As a former defense attorney in Southwest Georgia, I had the privilege of working in one of the first mental health courts in the country. It was my job to facilitate initial contact with the court, and represent clients who violated terms of their mental health probation or mental health court rules. Based on these experiences, I want to help healthcare practitioners understand the resources for people with mental illness who find themselves in the criminal justice system.
Mental health is a very serious concern in the criminal justice system. It is estimated that 20 percent of those in jail and 15 percent of those in state prisons have a serious mental illness. Based on the total number of inmates, this means that there are approximately 356,000 inmates with serious mental illness in jails and state prisons. This is 10 times more than the approximately 35,000 individuals with serious mental illness remaining in state hospitals (Torrey, Zdanowicz, & Kennard, et al. 2014). This statistic does not account for those with milder mental illness who may be in jails and prisons.
Over the years, practitioners in the justice system recognized that many people who are incarcerated or placed on years of probation suffered from some sort of mental illness. The problem with jails and prisons is that they are not the best place for someone with mental illness. Because of budgetary constraints, jails and prison cannot provide the sort of care that one can receive outside. Many times I would have clients complain that their psychiatric medications were changed and not as effective. Many people decompensate in jail. Their conditions become markedly worse and noticeable even to the lay person. It can become a vicious cycle as people are placed in jail or probation without adequately addressing their mental health issues. They are eventually released and often recommit a crime. This places strain on the justice system, community, clients, and their families. The natural conclusion is that jail and prison sentences simply do not work for those who have mental illness.
Mental health courts were created to address many of these concerns. In 1997, there were only four mental health courts in the U.S. Today, that number has grown to over 300, with programs in almost every state. (Justice Center, n.d.) Mental health courts target those who have a mental illness and frequently appear on court dockets or who have several probation violations. The mental health court uses a collaborative approach to help those in the program.
Mental health courts typically comprise of a judge, a court coordinator (a registered nurse that does mental health screening), probation officers, caseworkers (who often specialize in mental health and or substance abuse), public defenders, and prosecutors. Training is provided to all involved to help address mental health issues. Typically, mental health programs will accept those with non-violent felonies who have serious and persistent mental illness, comorbid mental illnesses, and substance abuse disorders. Common diagnoses include bipolar, psychotic, depressive, and anxiety disorders. The court draws on community resources like crisis stabilization units, residential programs for individuals with specific diagnoses, detoxification centers, transitional aftercare centers, and programs that provide transportation assistance, case management, and assistance applying for benefits and entitlements. This collaborative approach helps address virtually every obstacle that a person with mental illness may have in the criminal justice system. But many times, the mental health court goes further, by providing assistance with benefits, health care, and transportation. (Bureau of Justice Assistance, n.d.)
|The mental health court uses a collaborative approach to help those in the program
A vital component to the mental health court is the family unit. I found that strong family support can be the most important factor in keeping an individual out of jail. Many times those with little to no family support struggle with medication and appointment compliance and wind up in jail. Families can play a vital role in providing this support and advocating for their relative. The court typically wants to see that the person with mental illness has someone to help them take their medication, give them a place to stay, work with mental health court staff, and assist the client with appointments. When the court sees this, it is much more likely to agree to keep that person out of jail and in mental health court.
Clinicians and health care providers should be encouraged to see if mental health courts exist in their community. My guess is that they probably do, even in more rural communities. This can be done by calling the Clerk of Court in their jurisdiction. Another option is an online search for "name of local county and mental health court”. However, less developed mental health courts may not have a strong online presence. It is especially important for clinicians to look into this if they serve a population that has frequent or high encounters with the justice system. They should encourage families to approach their defense counsel about mental health court as an alternative to regular probation or jail. Many times counsel is not fully aware of a client’s mental health issues, making information from both clinicians and family invaluable. This input can drastically change the way defense approaches a case, resulting in the client having more appropriate treatment and, hopefully, staying out of jail.
The bottom line is that mental health courts are very important pieces in the criminal justice system. They decrease recidivism and effectively and respectfully serve those with mental illness.
Bureau of Justice Assistance, (n.d.). Dougherty Superior Court, Georgia, Mental Health Court: Program description. Retrieved from: http://csgjusticecenter.org/mental-health/learning-sites/albany-mental-health-court/
Torrey, E.F., Zdanowicz, M.T., Kennard. A.D. et al., (2014). The treatment of persons with mental illness in prisons and jails: A state survey. Treatment Advocacy Center, Arlington, VA.
Justice Center (n.d.) Mental health courts. Retrieved from: http://csgjusticenter.org/mental-health-court-project/
Robb Hunter is an attorney with Monnat & Spurrier, Chartered, in Wichita, Kansas. He brings impressive trial experience honed in the courtroom slug-fests of Southwest Georgia where he performed the tough work of a Georgia State Public Defender. In that role, he worked in the Dougherty County Mental Health Court representing clients with mental illness and advocating for their proper treatment. Mr. Hunter is admitted to practice before the federal and state courts in Kansas, Minnesota, and Georgia, as well as before the Georgia Court of Appeals, Federal District Court Middle District of Georgia, and the Supreme Court of Georgia. He is a member of the Wichita Bar Association, Kansas Bar Association, and Georgia Bar Association.