Mental Health Courts: A ‘humane mechanism’ for people with mental illness

By Phyllis Hanlon
February 4th, 2022

In the late 1980s, Janet Reno, then state attorney for Miami Dade County, Florida, founded the first drug court to address the underlying issues that repeatedly brought individuals into the criminal justice system. That model led to the creation of mental health courts, which aim to support, assist and encourage offenders with mental illness and divert them from incarceration.

According to retired District Court Judge Mary Hogan Sullivan, former specialty court director for the District Court who continues to consult with specialty courts, mental health courts use a multi-disciplinary team approach. Teams comprise a judge, probation officer, defense attorney, prosecutor and, most importantly, a clinician, usually a LICSW, she said. Team members are usually dedicated to one particular court.

The program, which is voluntary, begins with a clinical evaluation of the individual to determine appropriateness. The team reviews the report along with other related information, such as criminal history and circumstances. After hearing from the team, the judge decides whether to accept the individual into the program. “Most judges take anyone unless there is a good reason not to,” said Sullivan. “Some courts have exclusions, for example, if a person is a sex offender or is post-arson or if the services provided don’t meet the person’s needs.”

Services may be provided in a residential facility or in the community. Sullivan pointed out that medication compliance is a key piece of the program.

Initially, the person is required to appear in court once a week. The team and the judge constantly receive updates and reassess the treatment plan as necessary. The program tends to last an average of 18 months but could last as long as two years, according to Sullivan.

“Specialty courts like this allow us to work to address the underlying causes of mental health and criminal behavior, while getting people the support and treatment they need.” --Joseph D. Early Jr., Worcester County district attorney

Having a dedicated judge and probation officer is key to the success of the program, Sullivan noted, since the judge and participant develop a relationship. “The judge knows the individual and his or her struggles, the diagnosis and where they are in their treatment,” she said. “The judge holds the person accountable. The whole key is accountability. You want to keep the person in the community and give them the right tools. We have an obligation to provide treatment and supervision to hold the person accountable.”

Annabel Lane, LICSW, president of the NAMI-MA board of directors, noted that mental health courts provide a mechanism for individuals who have committed crimes stemming from a mental health condition to receive treatment, while still having oversight and accountability from the court.

Lane works in a police department outside of Boston and said that anecdotally, about half of the calls where charges need to be filed have some element of mental health, either as a primary or related factor.

So, in cases where it’s appropriate, these mental health court sessions divert people with mental illness from sitting in jail when both they and the community would be better served by engagement in treatment, she added.

Mental health courts also offer a degree of structure that can be beneficial. “People are checking in at the court generally every week or two weeks, so there’s a safety net in place if someone is starting to struggle where there can be extra support or measures put in place earlier,” Lane said, explaining that mental health courts are a “humane mechanism for people with mental illness.”

She added that generally in the community, if folks disengage from treatment, there’s no mechanism for checking in and making sure they are okay; there is no community accountability.

“The way our service system works overall is that you either have to be extremely self-motivated to access treatment, or spiral until you’re in a crisis and end up in the hospital or worst case, having criminal justice involvement,” Lane said.

According to Lane, there have been good outcomes from mental health court sessions in terms of lowering recidivism rates and helping individuals stabilize and get on a better path. “A lot of the success depends on having a judge who has that balance of compassion and structure,” she said. “The mental health courts are also only as successful as the services that are available.”

Lane noted that local NAMI affiliates can and have partnered with the courts to provide education on mental illness. The NAMI Mass Criminal Justice Diversion project advocates for diversionary efforts such as mental health court sessions, as well as police-based interventions, such as Crisis Intervention Teams and clinical partnerships, she said.

Worcester is currently in the process of setting up a mental health court. Sullivan reported that the court is hiring a clinician and lining up a team. She added that Judge Timothy Bibaud will be the presiding judge.

District Attorney Joseph D. Early, Jr. lauds the decision to locate a mental health court in Worcester and is eager to begin collaborative efforts. “We’re glad to be working with the Trial Court as they form this Mental Health Court in Worcester. Specialty courts like this allow us to work to address the underlying causes of mental health and criminal behavior, while getting people the support and treatment they need,” he said.

“It will also help us to remove the stigma regarding mental health. I tell my staff, show compassion, stay within the law. The Mental Health court will allow us to help those suffering from a mental illness to specifically address the underlying problems, while at the same time reducing recidivism rates. That’s good government.”

Sullivan reported that any district court judge would note that most individuals have underlying substance use disorders or a co-occurring mental illness. The development of the mental health court system is designed to address those issues and is guided by science, she added.

“Our knowledge has grown exponentially. We have tried to provide treatment appropriate to the individual. We assess the tools that tell us what’s needed,” Sullivan said. “We want to help individuals so they don’t return [to the court system].”

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