Mental health courts

Mental health courts are specialized court dockets that provide community treatment and supervision in lieu of incarceration for criminal offenders with mental illness. Like other "problem-solving courts," such as drug courts, domestic violence courts, and community courts, mental health courts seek to move away from the adversarial legal process to address the underlying causes of crime. Mental health courts also share common cause with Crisis Intervention Teams (CIT), jail diversion programs, specialized probation and parole caseloads, and a host of other collaborative initiatives intended to address the significant overrepresentation of people with mental illness in the criminal justice system.

History
Most observers of mental health courts cite a program in Broward County, Florida, as the first known example. Overseen by Judge Ginger Lerner-Wren, the Broward County Mental Health Court was launched in 1997, partially in response to a series of suicides of people with mental illness in the county jail. The Broward court and three other early mental health courts, Anchorage, AK, San Bernardino, CA, and King County, WA, were examined in a 2000 Bureau of Justice Assistance monograph, which was the first major study of this emerging judicial strategy. Since 2000, the number of mental health courts has expanded rapidly. An ongoing survey conducted by several organizations identifies more than 120 mental health courts across the country as of 2006. The proliferation of courts was spurred in large part by a federal grant program, which provided funding to 37 courts in 2002 and 2003.

Court Process
The operation of mental health courts varies widely, so much so that there is no generally agreed on definition of what constitutes a mental health court. That said, most mental health courts share a number of commonalities. Potential participants are usually screened early on in the criminal process, either at the jail or by court staff such as pretrial services officers or social workers in the public defender's office. Most courts have criteria related to what kind of charges, criminal histories, and diagnoses will be accepted. For example, a court may accept only defendants charged with misdemeanors, who have no history of violent crimes, and who have an Axis I diagnoses as defined by the DSM-IV.

Defendants who fit the criteria based on the initial screening are usually given a more comprehensive assessment to determine their interest in participating and their community treatment needs. Defendants who agree to participate receive a treatment plan and other community supervision conditions. For those who adhere to their treatment plan for the agreed upon time, usually between six months and two years, their cases is either dismissed or the sentence is greatly reduced. If the defendant does not comply with the conditions of the court, or decides to leave the program, their case returns to the original criminal calendar where the prosecution proceeds as normal. As a rule, most mental health courts use a variety of intermediate sanctions in response to noncompliance before ending a defendant's participation. An essential component of mental health court programs for protection of the public is a dynamic risk management process that involves court supervised case management with interactive court review and assessment.

Like other problem-solving courts, mental health courts tend to be judge-centered, in the sense that the same judge presides continually over the court docket and makes all final determinations about program entry, sanctions, graduation, and termination. That said, most mental health courts rely on a team approach in which the defense counsel, prosecutor, case managers, treatment professionals, and community supervision personnel (e.g., probation) work closely to coordinate oversight and support for participants. Many courts also employ a full-time coordinator who manages the docket and facilitates communication between the different team members.

Criticisms
Some have criticized mental health courts for deepening, as opposed to lessening, the involvement of people with mental illness in the criminal justice system. They argue that because mental health courts focus on misdemeanor offenders who would have received short jail sentences or probation if not for the mental health court, a long period of mandated community treatment is actually a greater burden on defendants than the traditional criminal process. These critics have urged mental health courts to accept defendants charged with felonies, which many of the more recent courts have started to do.

Critics have also raised concerns about the use of mental health courts to coerce people into treatment, the requirement that defendants enter a guilty plea prior to entering the court (a requirement in some, but not all, courts), and about infringement on the privacy of treatment information. Furthermore, many have noted that the rise of mental health courts is, in large part, the result of an underfunded and ineffective community mental health system, and without attention to the deficencies in community treatment resources, mental health courts can only have a limited impact.

Outcomes
Because mental health courts (MHC) are such a new phenomenon, there is little in the way of outcome data to determine their impact. Several studies of the Broward County court were released in 2002 and 2003 and found that participation in the court led to a greater connection to services. A 2004 study of the Santa Barbara County, California, Mental Health Court found that participants had reduced criminal activity during their participation. No multi-site mental health courrt comparison study has yet been completed.