrealistic. This debate will drive strongerEssential Elements. efforts in the field and maximize the effectiveness Two key principles underlie the 10 essential of America’s mental health courts.elements. First, at the heart of each element is col- Because mental health courts will continue tolaboration among the criminal justice, mental mature and new research will become available,health, substance abuse treatment, and related sys- changes to this publication are inevitable. Essentialtems. True cross-system collaboration is necessary Elements will periodically be updated to reflect inno-to realize any of these elements and, for that matter, vative thinking from the field and to include theto successfully operate a mental health court. It is benchmarks that mental health court administra-generally accepted that achieving this type of collab- tors can use to assess their progress in implement-oration is difficult, particularly in regard to breaking ing the essential elements in their courts.down institutional barriers and eschewing theadversarial process. Second, the elements makeclear, both explicitly and implicitly, that mental Methodologyhealth courts are not a panacea. Reversing the over-representation of people with mental illnesses in The essential elements are culled from a variety ofthe criminal justice system requires a comprehen- sources, including interviews with former BJA Men-sive strategy of which mental health courts should tal Health Courts Program (MHCP) grantees, on-sitebe just one piece. visits to grantee and non-grantee mental health Though these elements are drawn in large part courts, and a review of the scholarly literature.2 Anfrom the experience of existing courts, they are not original draft of the elements document was preparedresearch-based. Only a few studies have been com- for the 2004 BJA MHCP conference. Commentspleted, though more are underway, to better under- from the conference attendees were incorporated intostand the operation and impact of mental health a second draft, which served as source material for thecourts. Proponents of mental health courts hope Guide to Mental Health Court Design and Implementa-that these investigations will substantiate the rela- tion, a BJA-sponsored publication.tive importance of different elements for court This latest version was informed by commentsfunctioning and client outcomes. In the meantime, from the field transmitted through a well-publicizedthese elements should prove useful for communi- web-based discussion forum. A group of practition-ties interested in developing a mental health court ers and experts reviewed and discussed these com-or reviewing the organization and functions of an ments and suggested revisions to the draft. Thisexisting court program. version incorporates those suggestions. The elements described in this document willnot be present in every mental health court. When2. The first major investigation of mental health courts was “Emerg- to Mental Health Court Design and Implementation, July 2005, and ing Judicial Strategies for the Mentally Ill in the Criminal Caseload: the Rand study Justice, Treatment, and Cost: An Evaluation of the Mental Health Courts in Fort Lauderdale, Seattle, San Bernardino, Fiscal Impact of Allegheny County Mental Health Court, March 2007. and Anchorage,” by John Goldkamp and Cheryl Irons-Guynn, April Readers interested in these and other resources related to mental 2000. Since then, several studies about mental health courts have health courts should visit been published, including the BJA-sponsored report entitled Guideviii Improving Responses to People with Mental Illnesses
  10. 10. Ten Essential Elements1 planning and administration 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.Mental health courts are situated at the intersection The planning committee should identify agencyof the criminal justice, mental health, substance leaders and policymakers to serve on an “advisoryabuse treatment, and other social service systems. group” (in some jurisdictions members of the advi-Their planning and administration should reflect sory group will also make up the planning commit-extensive collaboration among practitioners and tee), responsible for monitoring the court’spolicymakers from those systems, as well as com- adherence to its mission and its coordination withmunity members. To that end, a multidisciplinary relevant activities across the criminal justice and“planning committee” should be charged with mental health systems. The advisory group shoulddesigning the mental health court. Along with suggest revisions to court policies and proceduresdetermining eligibility criteria, monitoring mecha- when appropriate, and should be the public face ofnisms, and other court processes, this committee the mental health court in advocating for its support.should articulate clear, specific, and realizable goals The planning committee should address ongoingthat reflect agreement on the court’s purposes and issues of policy implementation and practice thatprovide a foundation for measuring the court’s the court’s operation raises. Committee membersimpact (see Element 10: Sustainability). should also keep high-level policymakers, including Ideally, the development of a mental health those on the advisory group, informed of the court’scourt should take place in the context of broader successes and failures in promoting positive changeefforts to improve the response to people with men- and long-term sustainability (see Element 10). Addi-tal illnesses involved with, or at risk of involvement tionally, by facilitating ongoing training and educa-with, law enforcement, the courts, and corrections. tion opportunities, the planning committee shouldSuch discussions should include police and sher- complement and support the small team of profes-iffs’ officials, judges, prosecutors, defense counsel, sionals who administer the court on a daily basis,court administrators, pretrial services staff, and cor- the “court team” (see Element 8).rections officials; mental health, substance abuse In many jurisdictions, the judiciary will ulti-treatment, housing, and other service providers; mately drive the design and administration of theand mental health advocates, crime victims, con- mental health court. Accordingly, it should be wellsumers, and family and community members. represented on and take a visible role in leading both the planning committee and advisory group. The Essential Elements of a Mental Health Cour t 1
  11. 11. 2 target population Eligibility criteria address public safety and consider a community’s treatment capacity, in addition to the availability of alternatives to pretrial detention for defendants with mental illnesses. Eligibility criteria also take into account the relationship between mental illness and a defendant’s offenses, while allowing the individual circumstances of each case to be considered.Because mental health courts are, by definition, including drug courts and community courts, as tar-specialized interventions that can serve only a por- get populations are likely to overlap.tion of defendants with mental illness, careful Clinical eligibility criteria should be wellattention should be paid to determining their target defined and should be developed with an under-populations. standing of treatment capacity in the community. Mental health courts should be conceptualized Mental health court personnel should explore waysas part of a comprehensive strategy to provide law to improve the accessibility of community-basedenforcement, court, and corrections systems with care when treatment capacity is limited and shouldoptions, other than arrest and detention, for explore ways to improve quality of care when serv-responding to people with mental illnesses. Such ices appear ineffective (see Element 6: Treatmentoptions include specialized police-based responses Supports and Services).and pretrial services programs. For those individuals Mental health courts should also focus onwho are not diverted from arrest or pretrial deten- defendants whose mental illness is related to theirtion, mental health courts can provide appropriately current offenses. To that end, the planning commit-identified defendants with court-ordered, commu- tee should develop a process or a mechanism,nity-based supervision and services. Mental health informed by mental health professionals, to enablecourts should be closely coordinated with other spe- staff charged with identifying mental health courtcialty or problem-solving court-based interventions, participants to make this determination.2 Improving Responses to People with Mental Illnesses
  12. 12. 3 timely participant identification and linkage to services Participants are identified, referred, and accepted into mental health courts, and then linked to community-based service providers as quickly as possible.Providing safe and effective treatment and supervi- necessary, it should be expedited, especially forsion to eligible defendants in the community, as defendants charged with misdemeanors. The timeopposed to in jail or prison, is one of the principal required to accept someone into the programpurposes of mental health courts. Prompt identifi- should not exceed the length of the sentence thatcation of participants accelerates their return to the the defendant would have received had he or shecommunity and decreases the burden on the crimi- pursued the traditional court process. Final deter-nal justice system for incarceration and treatment. mination of eligibility should be a team decision Mental health courts should identify potential (see Element 8: Court Team).participants early in the criminal justice process by The time needed to identify appropriate serv-welcoming referrals from an array of sources such ices, the availability of which may be beyond theas law enforcement officers, jail and pretrial serv- court’s control, may constrain efforts to identify par-ices staff, defense counsel, judges, and family mem- ticipants rapidly (see Element 6: Treatment Sup-bers. To ensure accurate referrals, mental health ports and Services). This is likely to be an issuecourts must advertise eligibility criteria and actively especially in felony cases, when the court may seekeducate these potential sources. In addition to creat- services of a particular intensity to maximize publicing a broad network for identifying possible partici- safety. Accordingly, along with connecting mentalpants, mental health courts should select one or two health court participants to existing treatment, offi-agencies to be primary referral sources that are cials in criminal justice, mental health, and sub-especially well versed in the procedures and criteria. stance abuse treatment should work together to The prosecutor, defense counsel, and a improve the quality and expand the quantity oflicensed clinician should quickly review referrals available services.for eligibility. When competency determination is The Essential Elements of a Mental Health Cour t 3
  13. 13. 4 terms of participation Terms of participation are clear, promote public safety, facilitate the defendant’s engagement in treatment, are individualized to correspond to the level of risk that the defendant presents to the community, and provide for positive legal outcomes for those individuals who successfully complete the program.Mental health courts need general program param- process. In addition, program duration should varyeters for plea agreements, program duration, super- depending on a defendant’s program progress. Pro-vision conditions, and the impact of program gram completion should be tied to adherence to thecompletion. Within these parameters, the terms of participant’s court-ordered conditions and theparticipation should be individualized to each strength of his or her connection to communitydefendant and should be put in writing prior to his treatment.or her decision to enter the program. The terms of Least restrictive supervision conditions shouldparticipation will likely require adherence to a treat- be considered for all participants, especially thosement plan that will be developed after engagement charged with misdemeanors. Highly restrictive con-with the mental health court program, and defen- ditions increase the likelihood that minor violationsdants should be made aware of the consequences of will occur, which can intensify the involvement ofnoncompliance with this plan. participants in the criminal justice system. Whenever plea agreements are offered to peo- When a mental health court participant com-ple invited to participate in a mental health court, pletes the terms of his or her participation in thethe potential effects of a criminal conviction should program, there should be some positive legal out-be explained. Collateral consequences of a criminal come. When the court operates on a pre-plea model,conviction may include limited housing options, a significant reduction or dismissal of charges canopportunities for employment, and accessibility to be considered. When the court operates in a post-some treatment programs. It is especially important plea model, a number of outcomes are possiblethat the defendant be made aware of these conse- such as early terminations of supervision, vacatedquences when the only charge he or she is facing is pleas, and lifted fines and fees. Mental health courta misdemeanor, ordinance offense, or other non- participants, when in compliance with the terms ofviolent crime. their participation, should have the option to with- The length of mental health court participation draw from the program at any point without havingshould not extend beyond the maximum period of their prior participation and subsequent withdrawalincarceration or probation a defendant could have from the mental health court reflect negatively onreceived if found guilty in a more traditional court their criminal case.4 Improving Responses to People with Mental Illnesses
  14. 14. 5 informed choice 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 in the mental health court to address, in a timely fashion, concerns about a defendant’s competency whenever they arise.Defendants’ participation in mental health courts is defendant should be spelled out in writing. Defen-voluntary. But ensuring that participants’ choices dants should have the opportunity to review theseare informed, both before and during the program, terms, with the advice of counsel, before opting intorequires more than simply offering the mental the court as an option to certain defendants. Defense attorneys play an integral role in help- Mental health court administrators should be ing to ensure that defendants’ choices are informedconfident that prospective participants are compe- throughout their involvement in the mental healthtent to participate. Typically, competency determina- court. Admittedly, the availability of defense counseltion procedures can be lengthy, which raises varies from one jurisdiction to another. In some com-challenges for timely participant identification. This munities, defendants’ access to counsel depends onis especially important for courts that focus on the crime with which they were charged or the pur-defendants charged with misdemeanors (see Ele- pose of the hearing. Recognizing these constraints,ment 3: Timely Participant Identification and Link- courts should strive to make defense counsel avail-age to Services). For these reasons, as part of the able to advise defendants about their decision toplanning process, courts should develop guidelines enter the court and have counsel be present at statusfor the identification and expeditious resolution of hearings. It is particularly important to ensure thecompetency concerns. presence of counsel when there is a risk of sanctions Even when competency is not an issue, mental or dismissal from the mental health court. Defensehealth court staff must ensure that defendants fully counsel participating in mental health courts—likeunderstand the terms of participation, including all other criminal justice staff assigned to the court—the legal repercussions of not adhering to program should receive special training in mental healthconditions. The specific terms that apply to each issues (see Element 8: Court Team). The Essential Elements of a Mental Health Cour t 5
  15. 15. 6 treatment supports and services Mental health courts connect participants to comprehensive and individualized treatment supports and services in the community.They strive to use—and increase the availability of— treatment and services that are evidence-based.Mental health court participants require an array of Treatment providers should remain in regularservices and supports, which can include medications, communication with court staff concerning thecounseling, substance abuse treatment, benefits, appropriateness of the treatment plan and shouldhousing, crisis interventions services, peer supports, suggest adjustments to the plan when appropriate.and case management. Mental health courts should At the same time, court staff should check withanticipate the treatment needs of their target popula- community-based treatment providers periodicallytion and work with providers to ensure that services to determine the extent to which they are encoun-will be made available to court participants. tering challenges stemming from the court’s super- When a participant is identified and linked to a vision of the participant.service provider, the mental health court team Case management is essential to connect par-should design a treatment plan that takes into ticipants to services and monitor their complianceaccount the results of a complete mental health and with court conditions.4 Case managers—whethersubstance abuse assessment, individual consumer they are employees of the court, treatmentneeds, and public safety concerns. Participants providers, or community corrections officers—should also have input into their treatment plans. should have caseloads that are sufficiently manage- A large proportion of mental health court par- able to perform core functions and monitor theticipants have co-occurring substance abuse disor- overall conditions of participation. They shouldders. The most effective programs provide serve as the conduits of information for the courtcoordinated treatment for both mental illnesses and about the status of treatment and support services.substance abuse problems. Thus, mental health Case managers also help participants preparecourts should connect participants with co-occur- for their transition out of the court program byring disorders to integrated treatment whenever ensuring that needed treatment and services willpossible and advocate for the expanded availability of remain available and accessible after their courtintegrated treatment and other evidence-based prac- supervision concludes. The mental health courttices.3 Mental health court teams should also pay may also provide post-program assistance, such asspecial attention to the needs of women and ethnic graduate support groups, to prevent participants’minorities and make gender-sensitive and culturally relapses.competent services available.3. Evidence-based practices (EBPs) are mental health service interven- prior training of the individuals who are implementing it, whether tions for which consistent scientific evidence demonstrates their abil- they are social workers, nurses, or case management specialists” ity to improve consumer outcomes. R.E. Drake, et al., “Implementing (see SAMHSA’s Treatment Improvement Protocol [TIP] #27, “Case Evidence-Based Practices in Routine Mental Health Service Settings,” Management for Substance Abuse Treatment”). The definition of a Psychiatric Services 52 (2001): 179–182. Other EBPs include assertive particular case management approach can be derived from its func- community treatment, psychotropic medications, supported employ- tions and objectives. Case management functions include assess- ment, family psychoeducation, and illness self-management. ing, planning, linking, coordinating, monitoring, and advocating.4. The term “case management” has multiple definitions. Moreover, For example, the Office of Juvenile Justice and Delinquency Preven- specific interventions such as assertive community treatment tion (OJJDP) of the U.S. Department of Justice in its publication (ACT) and intensive case management (ICM) are themselves case Drug Identification and Testing in the Juvenile Justice System, defines management models. According to the Substance Abuse and Men- case management as “an individualized plan for securing, coordi- tal Health Services Administration (SAMHSA) “any definition of nating, and monitoring the appropriate treatment interventions and case management today is inevitably contextual, based on the needs ancillary services necessary to treat each offender successfully for of a particular organizational structure, environmental reality, and optimal justice system outcomes.”6 Improving Responses to People with Mental Illnesses
  16. 16. 7 confidentiality 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 participants’ court-ordered treatment program or services should be safeguarded in the event that participants are returned to traditional court processing.To identify and supervise participants, mental discussions about that person’s mental illness,health courts require information about their men- which can stigmatize the defendant. Even informa-tal illnesses and treatment plans. When sharing this tion concerning a defendant’s referral to a mentalinformation, treatment providers and representa- health court should be closely guarded—particu-tives of the mental health court should consider the larly because many of these individuals may laterwishes of defendants. They must also adhere to fed- choose not to participate in the mental health court.eral and state laws that protect the confidentiality of To minimize the likelihood that information aboutmedical, mental health, and substance abuse treat- defendants’ mental illnesses or their referral to thement records. mental health court will negatively affect their crim- A well-designed procedure governing the inal cases, courts whenever possible should main-release and exchange of information is essential to tain clinical documents separately from thefacilitating appropriate communication among criminal files and take other precautions to preventmembers of the mental health court team and to medical information from becoming part of theprotect confidentiality. Release forms should be part public record.of this procedure. They should be developed in con- Once a defendant is under the mental healthsultation with legal counsel, adhere to federal and court’s supervision, steps should be taken to main-state laws, and specify what information will be tain the privacy of treatment information through-released and to whom.5 Potential participants out his or her tenure in the program. Clinicalshould be allowed to review the form with the information provided to mental health court staffadvice of defense counsel and treatment providers. members should be limited to whatever they needDefendants should not be asked to sign release of to make decisions. Furthermore, such exchangesinformation forms until competency issues have should be conducted in closed staff meetings; dis-been resolved (see Element 5: Informed Choice). cussion of clinical information in open court should When a defendant is being considered for the be avoided.mental health court, there should not be any public5. For information on complying with the Health Insurance Portabil- ity and Accountability Act (HIPAA), please visit SAMHSA’s Web site at The Essential Elements of a Mental Health Cour t 7
  17. 17. 8 court team A team of criminal justice and mental health staff and service and 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.The mental health court team works collaboratively Mental health court planners should carefullyto help participants achieve treatment goals by bring- select team members who are willing to adapt to aing together staff from the agencies with a direct role nontraditional setting and rethink core aspects ofin the participants’ entrance into, and progress their professional training. Planners should seekthrough, the court program. The court team func- criminal justice personnel with expertise or interesttions include conducting screenings, assessments, in mental health issues and mental health staff withand enrollments of referred defendants; defining criminal justice experience. Planners should alsoterms of participation; partnering with community work to ensure that the judge who will preside overproviders; monitoring participant adherence to the mental health court is comfortable with its goalsterms; preparing for all court appearances; and devel- and procedures.oping transition plans following court supervision. Team members should take part in cross-train-Team members should work together on each partic- ing before the court is launched and during its oper-ipant’s case and contribute to the court’s administra- ation. Mental health professionals must familiarizetion to ensure its smooth functioning. themselves with legal terminology and the work- The composition of this court team differs ings of the criminal justice system, just as criminalacross jurisdictions. These variations notwithstand- justice personnel must learn about treatment prac-ing, it typically should comprise the following: a tices and protocols. Team members should also bejudicial officer; a treatment provider or case man- offered the opportunity to attend regional orager; a prosecutor; a defense attorney; and, in some national training sessions and view the operationscases, a court supervision agent such as a probation of other mental health courts. New team membersofficer. Many courts also employ a court coordinator should go through a period of training and orienta-responsible for overall administration of the court, tion before engaging fully with the court.which can help promote communication, efficiency, Periodic review and revision of court processesand sustainability. Regardless of the composition of must be a core responsibility of the court team.the team, the judge’s role is central to the success of Using data, participant feedback, observations ofthe mental health court team and the mental health team members, and direction from the advisorycourt generally. He or she oversees the work of the group and planning committee (see Element 1), themental health court team and encourages collabora- court team should routinely make improvements totion among its members, who must work together the court’s inform the judge about whether participants areadhering to their terms of participation.8 Improving Responses to People with Mental Illnesses
  18. 18. 9 monitoring adherence to court requirements Criminal justice and mental health staff collaboratively monitor participants’ adherence to court conditions, offer individualized graduated incentives and sanctions, and modify treatment as necessary to promote public safety and participants’ recovery.Whether a mental health court assigns responsibil- is common. But nonadherence should never beity for monitoring compliance with court conditions ignored. The first response should be to reviewto a criminal justice agency, a mental health agency, treatment plans, including medications, living situ-or a combination of these organizations, collabora- ations, and other service needs. For minor viola-tion and communication are essential. The court tions the most appropriate response may be amust have up-to-date information on whether partic- modification of the treatment plan.ipants are taking medications, attending treatment In some cases, sanctions are necessary. Thesessions, abstaining from drugs and alcohol, and manner in which a mental health court appliesadhering to other supervision conditions. This infor- sanctions should be explained to participants priormation will come from a variety of sources and must to their admittance to the program. As a partici-be integrated routinely into one coherent presenta- pants commission of violations increases in fre-tion or report to keep all court staff informed of par- quency or severity, the court should use graduatedticipants’ progress. Case staffing meetings provide sanctions that are individualized to maximizesuch an opportunity to share information and deter- adherence to his or her conditions of release. Spe-mine responses to individuals’ positive and negative cific protocols should govern the use of jail as a con-behaviors. These meetings should happen regularly sequence for serious noncompliance.and involve key members of a team, including, Mental health courts should use incentives towhen appropriate, representatives from the prosecu- recognize good behavior and to encourage recoverytion, defense, treatment providers, court supervision through further behavior modification. Individualagency, and the judiciary. praise and rewards, such as coupons, certificates for Status hearings allow mental health courts completing phases of the program, and decreasedpublicly to reward adherence to conditions of partic- frequency of court appearances, are helpful andipation, to sanction nonadherence, and to ensure important incentives. Systematic incentives thatongoing interaction between the participant and the track the participants’ progress through distinctcourt team members. These hearings should be fre- phases of the court program are also critical. As par-quent at the outset of the program and should ticipants complete these phases, they receive publicdecrease as participants progress positively. recognition. All responses to participants’ behavior, whether Courts should have at their disposal a menu ofpositive or negative, should be individualized. incentives that is at least as broad as the range ofIncentives, sanctions, and treatment modifications available sanctions; incentives for sustained adher-have clinical implications. They should be imposed ence to court conditions, or for situations in whichwith great care and with input from mental health the participant exceeds the expectation of the courtprofessionals. team, are particularly important. Relapse is a common aspect of recovery; non-adherence to conditions of participation in the court The Essential Elements of a Mental Health Cour t 9
  19. 19. 10 sustainability Data are collected and analyzed to demonstrate the impact of the mental health court, its performance is assessed periodically (and procedures are modified accordingly), court processes are institutionalized, and support for the court in the community is cultivated and expanded.Mental health courts must take steps early in the plans for staff turnover helps safeguard the integrityplanning process and throughout their existence to of the court’s operation.ensure long-term sustainability. To this end, per- Because sustaining a mental health court with-formance measures and outcome data will be out funding is difficult, court planners should iden-essential. Data describing the court’s impact on tify and cultivate long-term funding sources earlyindividuals and systems should be collected and on. Court staff should base requests for long-termanalyzed. Such data should include the court’s out- funding on clear articulations of what the courtputs, such as number of defendants screened and plans to accomplish. Along with compiling empiri-accepted into the mental health court, as well as its cal evidence of program successes, mental healthoutcomes, such as the number of participants who court teams should invite key county officials, stateare rearrested and reincarcerated. Setting output legislators, foundation program officers, and otherand outcome measures are a key function of the policymakers to witness the court in action.court’s planning and ongoing administration (see Outreach to the community, the media, andElement 1).6 Quantitative data should be comple- key criminal justice and mental health officials alsomented with qualitative evaluations of the program promotes sustainability. To that end, mental healthfrom staff and participants. court teams should make community members Formalizing court policies and procedures is aware of the existence and impact of the mentalalso an important component of maintaining men- health court and the progress it has made. Moretal health court operations. Compiling information important, administrators should be prepared toabout a court’s history, goals, eligibility criteria, respond to notable program failures, such as wheninformation-sharing protocols, referral and screen- a participant commits a serious crime. Ongoinging procedures, treatment resources, sanctions and guidance from, and reporting to, key criminal jus-incentives, and other program components helps tice and mental health leaders also helps to main-ensure consistency and lessens the impact when tain interest in, and support for, the mental healthkey team members depart. Developing additional court.6. The next edition of this document will include benchmarks that Outcome Data, May 2005, published by the CSG Justice Center will help courts determine whether this is taking place in their and available at jurisdictions. For guidance on collecting outcome data, please see MHC-Outcome-Data.pdf. Henry J. Steadman, A Guide to Collecting Mental Health Court10 Improving Responses to People with Mental Illnesses
  20. 20. ConclusionIn courtrooms across the country, judges, prosecu- as variation is the hallmark of this country’s crimi-tors, and defense attorneys are seeing increasing nal justice system, and one of its strengths. At thenumbers of defendants who have serious untreated same time, experts in criminal justice and mentalmental illnesses charged with committing low-level health practice agree that there are essential ele-crimes. Traditional court processes do little to ments to mental health courts, which enable themimprove outcomes for many of these people. They to span both the criminal justice and mental healthcycle again and again through jail, courtrooms, and systems effectively and to ensure that the rights ofour city streets. participants and community members are As an alternative to the status quo, court offi- respected. This publication describes and explainscials, working in partnership with leaders in the these essential elements of a mental health court.mental health system and local and state policy- To design and implement a mental health courtmakers, have designed problem-solving mental with attention to each of these elements is a chal-health courts. These courts depart from the tradi- lenge for those just starting a conversation about ational model used in most criminal proceedings. possible mental health court, as well as for thoseInstead, as a team and under the judge’s guidance, who have operated a mental health court for years.prosecutors, defense attorneys, and mental health Yet seasoned and new mental health court teamsservice providers connect eligible defendants with alike have demonstrated a willingness to addresscommunity-based mental health treatment and, in such complicated challenges. The essential ele-lieu of incarceration, assign them to community- ments described in this document are written forbased supervision. them and others following in their footsteps, all of The number of mental health courts in the whom work tirelessly to make communities health-United States has grown significantly. These pro- ier and safer, promote the efficient use of publicgrams share much in common from one county to resources and tax dollars, and improve outcomesanother. There are also aspects of each mental for people with mental illnesses who are involved inhealth court’s design and operation that are unique, the criminal justice system. The Essential Elements of a Mental Health Cour t 11
  21. 21. The Bureau of Justice Assistance, Office of Justice Programs,U.S. Department of Justice, provides leadership training, techni-cal assistance, and information to local criminal justice agenciesto make America’s communities safer. Read more Council of State Governments (CSG) Justice Center is anational nonprofit organization serving policymakers at thelocal, state, and federal levels from all branches of government.The CSG Justice Center provides practical, nonpartisan adviceand consensus-driven strategies, informed by available evidence,to increase public safety and strengthen communities. Readmore at Criminal Justice/Mental Health Consensus Project is anunprecedented national effort coordinated by the CSG JusticeCenter to improve responses to people with mental illnesses whobecome involved in, or are at risk of involvement in, the criminaljustice system. Read more at
  22. 22. Council of State Governments Justice Center100 Wall Street 4630 Montgomery Avenue20th Floor Suite 650New York, NY 10005 Bethesda, MD 20814tel: 212-482-2320 tel: 301-760-2401fax: 212-482-2344 fax: 240-497-0568