Title: Emerging Judicial Strategies for the Mentally Ill in the Criminal Caseload:
Mental Health Courts.
Series: Monograph
Author: Bureau of Justice Assistance
Published: April 2000
Subject: Mentally Ill Offenders, Case Processing
88 pages
241,664 bytes

----------------------------

Figures, charts, forms, and tables are not included in this ASCII plain-text file.
To view this document in its entirety, download the Adobe Acrobat graphic file
available from this Web site or order a print copy from BJA at 800-688-4252.

----------------------------

U.S. Department of Justice
Office of Justice Programs
810 Seventh Street NW.
Washington, DC 20531

Janet Reno
Attorney General

Daniel Marcus
Acting Associate Attorney General

Mary Lou Leary
Acting Assistant Attorney General

Nancy E. Gist
Director, Bureau of Justice Assistance

Office of Justice Programs
World Wide Web Home Page
www.ojp.usdoj.gov

Bureau of Justice Assistance

World Wide Web Home Page
www.ojp.usdoj.gov/BJA

For grant and funding information contact
U.S. Department of Justice Response Center
1-800-421-6770

----------------------------

This document was prepared by the Crime and Justice Research Institute,
under grant number 99-DD-BX-K008, awarded by the Bureau of Justice
Assistance, Office of Justice Programs, U.S. Department of Justice. The
opinions, findings, and conclusions or recommendations expressed in this
document are those of the authors and do not necessarily represent the official
position or policies of the U.S. Department of Justice.

The Bureau of Justice Assistance is a component of the Office of Justice
Programs, which also includes the Bureau of Justice Statistics, the National
Institute of Justice, the Office of Juvenile Justice and Delinquency Prevention,
and the Office for Victims of Crime.

----------------------------

Emerging Judicial Strategies for the Mentally Ill in the Criminal Caseload:
Mental Health Courts in Fort Lauderdale, Seattle, San Bernardino, and
Anchorage 

Acknowledgments

This examination of the emergence of mental health courts in the United States
was made possible by the special recognition and leadership shown by Nancy
Gist, Director, and Timothy Murray, Director, Program Development Division,
Bureau of Justice Assistance, U.S. Department of Justice. The research we
describe in this report involved observations, interviews and continuing
discussions with a number of officials and key actors in the nation's first four
mental health courts. This work was possible because of the cooperation,
assistance and patience of quite a number of very busy people.

Anchorage, Alaska

We are appreciative of the assistance and encouragement of the Honorable
Stephanie Rhoades, who made herself available to answer questions and
provide documentation about the work of her court. We would like to thank
JAS Coordinator/Caseworker Laura Brooks and Mental Health Coordinator
Colleen Reilly as well for their thorough descriptions and prompt responses to
requests for information. Chief Municipal Prosecutor John Richards was
particularly helpful in providing information and offering valuable insights into
aspects of the mental health court programs. In the Public Defender's Office,
Margi Mock was the source of important information from the perspective of
the mentally ill offender.

Broward County, Florida

We are very grateful for the assistance, cooperation and helpful discussions
with the Honorable Ginger Lerner-Wren in Broward County, the nation's first
mental health court judge in the first mental health court. She invited us to
observe her courtroom, arranged a meeting of all key actors, including the
Honorable Mark Speiser who played a major role in planning the court, in
which our questions were very patiently answered. Judge Lerner-Wren
welcomed the research and offered critical insight into the operations of the
court and objectives of her program. We appreciate the assistance of Broward
Mental Health Court staff, particularly Judicial Assistant Christine Paganelis and
Court Monitor Bertha Smith, who provided information about treatment issues.
We thank Assistant District Attorney Lourdes Roberts, who patiently provided
requested information.

King County, Washington

Our observation of the King County Mental Health Court was equally
eye-opening. We thank the Honorable James Cayce, Presiding Judge of King
County District Court and Mental Health Court judge, for his open support and
cooperation. He gave freely of his time in person and over the phone and made
sure we had our many questions answered. Program Manager Kari Burell
tirelessly answered all of our questions and responded promptly to numerous
requests for information. The help provided by Court Monitor Susie Rozalsky
is also greatly appreciated. Mark Larson, Chief Deputy District Attorney of the
Criminal Division, thoughtfully explained the issues, perspective and interests of
the prosecutor relating to the Mental Health Court. We appreciate the
cooperation of Public Defenders Floris Mikkleson and Dan Gross and their
willingness to describe the issues faced by the defendant, and the assistance of
Probation Officer Susan Butler in informing us about supervision and treatment
issues.

San Bernardino, California

Our visit to San Bernardino was originally intended to conduct focus groups
with participants in the San Bernardino Drug Court presided over by the
Honorable Patrick Morris. He invited us to observe the mental health court. His
court was impressive, differing from the others in taking felony as well as
misdemeanor matters. Its full docket dealt with very difficult cases and raised
many questions for us, which Judge Morris patiently discussed with us. He also
invited us to the precourt staffing of the cases and gave us an opportunity to
meet with the clinical staff and court personnel. Mental Health Court
Administrator Deborah Cima provided invaluable assistance. Conversations
with Dr. John Mendoza and Cheryl Hause provided us with valuable insight into
the treatment issues of the mentally ill offender as they related to the court. The
cooperation of the District Attorney's Office, provided by Assistant District
Attorneys Dan Lough and Charlie Umeda, was important in providing
perspective into the unique prosecutorial issues that arise in this mental health
court. Also much appreciated was the detailed information provided by Jane
Lawrence from the Public Defender's Office.

We are grateful for the opportunity this research represented to observe the
innovative efforts underway in these four jurisdictions and the dedication of
those involved. Our observations of the courtrooms and discussions with the
principal actors impressed us with the seriousness of the issues raised by the
mentally ill offender in the criminal caseload and the challenge accepted by
these mental health court pioneers.

Contents

Executive Summary 
The Origin of a Mental Health Court Approach 
Common Features of the Four Mental Health Courts 
Differences Among the Four Mental Health Courts 
Issues Raised by the Emergence of a Mental Health Court Model 

Chapter 1 Introduction   
Setting the Stage for Court Responses to Mental Illness in Criminal 
Justice Caseloads: Recent Precursors to Mental Health Courts 
Earlier Prototypes: Special Court-Centered Judicial Precursors to Mental
Health Courts 
Early Mental Health Court Approaches in Four Jurisdictions 

Chapter 2 The Broward County (Fort Lauderdale)
Mental Health Court   
Target Problem and Rationale 
Target Population 
Broward County Mental Health Court Procedure 
The Treatment Approach in the Broward County Mental Health Court 
Success and Failure in the Broward County Mental Health Court 

Chapter 3 The King County District Court 
Mental Health Court  
Target Problem and Rationale 
Target Population
King County Mental Health Court Procedure
The Treatment Approach in the King County Mental Health Court 
Success and Failure in the King County Mental Health Court

Chapter 4  The Anchorage Mental Health Court  
Target Problem and Rationale 
Target Population 
Anchorage Court Coordinated Resource Project (Mental Health Court)
Procedure 
The Treatment Approach in the Anchorage Mental Health Court  
Success and Failure in the Anchorage Mental Health Court  

Chapter 5  The San Bernardino (California) 
Mental Health Court  
Target Problem and Rationale  
Target Population 
San Bernardino Mental Health Court Procedure 
The Treatment Approach in the San Bernardino Mental Health Court 
Success and Failure in the San Bernardino Mental Health Court 

Chapter 6  Early Mental Health Court Initiatives: Common 
Themes and Emerging Issues  
Common Origins and Objectives  
Common Features 
Differences in the Approaches of the Four Mental Health Courts 
Emerging Issues 
References   
Sources for Further Information   

Executive Summary

The Origin of a Mental Health Court Approach

Beginning with the emergence of drug courts, the last decade has seen a
growing number of court-based, "problem-solving" initiatives that seek to
address the problems ("root causes") that contribute to criminal involvement of
persons in the criminal justice population. While breaking ground for other
"hands-on" judicial treatment innovations, the drug court model has itself
continued to evolve to address substance-abusing court populations across the
country. From the one begun as an experiment in Miami in 1989, drug courts
have grown in number to roughly 500 in the United States (and abroad)
currently. The judicial problem-solving methodology originating in drug courts
has been adapted to address other serious problems associated with large
numbers of persons in the criminal caseload. These have included community
issues (community courts), family violence (domestic violence courts), and drug
offenders returning to the community after serving prison terms (re-entry
courts). One of the most challenging applications of this therapeutically oriented
judicial approach, the mental health court, has focused on the mentally ill and
disabled in the criminal justice population. This report describes the emergence
of the mental health court strategy in four pioneering jurisdictions in the United
States, beginning with Broward County, Florida, where the idea was first
innovated. The Broward County Mental Health Court model has been adapted
to different settings and challenges in King County (Seattle), Washington;
Anchorage, Alaska; and San Bernardino, California.

The immediate pressures that have led to the development of the mental health
court strategy include crises in community mental health care (the long-term
effects of deinstitutionalization), the drug epidemic of the 1980s and 1990s, the
dramatic increase in homelessness over the last two decades, and widespread
jail overcrowding. Each of the mental health court jurisdictions has responded
to both the critical problems faced by the mentally ill in already overcrowded
jails, and the relatively common co-occurrence of mental illness among the large
numbers of substance abusers in the criminal justice population. Local jails,
which have been struggling for decades, to deal with chronic overcrowding,
have been particularly challenged by the need to care for the large numbers of
mentally ill persons found in their charge. As many jurisdictions have increased
emphasis on drug crimes and quality of life offenses, the jail and court
populations have increasingly included mentally ill and disabled individuals who
have extensive histories of involvement with the justice system and who have
not been successfully engaged by community mental health treatment agencies.

Common Features of the Four Mental Health Courts 

The four pioneering mental health court initiatives share a number of 
common attributes. Each court is voluntary; the defendant must consent 
to participation before he can be placed into the court program. Although the
mental health eligibility requirements for participants differ somewhat from court
to court, each jurisdiction accepts only persons with demonstrable mental illness
likely to have contributed to their involvement in the criminal justice system. The
mental health courts share the objective of  preventing the jailing of the mentally
ill and/or of securing their release from jail to appropriate services and support
in the community. In addition, each of the courts gives a high priority to
concerns for public safety, in arranging for the care of mentally ill offenders in
the community. This concern for public safety risk explains the predominant
focus on misdemeanor and other low-level offenders and the careful screening
or complete exclusion of offenders with histories of violence. The King County
court is open to defendants with a history of violent offenses which have been
triggered by mental illness, who are then provided with a level of supervision
sufficient to protect the public.

The four mental health courts also seek to expedite early intervention through
timely identification of candidates. Screening and referral of defendants takes
place within timeframes ranging from immediately after arrest to a maximum of
3 weeks after the defendant's arrest, depending on the jurisdiction. Each of the
courts makes use of a dedicated team approach, relying on representatives of
the relevant justice and treatment agencies to form a cooperative and
multidisciplinary working relationship with expertise in mental health issues.
Another core ingredient of the mental health courts' approaches is the emphasis
on creating a new and more effective working relationship with mental health
providers and support systems, the absence of which in part accounts for the
presence of mentally ill offenders in the court and jail systems. Each mental
health court provides supervision of participants that is more intensive than
would otherwise be available, with an emphasis on accountability and
monitoring of the participant's performance. The four mental health courts share
the core role of the judge at the center of the treatment and supervision
process, to provide the therapeutic direction and overall accountability for the
treatment process.

Differences Among the Four Mental Health Courts

The nation's first four mental health courts also differ from each other in
important respects. The nation's first mental health court in Broward County
was designed to be pre-adjudicatory and diversion oriented in its focus on
misdemeanants. Eligible participants are placed into treatment programs prior to
the disposition of their charges, which are held in abeyance pending successful
program completion. The rationale for this approach was therapeutic: the court
was to be as nonthreatening and nonpenal as possible and would seek to
prevent further penetration by the mentally ill offender into the formal
adjudication process. In contrast, the other jurisdictions opted for a
conviction-based approach. In those sites, participants generally plead guilty in
order to enter the program.

The implications of a candidate's decision to go to trial also differ in the four
mental health courts. In King County, during the first year of operations,
defendants were required to waive their right to a trial in return for admission to
mental health court. They could not choose to go to trial, get convicted and then
seek to enter mental health court. Today, defendants who request a trial are
free to return to treatment court should they be found guilty at trial. None of the
other sites has a strict policy against accepting individuals who have opted for a
trial, been convicted and then requested admission to the mental health court.
However, in these cases, admission is far from ensured, and is decided on a
case-by-case basis.

The four mental health sites also differ in their method of resolving criminal
charges. Successful participants in Broward often have no conviction on their
records, as charges are generally resolved through a "withheld adjudication" or
a dismissal of the charges. In King County, another significant policy adjustment
has recently been made. Deferred prosecutions and deferred sentencing are
now liberally granted, increasing the likelihood that successful completion will
result in the dismissal of charges. During its first year of operation, most of the
participants pled guilty. The other two courts generally require pleas of guilty or
no contest in order to enter the program, with the option of deferred disposition
or deferred adjudication offered rarely to defendants with few or no prior
contacts. In Anchorage, only these few defendants may end up without a
conviction. In San Bernardino, however, successful completion may result in the
withdrawal of the plea and, later, expungement of the participant's criminal
record.

The mental health courts diverge also in their handling of noncompliant
participants. While each court expects the treatment process to be potentially
difficult, given the population of mentally ill offenders with which they have
chosen to deal, they vary in the way they impose sanctions for noncompliance.
Short of program termination, the most severe sanction is jail confinement. The
use of this sanction seems least likely in Broward and Anchorage, somewhat
more likely in King County, and relatively commonplace in San Bernardino.
This difference in approach is accounted for in part by philosophical differences
among the sites about the appropriate response to noncompliance; however, it
is also related to the differences in the type of candidate admitted to the court.
San Bernardino is the only site that accepts low-level felony offenders, who are
usually incarcerated offenders with a previous diagnosis of mental illness as well
as a record of prior convictions. In addition, most of the San Bernardino mental
health court population has serious co-occurring substance abuse problems.

Issues Raised by the Emergence of a Mental Health Court Model

Early Identification of Mental Health Court Candidates

Problem-solving courts of different types share in common the need to identify
their target population candidates as early in criminal processing as possible.
The original drug court model was premised on the assumption that intervention
with addicted offenders should occur shortly after arrest to maximize the
opportunity to begin treatment when individuals may be most open to the
possibility. In domestic violence courts, there is urgency to correctly assess the
risks posed to victims and implement options for treating or otherwise dealing
with the offenders before further harm can occur. To be effective, mental health
courts share that critical need to identify mentally ill or disabled candidates at
the earliest possible stages of processing to avoid the damaging experience of
arrest and confinement, to intervene medically to stabilize offenders and then to
situate them in an appropriate placement process.

Like the other types of courts, however, the mental health court model faces
serious challenges in identifying appropriate candidates early through
appropriate and effective screening and evaluation procedures. Collectively, the
early mental health courts employ informal and formal methods for identifying
possible candidates and assessing them in some depth before detouring them
from the normal adjudication process. These methods may include informal
referrals at arrest, arraignment or jail admission of persons appearing to suffer
from mental illness or disabilities. They are followed by more indepth clinical
interviews at the jail or in court to assess the eligibility of defendants for the
mental health court programs. 

Fair, appropriate and effective screening procedures face three principal
challenges: timeliness, accuracy, and confidentiality. Each of the courts has
established procedures that identify mentally ill or disabled candidates as early
as possible in the criminal process to maximize the opportunity to intervene and
assist. The need to identify and assess the conditions of candidates quickly
potentially conflicts with the need to conduct the thorough clinical assessment
required for a reliable diagnosis on the basis of which processing in the mental
health court can begin. To put it simply, it is hard to rush such an assessment
and still have it be accurate and complete. This may be particularly true because
of the difficulty associated with communicating with some mentally ill
defendants. 

Early intervention by the mental health court depends on timely and accurate
information about the defendants' criminal justice and mental health
backgrounds. However, the goal of early intervention and prompt treatment
conflicts in part with the need for confidentiality and for consent by the
defendants to share the mental health information with the court staff. Devising
workable procedures that both enhance early intervention and enrollment of
mentally ill offenders in the mental health courts and respect confidentiality
pertaining to sensitive personal information represents one of the difficult
challenges facing the mental health court approach.

Voluntariness

Some observers see special courts as vehicles for "coerced treatment," a term
with favorable and unfavorable connotations. The favorable use of the term
suggests that the judicial role and application of sanctions and rewards
contribute a valuable tool for keeping participants in treatment and increasing
the chances of successful outcomes. The unfavorable reference alludes to the
problems associated with forcing treatment upon individuals who have not
voluntarily consented, from a due process perspective and from the perspective
that treatment cannot be effective unless it is wanted and the offender is "ready."
In fact, most problem-solving courts are premised on voluntary participation by
candidates, with the exception of some sentenced-based approaches (in which
judges may simply sentence a person to treatment in court). This is especially
true in diversion-based courts. Certainly, courts requiring guilty pleas from
participants for admission must demonstrate that a plea was made knowingly
and voluntarily on the record. Even when appropriate procedures are observed
to safeguard voluntariness in special courts, some critics argue that the choice
(between, for example, drug court and jail) is a coerced choice.

The question of voluntariness is even more difficult for mental health courts.
Although all the same legal issues dealt with in drug courts, domestic violence
courts and community courts exist for persons entering the mental health courts
examined in this report, they must also confront questions about a person's
mental capacity and ability to comprehend the proceedings and the options
being provided. Competency is a threshold issue that must be decided before
an individual can be considered as a mental health court candidate in each of
the courts. However, even among those deemed competent to stand trial,
serious questions may be raised about the ability of persons to really understand
the choices being presented and the consequences of those choices (e.g., going
to trial or participating in the mental health court in one of several possible legal
statuses). 

If a requirement for voluntary participation in the special courts is not only
competency as legally defined, but also an ability to understand and make
reasonable decisions, then achieving voluntariness among mentally ill or
disabled treatment candidates is a challenging proposition indeed. In the mental
health courts, it means that sufficient time must be taken by defense counsel and
by the court itself to make certain that the candidate's decision to enter the
mental health court is in fact voluntary. This means having a grasp, beyond the
threshold question of competency, of a defendant's mental condition. The
potential fear is that defense counsel and/or the court may make decisions in the
candidate's best interest when in fact the candidate, though competent, is
thoroughly confused and afraid.

Conflict Between Criminal Justice and Mental Health Treatment Goals

A challenge in the design of each type of problem-solving court was the need to
craft an approach that resolved conflicts in values and goals inherent in criminal
justice and treatment orientations (Goldkamp, 1999). For example, when
substance abuse treatment professionals might stress tolerance for relapse and
erratic performance (or a positive drug test) by drug abusers as part of the
therapeutic process, criminal courts might normally be inclined to revoke
conditional release (probation) and impose sanctions. While the criminal
process might need to proceed expeditiously to adjudicate criminal charges,
mental health professionals require time to diagnose the mentally ill defendant's
condition, take immediate steps to stabilize the defendant and then to place the
defendant in appropriate supportive services for treatment. From the
perspective of mental health treatment, potentially the worst experience for
many mentally ill persons would be arrest, jail and formal proceedings in the
criminal court. In short, these conflicts in method, aims, values and style pose a
particular challenge in the emerging mental health court initiatives to produce a
hybrid model that attends to the basic requirements of each.

Defining Success

The drug court treatment process, from which the mental health court approach
was adapted, was structured around clear phases of treatment through which a
participant passed on the way to graduation. Requirements for graduation were
clearly specified and typically included minimum periods of testing negatively for
drugs of abuse, completion of all treatment activities, payment of fees, etc. Drug
court participants therefore were able to chart their progress against clear
expectations and rules for completion of the program. Charting a course for
successful completion of requirements of the mental health court treatment
process is more complex. 

Mental health court participants may suffer from a variety of symptoms and
illnesses and, thus, lack a common starting point. The steps necessary to
stabilize participants and to situate them in living situations that will maximize
their effective functioning are likely to differ considerably from individual to
individual. While a goal for substance abusers can clearly and measurably be
abstinence within the timeframe of the drug court treatment program, such a
practical framework is not so readily available in the treatment of mental illness.
Courts cannot say, "be cured within 12 months." They can expect that
participants successfully follow the steps to improved functioning outlined in a
treatment plan agreed upon by the participant and the mental health
professionals. Thus, the challenge for setting achievable milestones for mental
health court professionals is more complex and the functional equivalent of
graduation may differ considerably from individual to individual.

Range of Responses to Participant Behavior/Performance

To an observer of other problem-solving courts, particularly drug courts where
some of the in-court techniques were first developed, the mental health court
model faces special challenges in devising responses to participant performance
in treatment. One might argue that the experience of drug courts in the United
States suggests that drug abusers respond well to a very structured system of
incentives and sanctions when moving through the treatment process toward
sobriety and improved functionality. These approaches are crafted based on
assumptions about the behaviors of addicted persons, including a belief that
very basic lessons and behaviors may have to be taught and retaught for
substance abuse treatment to be successful. Many drug courts have devised a
rich range of responses rewarding participants for forward progress through
treatment stages (until graduation). When these elements of the drug court
model are applied to the mentally ill and disabled in the criminal justice system,
the translation of the "rewards and sanctions" approach to mental health courts
raises some difficult challenges. It is apparent that, because of the nature of
mental illness (as compared to substance abuse or domestic violence), judicial
responses have to be more generally encouraging and supportive as the court
process seeks to move mentally ill and disabled participants into treatment and
supportive services. Thus, depending on a defendant's illness, the judge's
repertoire may need to draw on a wider range of incentives and supportive
responses to participant progress than other problem-solving courts. 

The notion that mental health courts should also call upon sanctions for poor
performance is more difficult. In some cases, it may be clinically appropriate to
employ the kinds of sanctions employed by drug courts in responding to
noncompliance in treatment, including returning participants to earlier and more
restrictive treatment stages or, even, making use of jail in selective instances. In
other types of cases, however, it may be questionable as to whether sanctions
(based on assumptions of deterrence) are at all appropriate to produce the
improved mental health outcomes desired. Real questions, therefore, are raised
about how the coercive power of the courts can be channeled to promote the
goals of mental health treatment. Can a court sanction a defendant who fails to
take medication? Does a court sanction a defendant who has difficulty
functioning and understands little of the current circumstances or expectations
due to mental illness? 

Community Linkage and Resources

A critical element of the emerging mental health court model involves
identification of the necessary treatment and related services in the community
and the development of an effective working arrangement between the courts
and the service providers that helps place participants in appropriate services,
and moves them out of jail, as quickly as possible. Moreover, the model is
premised on a working relationship, as represented by the dedicated team
approach, that facilitates ongoing supervision and case-management. Two
important problems are faced by the mental health court approach.

First, if it is true that the court system finds itself having to address the needs of
the mentally ill population, it is at least partly because existing institutions and
services in the community (at least outside of criminal justice) have failed to
serve this population. There is some irony, then, in designing a program that
uses the court to place mentally ill and disabled participants in those very
systems. Secondly, if the rationale for making use of these existing services is
that the mental health court creates a new, synergistic relationship that improve
both the court and treatment approaches, then the actual availability of these
services and the resources to support them becomes a critical concern. A
mental health court approach with a large population of persons in need of
treatment but few services available in the area may have great difficulty in
delivering treatment. Moreover, even when services are available and providers
are enthusiastic about the court-based mental health treatment approach,
effective identification of candidates in the criminal justice population risks
placing a new and large demand on treatment resources.

Each of the mental health courts described in this report have identified
potentially large populations of mentally ill and disabled defendants who are in
need of mental health and related supportive services. Each has also found that
treatment resources and funding are insufficient for the populations they are
serving and plan to serve in the near future. When resources exist, they do not
adequately provide the type or range of services the mentally ill and disabled
persons in the criminal justice population require.  

Mental Health Courts as a Community Justice Initiative

The mental health court strategy shares with prior problem-solving court
undertakings the fact that a difficult problem has not been adequately dealt with
through community institutions and services. Presumptively, effective community
interventions could prevent the need to find and treat mentally ill citizens in the
criminal justice system. The criminal behavior of the mentally ill ranges from
nuisance and quality-of-life levels to more serious offenses that sometimes
endanger themselves or other citizens. Although there are a range of behaviors
associated with the mentally ill and disabled, it is highly unlikely that they have
gone unnoticed in the community until their encounters with the criminal justice
system. In fact, the presence of untreated, low-level mentally ill offenders
represents an important quality of life and community justice concern in many
localities.

Because other community networks or institutions have not effectively treated
and supported the mentally ill-because community-based safety nets have
failed-they enter the justice system, usually involved in minor, nuisance, and
quality of life offenses. Often, by then, they have other serious problems-such
as alcohol or other drug addiction, housing, employment and physical health
problems-that also have not been addressed. In many instances, the mentally ill
or disabled find themselves in criminal justice primarily because of their mental
illness and their inability to connect with or stay in supportive community-based
treatment services.

Like the other special court approaches, the mental health courts described in
this report attempt to address the problems of their target populations on two
levels:

o By dealing with their problems in the criminal justice system. 

o By building linkages to community services and support structures that have
for a variety of reasons failed to reach them prior to their criminal justice
involvement. 

Each of the mental health courts discussed has developed strategies for
identifying mentally ill and disabled offenders at the earliest stages of processing,
sometimes involving contacts from police officers at the arrest stage. Each
jurisdiction has taken steps to implement early screening procedures to evaluate
candidates for the court treatment process as soon as possible so that
unnecessary delay, criminal justice processing, and jail confinement can be
avoided. Each of the courts began with a primary focus on defendants entering
the criminal process shortly after arrest, but expanded to accept referrals from
other courts, attorneys, police, friends, relatives or other community contacts
aware of mentally ill or disabled individuals caught up in the justice system.
Each of the courts established a close link to the local jail, so that mentally ill
inmates could be identified and admitted to the mental health court treatment
process, at whatever stage of processing in the criminal justice system. In short,
consolidating justice procedures to identify and enroll candidates in treatment
has been an aim of these first pioneering mental health courts.

In each case, the in-house approach is closely tied to a focus on community
treatment resources and linkages. Depending on the kinds of illnesses
evidenced and the types of resources available in their locales, each of the early
mental health courts takes steps to place participants in community-based
treatment services, either immediately or after initial crises are addressed and
individuals are stabilized. Each court emphasizes the importance of proper and
timely diagnosis and of placement in proper treatment and supportive care
services, where they exist. Each court builds the treatment process around
court supervision as a critical, core element ensuring both that enrolling
participants cooperate and that appropriate services are indeed provided. At
the core of the mental health court approach is a newly established working
relationship between the supervising court and community mental health
treatment and related services.

Mental health courts, in this regard, represent important court-based community
justice initiatives. They are strengthening the effectiveness of community mental
health treatment approaches by offering their close attention and supervision.
They are returning mentally ill persons from custody and processing in the
criminal justice system to the community to function there. They are encouraging
community-based justice and health approaches that would prevent mentally ill
and disabled individuals from entering the justice system in the first place. Thus,
successful court strategies would ideally put themselves out of business: they
would find far fewer mentally ill persons in criminal justice, because they would
be more effectively and appropriately dealt with through improved community
intervention, services and support mechanisms.

----------------------------

Chapter 1

----------------------------

Introduction

American jails and prisons have long struggled with problems associated with
mentally ill persons in their care and custody (Fosdick et al., 1922: 440-443;
Beeley, 1927; National Commission on Law Observance and Enforcement
1931; National Advisory Commission on Criminal Justice Standards and Goals
1973; Mattick, 1975; American Bar Association, 1986; 1989; Matthews,
1970; McFarland et al., 1989). The challenges faced by jails in managing
mentally ill persons in their custody have been particularly acute (Steadman and
Veysey, 1997; Abram and Teplin, 1991; Teplin, 1990 Henderson, 1998).
With scarce resources, local jails have traditionally had difficulty in providing
adequate mental health treatment services to inmates who may be in their care
for relatively short stays, often in a mix of legal statuses. Although jail
populations have accounted for high concentrations of persons with mental
health problems, most justice agencies deal with individuals with serious mental
health issues, in areas ranging from the most minor to the most serious criminal
matters, from criminal trespass and disorderly conduct to capital cases
(Matthews, 1970; McFarland et al., 1989; Wolff, 1998, Harris and Koepsell,
1998). Public perception of the mentally ill offender may be most dramatically
shaped by incidents of random violence in the community as treated by the
mass media-which appear far too common-and include the beliefs that mental
illness contributes to high rates of recidivism. 

The concern for mental disability or illness in the criminal justice population is,
as a matter of legal philosophy, traditional. In fact, the normal adjudication
process is bounded by concerns for the mental capacity and adequate
functioning of defendants and offenders. At the early stages, participation in the
criminal process is premised on the assumption that a defendant is mentally
competent to participate in and understand the proceedings (Winnick, 1995).
Criminal responsibility and assignment of punishment are limited by questions of
insanity and guilty-but-mentally-ill.[1] Beyond these special issues, however, it
is unarguable historically that persons with mental illness have always been
found in criminal justice populations and have posed longstanding and stubborn
issues for justice agencies and institutions. 

A recent Bureau of Justice Statistics survey (1999), estimating conservatively
that 238,000 mentally ill offenders were incarcerated in American prisons and
jails in 1998, underscores the magnitude of the problem currently dealt with by
correctional agencies nationwide. This number represents 16 percent of all state
prison and local jail inmates, and 7 percent of Federal prisoners. When the
massive volumes of arrests,[2] criminal cases processed,[3] police contacts
with citizens, persons supervised by pretrial services, and probation and parole
agencies are also taken into account, the numbers of mentally ill persons dealt
with and/or supervised by the criminal justice system on a routine basis in the
United States is extraordinarily large.

Several developments may account cumulatively for the current state-of-affairs
represented by the mentally ill in the American criminal justice systems. The
deinstitutionalization movement in mental health during the 1960s and 1970s
(Whitmer, 1979) had the foreseeable result of diverting greater numbers of
persons with serious mental illness into the community. As the hoped-for
community-based mental health treatment system was not effectively realized,
by default, the criminal justice system increasingly absorbed individuals who
were not able to function acceptably and independently in the community. This
phenomenon was aggravated by the dramatic increase in homeless populations
in American cities and towns during the 1970s, 1980s, and 1990s, among
which the mentally ill were, also predictably, well represented (Smith, 1996;
Solomon et al, 1992; Snow, 1989). 

Many mentally ill suffer from co-occurring disorders, often including substance
abuse[4] (Abram and Teplin, 1991). The enforcement efforts of the "War
Against Drugs" of the mid-1980s and early 1990s directed against drug
offenders inadvertently fostered increases in arrests and prosecutions of
drug-involved offenders with mental illness. Moreover, recent law enforcement
strategies emphasizing strict enforcement of "quality-of-life" offenses and local
ordinance violations have added to the probability that the mentally ill (and
particularly the homeless mentally ill) will find themselves increasingly involved
in the criminal justice system for minor offenses. Together, these factors have
contributed to the perception that, for the mentally ill and the
substance-abuse-involved, the criminal justice system has increasingly come to
serve as the "social service system of last resort."[5] 

Setting the Stage for Court Responses to Mental Illness in Criminal Justice
Caseloads: Recent Precursors to Mental Health Courts

The potentially large numbers of mentally ill persons in the criminal justice
population have in common a processing in the criminal courts. Simple math
suggests that the potential impact of the problems associated with the mentally
ill on the judiciary in disposing of its criminal caseload is significant. Beyond the
relatively infrequent special judicial determinations relating to civil commitment,
competency, insanity and guilty-but-mentally-ill defenses, mentally ill defendants
and offenders raise a more general challenge to normal case processing, when it
appears that patterns of offending are explained by mental illness or disability
and/or that effective treatment could control or prevent the occurrence of such
patterns.  

Two more recent developments have played an influential role in the emergence
of mental health courts: the national crisis of overcrowding in local jails and the
development of drug courts. At the conclusion of the 1980s, jails in many
American jurisdictions reached critically overcrowded levels, driven in part by
the large increases in arrests for drug-related crimes. This meant that in addition
to previously unknown concentrations of substance abuse involved inmates,
they also had to deal with growing numbers of inmates with mental health
problems. Court systems in the most crowded jurisdictions participated in
systemwide review of practices and problems that contributed to delays in
processing and to the avoidable use of confinement of defendants and offenders
in local jail facilities. Whether in response to Federal lawsuits or the need to
address system dysfunction, many jurisdictions developed strategies to improve
justice practices and implemented alternatives to routine processing and
incarceration. To do this, they focused on the categories of inmates that
contributed most to the excessive jail population levels, including drug
offenders.

The "decarceration" of categories of inmates in local jails, through emergency
release procedures or more planned system improvements, forced local
criminal justice systems to devise strategies to manage higher-risk defendants
and offenders in the community. Key in most significant alternatives to
incarceration or system improvement strategies were the criminal courts,
because their procedures for organizing and disposing of the criminal cases and
their uses of local confinement at pre- and post-conviction stages were the
dominant influence on the local correctional population. At the end of the 1980s
and the beginning of the 1990s, as drug enforcement expanded and criminal
penalties for drug offenses increased, reform strategies inexorably sought to
come to grips with the drug-related criminal caseload and drug offenders who
were confined in state and local institutions. Thus, local justice systems faced
the prospect of handling greater numbers of higher-risk and often drug-involved
offenders in the community. The development of drug courts was prompted by
the crowding crisis in the jails and criminal caseload crises in the courts. 

Against the system strains brought on by the crack/cocaine epidemic and drug
enforcement efforts, the "invention" of the nation's first treatment drug court in
the Dade County (Miami), Florida, court system in 1989 represented a major
reform milestone in American criminal courts in a number of ways. First, the
philosophy underlying the Miami Drug Court departed sharply from the
traditional process-and-punish orientation of large criminal court systems.
Overwhelmed by unparalleled increases in the drug-related felony caseload, the
Miami court leaders, the prosecutor (Janet Reno) and the public defender
decided to reject "more of the same." The Miami system had shown that more
enforcement, faster adjudication, more severe penalties and, even new jails had
not reduced drug crime. However, they had clearly overburdened the resources
of the local criminal justice system and, with a seemingly inexhaustible supply of
drug offenders, there appeared to be no end in sight. To respond to this
situation, Miami justice leaders designed what Attorney General Reno
describes as a "carrot-and-stick" approach to provide drug treatment to felony
offenders through a different use of the criminal court as a treatment catalyst
and therapeutic tool.

The drug court movement is described elsewhere in detail.[6] Its relevance to
understanding the emergence of mental health courts stems first in its
philosophical breakthrough, that is, the decision that criminal courts could
appropriately intervene to "treat" addicted offenders, and also in its provision of
a significant alternative to confinement in the local or state correctional systems.
The reasoning was simple and recognized the principle that to reduce drug
crime it made sense to tackle its cause: substance abuse. In addition to its
tough-minded but helping philosophy, the Miami Drug Court departed from the
traditional hands-off approach of the judiciary, which reflected a belief that the
myriad social problems in the lives of offenders were not the responsibility of
the courts to address. (This included a strong belief that judges were not social
workers.) 

The judicial philosophy behind the Miami Drug Court was, instead, hands-on,
arguing in sharp contrast that the criminal court judge and criminal courtroom
could play a major role in getting offenders off drugs and setting them in the
direction of more productive and law-abiding lifestyles. Another revolutionary
element of the Miami innovation was the development of a new working
relationship between (drug treatment and other health) professionals and the
criminal court. The Drug Court was based operationally on multidisciplinary
teamwork and cooperation at all stages (although led and supervised by the
judge).

The success of the drug court idea in the United States and abroad is now
well-known. The Miami approach struck such a chord among other localities
and court systems that first one, then a handful, and then hundreds of other
court systems adapted the treatment court model to address their own local
drug crime problems. Remarkably, the drug court model of demand reduction
among substance abusing offenders is now supported through a variety of state
and federal funding sources with a dedicated office in the Department of Justice
(the Drug Court Program Office of the Office of Justice Programs). 

More important for understanding the emergence of mental health court
strategies than the apparent popularity of the Miami innovation, is the fact that
the Miami Drug Court opened the door to direct judicial involvement in dealing
with the significant problems associated with large numbers of persons in the
criminal caseload, and in focusing on substance abuse. The proactive,
hands-on, problem-solving model pioneered in Miami accomplished much
more than just to help proliferate the drug court model across the nation. It
broke down important barriers that made possible other court-based justice
innovations that continue to reshape American courts. Spin-off innovations
include the Midtown Community Court and a whole second generation of
community courts, a growing number of domestic violence courts,
court-initiated programs focusing specifically on female offenders and their
treatment needs, and other special court approaches dealing with problem
populations making up the criminal caseload. 

The drug court innovation set the stage for other special court approaches,
including mental health courts, by providing a model for active judicial problem
solving in dealing with special populations in the criminal caseload. But, in
addition and not coincidentally, as the involved judiciary learned more about
substance abuse and serious addiction among offenders, they also learned more
about disorders, such as serious mental illness and disabilities, frequently
co-occurring with substance abuse. In fact, as drug courts became more
efficient at identifying candidates and providing treatment, the prevalence of
mental illness in the substance-abusing justice population became increasingly
apparent.

Earlier Prototypes: Special Court-Centered Judicial Precursors to Mental
Health Courts

The criminal justice system generally, and particularly the courts in considering
probation, the jails in housing inmates locally for short periods, and the police in
enforcing nuisance offenses have struggled with the problems posed by mentally
ill defendants and offenders for decades. The very recent emergence of the
mental health court approach in a handful of jurisdictions does have parallels, if
not direct origins, in earlier court-centered initiatives dealing with mentally ill
offenders in the 1960s. Matthews (1970), for example, describes
"court-centered mechanisms" for "therapeutic disposition" of cases of
defendants exhibiting mental illness in the Municipal Court of Chicago and the
Supreme Court of the City of New York. 

Matthews reports that early in the 1960s, the Municipal Court of Chicago had
jurisdiction over misdemeanors and sat as committing magistrates for felony
cases. The Psychiatric Institute, which was administratively attached to the
court, had two divisions. One was housed in the same police headquarters
building as the misdemeanor branch of the court and handled misdemeanor
referrals. The other, an in-patient facility, was located at the main city jail next
to the building housing the felony branch of the municipal court. The primary
function of the Institute was to make psychiatric evaluations on issues of
competency to stand trial and on issues of criminal responsibility of defendants
charged with felonies. If the Institute found that a felony defendant referred for
evaluation was suffering from a mental illness, and the gravity of the crime or the
danger posed by the defendant was not too serious, it could recommend
alternatives to criminal justice sanctions, including civil commitment or, in the
case of minor felonies, out-patient therapy as a condition of probation. Cases
were sent back to criminal court when mental disorder was not found or was
found to be irrelevant to the crime charged. 

Misdemeanor defendants were referred to the Institute by administrative order,
often by the arresting officer or by the judge after observing odd behavior in a
pretrial hearing. Such cases usually involved defendants who were unable to
make bail or afford the services of private counsel. Although there was no legal
basis for the referral, there was little objection to it. Public defenders did not
object, as the referral often led to a nonpenal disposition for the defendant. A
psychologist and a psychiatric social worker interviewed the defendant. The
psychiatrist would then prepare a letter for the court containing sentencing
recommendations for non-criminal dispositions that were almost always
followed. In 1 year, according to Matthews (1970:180), Institute referrals
resulted in the diversion of 1,729 mentally ill offenders. Recommendations
included out-patient treatment in a clinic or office, out-patient neurological
treatment, and alcohol treatment, but most of the recommendations were for
civil commitment. In addition to the evaluations and recommendations, the
Institute provided temporary clinical custody for referred defendants and made
the arrangements for the therapeutic dispositions. When referrals resulted in
therapeutic dispositions, the criminal charges were routinely dismissed.

According to Matthews (1970:186-92) the New York procedure through
which mentally ill defendants were diverted to the health care system was more
likely to occur at the time of arrest than after the case had gotten to the
courtroom, as in Chicago. He describes the emergency detention procedure in
New York as more effective in producing referrals than the Chicago model
because it was easier for police to access.[7] Male arrestees were taken to
Bellevue Hospital, while females were taken to Elmhurst Hospital. Both
Hospitals had prison wards that were administered by the department of
corrections, a connection that facilitated interactions between the criminal
justice system and the mental health system in New York City. 

When defendants were referred for competency/responsibility evaluations by
the court, according to Matthews (1970:187) they were committed by court
order to 30 days of in-patient observation and examination. Felony defendants
were given a hearing in the prison ward, of which a transcript was kept. The
hospital prepared a report and recommendation for the court that included
medical opinions regarding the defendant's ability to get along outside of the
hospital and/or on probation, and relating to the defendant's criminal
responsibility and competency to stand trial. When a noncriminal disposition
was proposed, a treatment plan was prepared. If a felony defendant was found
incompetent, New York law mandated commitment to Mattawan State
Hospital. Civil commitment was often recommended in the cases of
incompetent misdemeanor defendants. The court frequently followed the
medical recommendation for nonpenal dispositions. Elmhurst Hospital generally
arranged the treatment program and began treating its female patients before
the case was referred back to court for final disposition. Bellevue did not
arrange for the treatment of the male patients processed there.

Early Mental Health Court Approaches in Four Jurisdictions

The recent emergence of mental health court strategies can be understood in
part against the background of longstanding criminal justice difficulties in dealing
with mentally ill persons, earlier court-based initiatives, the deinstitutionalizing of
the mentally ill, the pressures of jail crowding, the exploding drug caseloads,
and, more recently, the alternative judicial philosophy and methods of the
treatment drug court model. Momentum for the development and
implementation of such initiatives has also been created by dramatic incidents
involving random violence, focusing public, media, political and criminal justice
system attention on the problems of the mentally ill in the criminal justice system.

Within this historical context, this report examines four pioneering mental health
courts to identify common, critical ingredients that may form basic elements of a
mental health court model, as this judicial problem-solving strategy becomes
more prominent. At the time of this writing, the mental health court initiatives in
Broward County, Florida; King County, Washington; Anchorage, Alaska; and
San Bernardino, California, represent the first judge-supervised, court-based
innovations designed to address the problems of mentally ill defendants and
offenders in the criminal caseload in the United States.  

----------------------------

Chapter 2

----------------------------

The Broward County (Fort Lauderdale) Mental Health Court

Target Problem and Rationale

The Broward County judicial strategy, focusing on misdemeanor cases in
County Court, grew out of a recommendation of a multiagency Criminal Justice
Mental Health Task Force formed in 1994 to address broad concerns about
the mentally ill in the criminal justice-and particularly the local
correctional-population. The task force, led by Circuit Court Judge Mark A.
Speiser, was convened in response to a series of incidents involving mentally ill
offenders, including suicides of persons incarcerated in local facilities. The task
force included community leaders, state and county government officials, mental
health advocates, mental health providers, and law enforcement representatives.
Their goal was to develop a system of care for mentally ill defendants and to
devise ways to integrate and more closely link the community-based mental
health care system with the criminal justice system. The work of the task force
was given momentum when, as the result of efforts of a local criminal defense
attorney, a grand jury was formed to investigate the treatment of the mentally ill
in the jails. The grand jury later issued a highly critical report.[8] 

The Broward task force concluded that the normal criminal process dealt
poorly with the mentally ill offender and recommended establishing a mental
health court as one of its core strategies for improvement. The proposed mental
health court would adopt special procedures to deal primarily with the
misdemeanor population by intervening early in the process to divert low-level
offenders from routine case processing and to place them in appropriate
treatment services under the care of mental health professionals and the
supervision of the mental health court judge. County Court Judge Ginger
Lerner-Wren was appointed to preside over the nation's first mental health
court, which began operation June 6, 1997, in Broward County in Florida's
17th Judicial Circuit by administrative order of its Chief Judge, the Honorable
Dale Ross.

Target Population

The Broward County Mental Health Court was begun as a part-time court
designed to respond on an as-needed basis to an unknown volume of cases
involving mentally ill misdemeanor defendants. The decision to intervene in
misdemeanor cases was intended as a prevention strategy to target defendants
who, without treatment and supportive services, could become involved in
more serious matters at a later time when appropriate treatment would be more
difficult to arrange. The Broward Mental Health Court currently accepts and
screens mentally ill defendants charged with a range of misdemeanor offenses
(which carry a statutory maximum of 1 year in jail under Florida law).
Defendants charged with driving-under-the-influence (of alcohol or a controlled
substance) or with domestic violence are ineligible because separate court
programs are already in place to handle these types of cases. In addition,
defendants charged with misdemeanor battery are eligible only with the consent
of their victim. 

Because the Mental Health Court was designed to deal with minor offenders
who, because of their illness, return frequently to the criminal justice system, the
Broward Court accepts defendants with prior convictions. Defendants with
criminal histories that include violent crime are carefully screened to avoid
involving defendants who pose an extreme threat to public safety. However, if a
candidate with crimes of violence on their record expresses a genuine desire to
participate and nothing prevents the candidate from achieving therapeutic gains,
he or she may be admitted into treatment court.[9] Beyond current charges and
prior criminal history, potentially eligible misdemeanor defendants must have
been diagnosed with an Axis I mental illness,[10] have an organic brain injury
or head trauma, or be developmentally disabled. Use of these clinical criteria in
screening potential candidates was intended to ensure that the Mental Health
Court would focus its resources on the seriously mentally ill or disabled in the
misdemeanor population.

Program statistics maintained by the Broward Mental Health Court indicate that
from July of 1997 through September 1999, 882 cases were placed under
Mental Health Court jurisdiction. As of September 29, 1999, a total of 445
cases were disposed since the program's inception in the summer of 1997.
According to court data, the typical court participant is male and is between the
ages of 28 and 54. About 21 percent had at least one prior misdemeanor
arrest, and 17 percent had prior felony arrests. One of four mentally ill
participants entering the Court during that year was diagnosed as having a
co-occurring substance abuse disorder. Out of the 469 new participants who
entered the program between July 1998 and September 1999, 26 percent
were homeless. 

Broward County Mental Health Court Procedure

By design, the Broward Mental Health Court seeks to identify and intervene in
the cases of mentally ill defendants as early as possible in the misdemeanor
criminal process. (For an overview of the Broward County Mental Health
Court procedure, see Figure 1.) The Mental Health Court serves principally as
a pre-adjudication diversion program, although there is some flexibility in
accepting candidates that are identified in later processing stages, including
defendants who may have been convicted and placed on probation by other
judges in traditional court. The Court's rationale in focusing on pre-adjudication
intervention in misdemeanor cases is to avoid criminalizing mental health
problems by preventing the unnecessary (and counterproductive) use of
confinement and further criminal processing. Instead, the Court seeks to link
mentally ill arrestees to appropriate diagnostic and treatment services. A guiding
premise for the initiative is that jail and formal adjudication will do little to
address the reasons for the involvement of mentally ill individuals in the justice
system, will probably exacerbate their conditions, and will likely contribute to
their recycling in and out of criminal court.

Many candidates for Broward Mental Health Court are identified at the
misdemeanor bail stage (probable cause/bond hearing stage) within 24 hours of
their arrest. Clinicians (advanced doctoral students from Nova Southeastern
University) assigned to the Public Defender's office screen in-custody
defendants for mental illness prior to the first probable cause/ bond hearing.
Any inmate who has visible mental health issues during intake at the jail, or who
admits to any past contact with the mental health system will be housed in the
mental health section of the jail pending a full assessment of his status by the
EMSA psychiatrist. When symptoms of mental illness are found at the clinical
screening interview, the Defender informs the court about the defendant's
situation during the hearing, which is generally conducted via closed circuit TV.
The County Court Magistrate presiding at the bond hearing refers possible
candidates to Mental Health Court the same day or the next day depending on
the time of arrest. The Mental Health Court judge sees defendants referred
from the in-custody screening process and other first referrals every day at
11:30 a.m. Referrals also include some jailed defendants who were not
identified at earlier proceedings and who are being held in custody pending a
probable cause hearing or other pre-adjudication proceedings. These 
defendants are screened by Emergency Medical Services Associated (EMSA),
which contracts with the jail to provide mental health, medical and dental
services to the inmates. 

When the evaluation finds that a defendant poses a danger to himself or others,
the psychiatrist seeks an order from the judge to transport the defendant to a
crisis center for stabilization. Defendants who are found to have mental health
problems but deemed stable are referred to Mental Health Court. 

In addition, other judges may refer misdemeanor defendants to the Court if they
believe them to have serious mental health problems. Out-of-custody
defendants on pretrial release, who have been issued citations and dates to
appear in court, can be referred to the Mental Health Court by the magistrate,
the defense attorney, the police, the defendant's family, or their mental health
caseworker. In each instance, whether from jail custody or out of custody
awaiting a hearing, an attempt is made to have the defendant appear in Mental
Health Court as soon as possible, often within a few hours. Out-of-custody
defendants are generally not processed as quickly as in-custody defendants
because their arraignment dates are scheduled later than in-custody defendants
and they are not subject to mental health screening. Once they are referred to
the Mental Health Court, however, they are generally scheduled to appear in
Mental Health Court within 24 hours. 

Mental Health Court staff has estimated that as many as 30 percent of
misdemeanor defendants making their first appearance in Mental Health Court
are acutely ill. In cases when an acute episode may have triggered the offense,
the defendant may still be unstable when appearing before the Mental Health
Court judge. In such instances, the judge seeks to put the defendant in the care
of medical services to stabilize the defendant's symptoms. This involves sending
defendants to the 19th Street Crisis Center, or other receiving facility for an
independent evaluation under the Public Health statute, Title XXIX, Chapter
394, to determine whether an involuntary civil commitment is necessary. The
statute requires that the evaluation be completed within 72 hours of arrest. If the
results of the evaluation indicate that the defendant is a candidate for
commitment, the General Master holds a hearing at the facility to determine
whether commitment is appropriate. If long term hospitalization is deemed
necessary, the defendant may be involuntarily committed for up to 6 months at
the South Florida State Hospital until stabilized. These defendants typically are
not returned to Mental Health Court, and charges are ultimately dismissed. If
the defendant is retained at the crisis center for short-term stabilization, and then
are deemed to be stable, they are returned to Mental Health Court for further
action. Upon the return of the defendant to mental health court, a status hearing
is held, where one of the first issues addressed is competency. 

When defendants are believed to be incompetent, the judge enters an order
requiring that they be evaluated for competency. If the defendant is in custody,
the evaluation may be done at the holding facility. Out-of-custody defendants
are ordered to attend the evaluation. If the evaluation confirms incompetency,
the court will order a conditional release subject to treatment and special
provisions for adequate supervision and/or out-patient services. Defendants
with no suitable living arrangements are housed at the court's transitional
housing facility, Cottages on the Pines. The Mental Health Court judge requires
that conditions of release be observed and receives periodic reports on the
defendant's compliance with the conditions from the agencies handling his
care.[11] During this process, the state maintains jurisdiction over the criminal
case for 12 months. If competency is not restored within this time period, the
charges are dismissed and the individual will be evaluated to determine whether
civil commitment is necessary.

Once the competency issue has been resolved, a probable cause hearing is held
in Mental Health Court to review the basis of the charges. Defendants are
advised in open court about the nature of the Mental Health Court treatment
process, what would be done for them and what would be expected from them
if they decided to participate. Also discussed are all issues involving housing,
the defendant's prior criminal history and public safety, as well as how the
defendant feels and is looking for in terms of community services. Family
members are encouraged to be at all hearings, and their input, concerns and
needs are a key to understanding the candidate's history and current needs.
Participation of eligible candidates in the mental health court process is
voluntary. The Mental Health Court judge considers the information presented
from criminal justice and mental health professionals to decide whether a
particular candidate can be helped by the Court's services. The judge may
decide, for example, that a defendant's needs are so extreme as to best be
addressed through other resources, or, if the defendant is already engaged in
treatment, taking medication and living in a stable environment, that supervision
is not needed. In such a case, the judge may resolve the charges right away to
permit the defendant to go forward with treatment outside of the criminal justice
setting. Otherwise, the defendant is given the option of entering treatment under
the supervision of the Court after consulting with an attorney and being
interviewed by mental health professionals.

Following the defendant's agreement to participate in the Mental Health Court,
the state's attorney may hold the criminal charges in abeyance, pending ongoing
review of progress in treatment.[12] The Mental Health Court can monitor
cases for up to 1 year. The actual length of supervision of the defendant by the
Mental Health Court varies on an individual basis, depending on the particular
needs and progress of each defendant. Defendants who participate in the
appropriate mental health services, stabilize and perform well in the community
may have court supervision terminated before the end of 1 year. Once
treatment is completed (and after consulting with the mental health
professionals, defense and prosecution, the defendant and, in some cases,
family members), the judge may resolve the charges. Defendants with minor
charges and no criminal history may have the charges dismissed with the
consent of the prosecutor. In most cases, adjudication is withheld, meaning that
there is a record of the arrest and treatment court disposition, but no
adjudication is ever entered.  

During the treatment process, participants regularly report to Mental Health
Court so that the judge can review their progress. Status review hearings are
held periodically on an as-needed basis determined by the judge, but usually
after 2, 3, and finally 4-week intervals, as participants demonstrate satisfactory
progress. An observer of status reviews is struck by the problem-solving nature
of these hearings, as the judge draws on the staff to help first solve any
treatment-related concerns and criminal justice issues defendants may be facing
and to encourage the defendant's full participation in the individualized,
therapeutic treatment process. 

Defendants with minor or nuisance charges are assisted in accessing mental
health treatment services and may be released into the transitional housing
reserved for Mental Health Court participants or placed into a residential
treatment program until other appropriate placement can be arranged. A review
hearing may be held to check on participant progress. Once the defendant is
stable and following the treatment regimen, charges may be resolved early
through dismissal or withholding of adjudication. 

In eligible cases involving more serious charges and criminal history, defendants
may be released on their own recognizance (ROR) if they participate in the
Mental Health Court treatment process and follow the agreed upon treatment
plan. The plan may include residing in an appropriate setting (e.g., residential
treatment or transitional housing and day treatment). Defendants participating in
the Mental Health Court while on pretrial release are supervised by a case
manager who stays in contact with them and ensures that court
recommendations are followed. When difficulties arise, the case manager
reports violations of the agreement to the court (mental health) monitor, who
reports the violation and requests a hearing before the judge. Criminal charges
are not disposed of until after the participant has been shown to be stable and
has performed consistently in treatment, long enough to demonstrate
responsibility. When these standards have been met, the charges are resolved,
most often through withholding of adjudication. In the most serious eligible
misdemeanor cases, a plea may be taken with credit given for time served in the
Mental Health Court treatment process. In this situation, a conviction is
recorded but the defendant has still had access to mental health services.

The Treatment Approach in the Broward County Mental Health Court

The debate first instigated by the establishment of drug courts about the
appropriateness of courts serving as the "social service institution of last resort"
(and the social worker role of the judge) was already partly academic by the
time the Broward Mental Health Court was established. Like the earliest drug
courts, the Broward County Mental Health Court grew out of the recognition
that community treatment and social service agencies simply had not engaged a
large part of the local populations with serious behavioral health needs, persons
who would find their way into the criminal justice population. This
understanding of the reason for the prevalence of serious mental health
problems in the criminal justice population was based on a perception that
community-based treatment services had failed mentally ill citizens in important
ways. They had failed to locate them, to engage them in services, and to keep
them stable and in treatment. 

According to this understanding, the mentally ill, like the substance abusers
addressed by drug courts, form an elusive population that, due to its nature, is
characterized by individuals who do not perform simple functions well. Both
populations are made up of people who routinely do not hold jobs, make and
keep appointments (e.g., with treatment agencies) or function predictably and
consistently-except in a negative sense. Recognizing that the social service and
treatment failure that has allowed so many mentally ill individuals fall through the
cracks and be without services, the Broward Mental Health Court has sought
to identify and, through clinical assessment, facilitate treatment for
misdemeanants with mental illness. The court's goals include helping defendants
access appropriate treatment and services to improve their functionality and
quality of life in society, promoting personal responsibility, and enabling
participants to manage their own mental health needs and coordinating
fragmented mental health services through the Mental Health Court process and
under the strict supervision of a judge.

The courtroom is a critical arena for the therapeutic process in the Broward
Mental Health Court. Borrowing again from the method of drug courts, the
Broward Mental Health Court was designed to be informal, often involving
interaction and dialogue between the judge and the participant about problems
and treatment options. Just as the drug court model involves a therapeutic view
of the addict and employs clinical terminology about addiction and recovery,
the Broward Court incorporates a respectful and helpful manner toward
participants, makes careful use of language that is sensitive to the issues related
to mental illness, and is informed by an understanding of the nature and
treatment of mental illness. The Broward Court adopts a supportive, instructive,
problem-solving and understanding style in presiding over the special calendar
of the Mental Health Court, and avoids threatening or punitive language, or
language that might contribute to labeling or stereotyping. In other words, the
informal style of the Mental Health Court is designed to reflect the methods of
mental health treatment and to contribute to the improved mental health of its
participants. 

The Broward Mental Health Court employs a team model based on a great
deal of consultation and cross-disciplinary input, although there is no doubt that
the judge is the leader of the group problem-solving that transpires and has final
responsibility for all decisions. The court personnel are not rotated into the
assignment on a short-term basis, but rather have become specialists in dealing
with the mentally ill in the justice setting. In addition to the judge, court
personnel include a prosecuting attorney (sometimes two because of
overlapping city and county jurisdiction in misdemeanors), a representative of
the jail, the public defender, the court monitor, a forensic social worker, and a
case manager. All are specifically assigned to Mental Health Court and have
considerable background, experience and interest in the problems of the
mentally ill in the justice system. 

The team approach contributes to an active courtroom that seems to have a
variety of activities going on simultaneously, rather than a one-case-at-a-time
orientation. The judge may be dealing with several cases simultaneously and
asking various staff to investigate, interview, make calls for placements, or
compile necessary information to resolve the statuses of persons appearing
before her, some for the first time, others for regular status reviews. Not many
issues are postponed; rather the judge seeks to have answers and problems
solved before sending a participant out of the courtroom or back to jail to await
another hearing. With each of the appropriate agencies and functions
represented in the courtroom, the judge is able to craft and implement a
response and to request necessary action and follow-up on the spot.

The issues dealt with by the Broward Mental Health Court judge cover a wide
range of problems, from getting a newly arrested person to identify herself and
to understand where she is, to arranging for immediate medical care for
individuals who have been off medication and are unable to function, to seeking
input from a care provider who did not appear in court, to arranging temporary
housing for a participant who has no place to stay. The mental health courtroom
differs from the drug court experience because in courts, with the exception of
some participants with co-occurring disorders and disabilities, participants
appear to understand the proceedings and events going on around them fairly
well. This cannot be so easily assumed in the mental health court.

In the Broward Mental Health Court, understanding and communication are
viewed as part of the problem-solving process. In some cases, the judge
speaks very slowly and waits patiently for participants to understand and
respond-sometimes with the help of mental health professionals or lawyers in
the courtroom. The patience and tolerance for the problems of comprehension
and communication that defendants may have create an impression that speedy
disposition of a large number of cases is not necessarily high priority. Some
hearings go smoothly and quickly because participants are doing well in their
various treatment settings, while others are almost painfully slow as difficult
problems and suitable options are identified and discussed.

The Broward Mental Health Court calls on both county and private service
providers to respond to the treatment needs of its participants. At the initial
stages, once a referral is made, the court monitor interviews the defendant. She
checks to see if the defendant is already involved in mental health treatment
and, if so, consults with his caseworker about the nature of his illness and his
treatment needs and progress. If the defendant is not already in treatment, he is
referred to the Henderson clinic or the Nova University Community Mental
Health Center to determine whether he meets the mental health eligibility
requirements. In-court screening interviews are carried out before the hearings
by a court clinician, who is a licensed clinical social worker, in addition to
advanced doctoral interns associated with the clinical psychology program at
Nova Southeastern University. The local jail contracts with EMSA, which
provides several staff with specific training in mental health including a
psychiatrist and a psychiatric nurse, who help identify candidates for the court
from the jail population. The court refers newly arrested persons in need of
immediate diagnosis and emergency treatment services to a nearby state mental
health facility. Once participants are stable or able to be placed in appropriate
longer-term services, the Mental Health Court refers them to one of two
different treatment providers with a range of services located in different parts
of Broward County. 

The court monitor has access to most area providers, but the two major
sources of care are the Henderson Mental Health Center and Nova University
Community Mental Health Center. Services provided include short- and
long-term residential treatment, including supportive housing, substance abuse
treatment, and assertive community treatment. Assertive community treatment
utilizes a community-based, interdisciplinary, intensive case management team,
which includes a psychiatric nurse, a peer recovery counselor who has been
through the mental health system, a case manager and a psychiatrist. The team
works on a 24-hour basis with a small group of defendants to support them as
they learn to live in the community. The court has recently implemented a new
gender-specific program called "Options" with a grant from the Bureau of
Justice Assistance, which targets women with histories of sexual and assaultive
abuse, who are also suffering from depression, post traumatic stress syndrome,
or drug and alcohol issues. "Options" is a comprehensive program that
addresses physical and mental health issues, as well as family issues involving
children, and parenting skills. At this point, the program is run on an out-patient
basis by Nova Southeastern University. Eventually, however, a residential
component will be added. There are currently 12 women enrolled in the
program, which has a present capacity of 40. 

Defendants with developmental disabilities are referred to treatment through the
Developmental Services Division of the Department of Children and Family
Services, a state agency. Dually diagnosed participants face a shortage of
specially tailored programs, with a limited number of day treatment programs
and residential placements that are open to the severely impaired defendant.
With an estimated 26 percent of the mentally ill defendants homeless in the
Broward Mental Health Court, transitional housing is a high priority as
participants wait for openings in longer-term treatment settings. The Mental
Health Court has its own, dedicated transitional housing program, which
operates on the grounds of the Henderson Center. The "Cottages in the Pines"
has 24 beds used to house program participants on a temporary basis for up to
5 months until more permanent living arrangements are available. Services
provided in that setting include primary health care, substance abuse treatment,
daily medication dispensing, and vocational training.

Success and Failure in the Broward County Mental Health Court

The Broward County Mental Health Court is similar in some ways to the
precursor drug court model because it focuses on health problems in
therapeutic ways but in the context of the criminal court process. However,
despite the similarity and overlapping nature of the problems addressed by the
two approaches-addiction and mental illness-they pose very different issues and
problems for a court-centered approach. If the aim of a drug court is to bring
about sobriety and a normal, productive life functioning (without crime) within a
specified timeframe, the Mental Health Court's aim is to promote mental health,
stable functioning and improved life circumstances so that the illness does not
continue to overwhelm participants and bring them back to the criminal justice
system. 

How the court encourages the treatment process and participants' compliance
may differ considerably under the two models. Some drug courts rely heavily
on sanctions, including time in jail, to encourage compliance. How well punitive
(deterrent) sanctions serve to promote the therapeutic process in a mental
health setting remains an important and somewhat controversial question. The
Broward Mental Health Court was designed with the knowledge that if it
enrolled its target population, compliance problems would be common among
its participants-by definition. Generally, the participants have found their way
into the Mental Health Court precisely because they have not succeeded in
meeting the minimum demands of normal life or of the community-based mental
health treatment process. 

The Broward Mental Health Court judge has rarely employed confinement as a
means of furthering the treatment process, although defendants who are
arrested on new charges and those who simply have not cooperated may
ultimately be held in jail while awaiting adjudication. By philosophy, the
Broward Mental Health Court judge views jail as the opposite of what mentally
ill persons caught up in the criminal justice system need and sees jailing of the
mentally ill as representing the failure of all prior intervention efforts. The judge
would be likely to order confinement only if the nature of the offense demanded
it. Should defendants fail to take necessary medication and become a threat to
the public as a result, the judge might agree that a temporary stay in jail was
required pending development of more appropriate means of dealing with the
person. In the event that a relatively serious new crime was committed while the
defendant is on release, the state attorney may move to revoke a participant's
status in Mental Health Court and request adjudication and sentence. Any time
current or former participants are arrested on a new misdemeanor, they are
ordered to appear in Mental Health Court for disposition in the interest of
continuity of treatment.

In drug courts, graduation from a 1-year to 18-month process of treatment
rewards periods of abstinence and crime-free behavior. The Broward Mental
Health Court seeks the same among its participants with drug problems, but the
goals for mental health issues may differ among defendants. Generally, the
Broward Court completes its relationship with a participant when he or she has
made the transition into the required treatment and supportive services, which
may involve medication, counseling, housing, training or employment. When the
criminal court is no longer needed to facilitate those connections, the participant
is considered to have been "successful" and has the charges resolved.

----------------------------

Chapter 3

----------------------------
The King County District Court Mental Health Court

Target Problem and Rationale

The process that formed the King County Mental Health Court was catalyzed
by the brutal, random murder of Fire Department Captain Stanley Stevenson
by a mentally ill offender in a Seattle park in August 1997. The assailant was a
misdemeanor defendant who had been found incompetent by the Seattle
Municipal Court. The defendant was released into the community by the court
just prior to the homicide. The shocking incident prompted King County
executive Ron Sims to convene a task force including broad representation of
mental health and justice system professionals to review how mentally ill
offenders were handled by the justice system. The Mentally Ill Offenders Task
Force, chaired by the Honorable Robert Utter, retired chief justice of the
Washington Supreme Court, was given the responsibility of making
recommendations for improving the handling of mentally ill persons in the
criminal justice system. Among many other suggestions, including reevaluation
and reform of competency law, the Task Force recommended the
establishment of a mental health court in the King County District Court on a
pilot basis. 

King County District Court Chief Judge James Cayce led a Mental Health
Court Task Force to develop plans and examine the feasibility of establishing
such a court. In February 1998, as part of that process a group of judges, as
well as other justice and health system officials, visited the Broward Mental
Health Court and, upon their return, incorporated their observations into a plan
released by the Mental Health Court Task Force in August 1998. After further
planning, budgeting and coordinating activities, the King County District Court
Mental Health Court began operation in February 1999.

King County's Mental Health Court Task Force identified several areas in
justice processing that failed to address difficult issues raised by the mentally ill
and that appeared likely to contribute to their frequent returns to the system.
Under normal court procedures, defendants might appear before a number of
different judges as their cases were heard at various stages of processing, even
in the same case. With little extra attention paid to individual defendants as
cases moved through a high-volume court system, mentally ill
defendants-whose mental illness may have caused their involvement in criminal
justice-were simply moved through the court process like everyone else.
Moreover, judges presiding over high-volume courtrooms did not have special
training in dealing with the special issues presented by the mentally ill, nor were
they generally aware of the treatment resources that might be available in the
county to treat the offender and protect the public. 

When charges were dismissed, the mentally ill defendant merely disappeared
from the court's jurisdiction, hopefully to be handled by other agencies
elsewhere. Other mentally ill offenders would, upon conviction, be sentenced to
probation or local jail time, two options also usually poorly suited to their
problems. The Mental Health Task Force found that, as a result of normal
procedures, mentally ill defendants and offenders often re-offended and were
recycled through the system again and again. In fact, the King County Mental
Health Court Program Narrative reports that a 1991 study of the King County
Jail showed that offenders admitted to the psychiatric unit had an average of 6
bookings into the jail in the 3 years prior to their current offense, with longer
average lengths of incarceration than comparable nonmentally ill inmates
(Steadman, 1991).

In its planning stages, the King County Mental Health Court was greatly
influenced by the Broward County Mental Health Court, which began
operation about a year and a half earlier. The King County Mental Health
Court had seven primary goals outlined by the Task Force in
Recommendations for the King County Mental Health Court (August 1998).
They included:

1. To reduce the number of times mentally ill offenders come into contact with
the criminal justice system in the future;

2. To reduce the inappropriate use of institutionalization for people with mental
illness;

3. To improve the mental health and well-being of the defendants who come in
contact with Mental Health Court; 

4. To develop greater linkages between the criminal justice system and the
mental health system;

5. To expedite case processing; 

6. To protect public safety; 

7. To establish linkages with other County agencies and programs that target
the mentally ill population in order to maximize the delivery of services.

Following the example of the Broward Court, the King County Mental Health
Court employs a team approach. It is made up of court representatives from
justice agencies and treatment providers who are assigned to the Mental Health
Court and develop relevant expertise through intense training and experience in
the mental health and court systems. An important aim of the approach is to
have a strong and experienced team proficient in dealing with the problems
associated with the mentally ill in the criminal caseload; one consisting of
individual members who work well together and who provide a "seamless
connection" between community mental health and the criminal justice system.
In King County the dedicated team approach is intended to eliminate the gaps
and problems in communication characteristic between agencies and
organizations that are part of the problem.

Target Population

District Court has jurisdiction over misdemeanors (offenses with maximum
penalties of no more than 1 year in jail) in King County, although municipalities
in the county, like Seattle, also have municipal courts that have jurisdiction over
misdemeanors. With an estimated 29,199 misdemeanor cases entering the
system in 1999,[13] the King County District Court represents a high-volume
urban misdemeanor court. The King County Mental Health Court considers
candidates who are charged with misdemeanor offenses. 

Mental Health Court candidates include individuals whose crimes or charges
appear related to mental illness, who have been referred for competency
evaluation, whose medical histories include a diagnosis of a major mental illness
or an organic brain impairment, or who are determined by court clinicians to
need mental health treatment. In addition, many candidates have records of
prior arrests or convictions, which may include felonies and crimes of violence,
provided mental illness is believed to have been a causative factor in the
candidate's history, or a factor in the current offense. In fact, one current court
participant has a prior conviction for murder and rape, both of which are
believed related to his history of mental illness. The court believes that they are
able to provide proper supervision for these types of defendants, and considers
part of its mission the treatment of dangerous individuals such as the violent
offender whose much publicized crime triggered the development of the court
initially. Participation in the Mental Health Court is voluntary and, after the
model of some drug courts, was originally designed to require a guilty plea or a
plea of no contest and, in most cases, results in a term of probation and a
suspended jail sentence. Consequently, most of the defendants were likely to
have convictions on their record at the end of the treatment process. Since that
time, the program has evolved, such that a larger number of defendants may
enter the court through a statutory petition for deferred prosecution or an
agreement with the prosecution for a deferred sentence. With successful
participation in the Mental Health Court, these defendants are much more likely
to have charges withdrawn and not reflected on their records.

Candidates for the Mental Health Court are identified principally at the
post-arrest stage by the jail medical staff while awaiting their first court
appearance in the county jail. However, referrals also come from justice
officials, other misdemeanor courtrooms, or friends or family who may believe
that an individual's involvement in the criminal process is the product of mental
illness. To expand the scope of misdemeanor defend-ants eligible for its
services, the District Court has been negotiating with misdemeanor courts from
nearby cities, including Bellevue and Shore Line, to have their defendants
referred for participation in the King County Mental Health Court.

The King County Mental Health Court has received 199 referrals since
February 1999. Most (76 percent) were male, between the ages of 31 and 50
(61 percent), and white (74 percent). About half (51 percent) had been
referred by the jail, with an additional 43 percent sent by judges, 3 percent by
defense attorneys and the remainder by family members or probation officers.
Seventy-one percent of the defendants were in custody at the time of the
referral. The majority of the referred defendants (55 percent) were not in
mental health treatment at the time of the referral. Twenty-five percent were
homeless at the time of referral. Only 22 percent were able to live
independently. The remainder lived in either some form of supported living
arrangement, or their residence location was unknown to the court. Forty- five
percent of those referred had a co-occurring drug or alcohol disorder.

King County Mental Health Court Procedure

The King County Mental Health Court process begins with identification of
possible candidates at the probable cause/bail hearing stage. (For an overview
of the referral process in King County, see Figure 2.) Although referrals to the
Mental Health Court can come from police who believe an arrestee may be
mentally ill, generally candidates are drawn from among misdemeanor arrestees
who have been detained pending their first court appearance (which occurs
within 24 hours of arrest). Upon admission to the detention facility in Seattle,
mentally ill defendants are first identified through the jail's normal intake
screening procedure. When the assessment indicates that a detainee has serious
mental health problems and might be a candidate for the Mental Health Court,
the defendant is informed about the program and his or her consent is requested
so the jail staff may share the information in the assessment with the Mental
Health Court. Should the defendant refuse but be found competent,[14] the
confidentiality of the information obtained is assured. When a defendant
appears to be mentally incompetent, the court is alerted by the jail staff, who
then send a memo to the court containing the defendant's name and charges
only, without detailed defendant information. When a defendant does give
consent, the assessment information is provided to the court for review. All
members of the Mental Health Court team of professionals are notified by
e-mail that the particular defendant is being referred. In this way, each actor in
the court process has an opportunity to prepare for the defendant's first
appearance in the court, usually the following afternoon.

Generally prior to their first appearance in the Mental Health Court, candidates
are interviewed at the jail by the court monitor. Her job is to gain an
understanding of the defendant's mental health issues. As part of that process,
she requests a release of information approval from the defendant to enable her
to access the defendant's treatment history, if any. If possible, she will also
communicate with the case manager who has handled the defendant's treatment
in the past. The court monitor prepares a report for the Mental Health Court
containing information about the defendant's history, including any current
medications, history of compliance with treatment, behavior at home and/or in
the jail, as well as information about housing and family support, if any. 

In addition, the monitor prepares a treatment plan that would go into effect
upon the defendant's release and participation in the King County Mental
Health Court, including living arrangements and provisions for supervision and
treatment. During this process, the monitor spends time getting to know the
defendant as well as explaining the workings of the Mental Health Court to the
defendant and offering preparation for the hearing and the period following.
Ideally, the report and proposed treatment plan that the monitor produces are
provided to each of the relevant courtroom staff prior to the defendant's first
hearing. The Mental Health Court is also alerted to competency issues based
on the opinion of the court monitor through her informal evaluation and
information given to her by the jail medical staff. There is currently no formal
assessment instrument, although such a tool is being developed for use by
Mental Health Court staff. 

Prior to the start of the first hearing, the prosecutor, the public defender and the
court monitor, will meet to review the information gathered about the
candidates and to discuss the particular mental health issues that may be
involved. The discussion includes the analysis and recommendations of the
court monitor as well as analysis from the jail mental health staff, with input from
the prosecutor and defense counsel. 

The first hearing begins with a determination of probable cause, particularly if
defendants were referred to mental health court before a probable cause
hearing was held in the normal fashion before a traditional court judge. Once
probable cause has been established, the King County Mental Health Court
judge then proceeds to address the major threshold issues: competency and
detention. Most of the defendants who are candidates for this court are in
custody due primarily to homelessness or instability related to their illness that
puts them at higher risk than nonmentally ill defendants to fail to appear in court
for the next hearing date. One of the Court's principal objectives is to place
candidates in treatment as soon as possible and avoid further confinement. 

The Program Manager reports that an estimated 15 percent of the candidates
appearing at the first hearing in Mental Health Court appear to be incompetent
and are referred to Western State Hospital for competency evaluations through
an order of the judge. Defendants who are found competent are returned to the
Mental Health Court. Incompetent defendants charged with a violent offense,
who have a history of violence, or have been found not guilty by reason of
insanity or incompetency on charges involving physical harm in the past, may be
held under the state's competency statute, Title 10 RCW, section
10.77.090,[15] which allows for hospitalization for up to 29 days (including the
time it takes to complete the evaluation), and/or 90 days of out-patient
treatment, to try to restore competency. Defendants who do not meet the
criteria may not be held by the state for the additional 14 days and must have
the charges dismissed. However, such defendants may also be evaluated to
determine the appropriateness of civil commitment. 

Defendants who, at the end of this period, are restored to competency are
rescheduled to appear in Mental Health Court to decide upon participation in
its program. Defendants who are still found to be incompetent at the end of the
statutory treatment period must have their criminal charges dismissed. They
must also be referred to the county-designated mental health official for
evaluation to determine the appropriateness of involuntary civil commitment. At
this stage, the focus of the inquiry will be on whether the defendant poses a
danger to public safety or security, and will not depend upon whether or not the
defendant was charged with a felony.[16] In the past, the court lost jurisdiction
over misdemeanor cases once the defendant was found incompetent to stand
trial.

Once the threshold question relating to competency is resolved, the judge
decides whether to accept the case and determines whether the defendant
wishes to participate in the program based on the input from the Mental Health
Court team and on consideration of the monitor's report and treatment plan. In
the cases of defendants who are competent but unstable, the judge's next
concern is to determine the nature of treatment and support services
appropriate for the defendant so that an informed decision about entry into the
Mental Health Court program can be made. 

Because in many cases the defendant is confined prior to this hearing the next
important decision involves the defendant's release from custody. The judge not
only seeks to release the defendant from custody but to place the defendant in
the community with the services that will be needed to ensure safety and
stability. Once such a service plan is set up, the defendant will be released as
soon as possible under the supervision of a case manager who will monitor and
support the defendant, now a Mental Health Court participant, through the
process. Defendants who already have a home to return to with an appropriate
support system are released quickly. Others are released from jail when a
shelter bed or other appropriate placement becomes available, usually within a
week. Thus, although the judge seeks to release the defendant from custody as
soon as possible, the defendant remains in custody at the jail with jail-based
services and monitoring by the Mental Health Court until the appropriate
release options can be employed.

In the experience of the King County Mental Health Court so far, it appears
that few defendants refuse the treatment option once the preliminary matters are
completed. Even so, most candidates who wish to enter the program are
released pending adjudication under the terms of the service plan for an initial
period of a week or two. During this period of provisional participation,
defendants are given the opportunity to become familiar with the aspects of the
proposed treatment regimen under the supervision of the court monitor before
they are returned to court to make a decision about whether they wish to
continue. Upon return to the Mental Health Court, if a defendant should decide
to opt out of the program, the criminal case is simply listed in the normal fashion
for adjudication. Defendants may occasionally prefer going to adjudication
because they do not agree that they have a serious mental health problem or
because they believe that they have a good chance of a favorable outcome at
trial.[17] Under the original program design, defendants who choose
adjudication were not eligible to return to Mental Health Court upon conviction.
This policy was recently revised to allow a defendant who requests a trial to
continue to attend the treatment program to which they were provisionally
assigned on their own, whether they are ultimately convicted or not. Should
they be found guilty at trial, the defendants are now eligible to return to
treatment court program. 

Defendants who decide to enter the Mental Health Court treatment program
must address their charges first, either by entering a plea of guilty or no contest
to the misdemeanor charges, petitioning for a deferred prosecution,[18] or
entering an agreement with the prosecutor for a deferred sentence. Statute
governs the deferred prosecution in Washington, where it is considered a
pre-arraignment disposition. No finding of guilt is entered for the defendant and
upon successful completion of the program the defendant is eligible to have his
charges dismissed. The defendant must petition for the deferred prosecution,
which may be granted by the judge over the objection of the District Attorney.
The deferred sentence generally comes about as a result of plea negotiations
between the prosecutor and the defense attorney. While there is an initial finding
of guilt, defendants who successfully complete the program are eligible to have
their charges dismissed. A disposition can be granted by the judge over the
objection of the prosecutor. In most cases, the defendant will be placed on
probation in the Mental Health Court for up to 2 years or will receive a
suspended sentence of up to 1 year while participating in the program. For
individuals pleading guilty to driving-under-the-influence charges, pleas are
accepted and a sentence of up to 5 years' probation may be imposed. In some
instances, persons charged with domestic violence misdemeanors are
determined to be eligible for the court. In these cases, defendants are granted a
"stipulated order of continuance." In it they waive the right to a jury trial and
agree that if they do not comply with the conditions of release to the Mental
Health Court treatment program the judge can find him guilty on the basis of the
facts in the police report without taking any testimony. 

In appropriate domestic violence cases, successful completion of the Mental
Health Court treatment program results in dismissal of the charges (and no
record of conviction), following procedures often employed in misdemeanor
domestic violence cases in regular court. This permits an opportunity in cases of
mentally ill defendants who have been charged with domestic violence-related
offenses to begin and complete treatment without being required to plead guilty.
The matter is handled in this way in order to assure that these defendants are
not penalized for trying to address their illness by opting to enter treatment
court.

From February through December 1999, 54 defendants (27 percent) of the
199 defendants referred decided not to enter the King County Mental Health
Court treatment program and were transferred back to normal criminal
calendars. Dispositions for the remaining 145 defendants included the following:
69 defendants (48 percent) chose to participate and an additional 33 (23
percent) remained undecided as of December 31, 1999. Of the remaining 43
defendants, 6 cases had been closed, 17 cases were dismissed by the
prosecutor, 13 cases were screened out as being inappropriate for mental
health court, and the prosecutor elected not to file charges in District court in 7
cases. Of the 69 defendants who entered mental health court, 35 pled guilty, 8
received stipulated orders of continuance, and 6 were granted deferred
prosecution status. The 20 remaining participants were referred from other
courts, either having already been placed on probation, or having pled and had
the sentencing transferred to mental health court. As of the end of the year, 63
participants were on active probation.

Once the candidate opts in or formally enters the Mental Health Court, a
probation officer is appointed to supervise the participant. The probation officer
works as part of the Mental Health Court team and maintains close contact
with the participant, whether in custody or in the community. The probation
officer coordinates and communicates with the caseworker at the treatment
facility handling the defendant's care and the Mental Health Court case
manager. Once the treatment plan is put into effect, the probation officer and
the case manager check on the participant's progress and ensure that
court-ordered treatment is being provided.

Participants are required to return to King County Mental Health Court for
review hearings at regular intervals-or when the judge determines that it is
necessary-to assess whether they are complying with the requirements of the
treatment process or there are any difficulties that need to be addressed. One
of the most common issues for supervision surfacing at the review hearings
involves the participant's failure to take the prescribed medication. In cases in
which the participant appears to be having great difficulty in complying with the
treatment process, a hearing may be scheduled and the defendant may be taken
into custody if found to be in violation of the terms of probation, and such a
sanction is deemed appropriate. In rare instances, failure to take medication
may mean that the participant can become a threat to himself or others. In such
cases the court may refer the defendant to the state hospital to determine
whether temporary involuntary civil commitment is necessary. The use of jail to
motivate the participant to take the program seriously is rare (usually jail is what
the Mental Health Court is seeking to avoid). When it occurs, it usually is for
short periods of no more than a few days detention. Defendants who are
purposefully noncompliant and who do not respond to repeated counseling by
team members and the judge in court appearances may have their probation or
suspended sentences revoked and be ordered to serve their sentences in jail.

The Treatment Approach in the King County Mental Health Court

King County Mental Health Court supports its participants in treatment by
drawing on an array of treatment programs and ancillary services available
through the county's existing community mental health system. The community
mental health network of services includes 17 treatment facilities at locations
throughout the county. Although the geographic coverage offered by these
programs is an asset to the Mental Health Court, the size of the county and the
number of treatment services involved initially posed a challenge to the Mental
Health Court in coordinating services, communication and procedures. 

The King County Mental Health division has contracted with United Behavioral
Health (UBH) to oversee the managed care network, to coordinate the
treatment, and to monitor and act as case manager for its participants as they
are referred to the 17 mental health providers. The court monitor employed by
UBH for the purpose of managing the Mental Health Court caseload is the link
between treatment providers and the court. The monitor ensures that the
providers respond to the wishes of the court promptly, from expediting
screening of candidates for the court to addressing particular problems with
services that might arise during the Mental Health Court treatment process. The
court monitor assigns an agency to each participant to determine what services
are needed and to monitor the progress of treatment carefully for the court. 

Participants are assigned to programs based upon their individual needs, and at
locations as near to their living situations as possible to facilitate attendance in
treatment. The types of services provided vary depending on the particular
problems of the participants, but may include medical evaluation, monitoring of
medications, psychotherapy, supervised living situations, and other relevant
social services. In addition, vocational pre-paration and an educational
component are available to defendants who have the ability to benefit from
them. Most of the defendants are placed in community-based, out-patient
programs, unless acute care or more intensive services are needed. When
in-patient or residential treatment is recommended, participants must specifically
consent before they can be placed in a program. Participants who refuse the
structure, support and supervision of in-patient programs may be held in jail for
lack of other sufficiently secure options. Jail is used as a last resort, in part
because services provided there are not as comprehensive and are by nature
short-term, and in part because the Mental Health Court seeks as one of its
primary goals to move mentally ill individuals out of jail into community
treatment. 

The participants entering the King County Mental Health Court present a
variety of challenges for treatment services. One of these challenges is the large
number of participants dually diagnosed with substantial substance abuse
problems as well as serious mental illness. Given the nature of the criminal
justice-based population of participants entering the treatment process, the
King County Mental Health Court has discovered in its early stages of
development that services for the dually diagnosed are insufficient.
Unfortunately, only eight providers in the county network are able to treat
dually diagnosed participants on an out-patient basis. In addition, only two
programs, one run by the county, and the other by the state, are available to
provide MICA services on an in-patient basis for these participants, and there
is a long waiting list at both facilities. Thus, there is a shortage of treatment
resources available to deal with this commonly encountered type of participant.
There are also special programs available in King County to address problems
such as anger management or domestic violence issues. 

The Mental Health Court experience in the early stages has also shown that a
majority of participants require assistance in finding appropriate living
arrangements. Resources are very limited for patients requiring residential
programs and structured living arrangements. The need for structured living
situations varies on a case-by-case basis. For some participants who are in
immediate crisis, special housing to support stabilization of their mental health
symptoms is an urgent requirement. Others homeless participants may have
been accustomed to living in makeshift living arrangements and now resist any
type of structured living arrangement. Although a variety of programs are
utilized to try to address these needs, the county is not well funded to meet the
needs of the mental health defendants for structured residential care. To make
up for the lack of availability of structured care situations, the Mental Health
Court attempts to supplement the support and supervision it provides with
"wrap around" services. Through these services the defendant is engaged in
some sort of structured treatment or activity from morning to night each day,
with specialized case managers who visit the participant daily to monitor
compliance with day treatment and medication, and try to respond to problems
as they arise. 

At this stage of its development, the King County Mental Health Court itself
does not have an aftercare program, but seeks to facilitate the participant's
transition to full use of community mental health services after involvement with
the court. The use of community services is voluntary, of course, so that an aim
of the court treatment process is to build strong links to appropriate services for
participants so that most will carry on without supervision by the Mental Health
Court. In its planned evaluation research, the Mental Health Court intends to
track the clients for 3 years after release from probation to see whether they
were successful in preparing clients to continue to access the support services. 

Success and Failure in the King County Mental Health Court

It is early in the development of the King County Mental Health Court to
measure program successes. However, two kinds of measures seem to be
available for assessing the realization of the court's goals, short of the
longer-term evaluation it has planned. The court's initial aims have included
identifying and enrolling (from the jail, other courtrooms, friends, relatives and
attorneys) mentally ill persons charged in misdemeanors. In 10 months of
operation, the King County court had screened (received and evaluated) 199
referrals and enrolled less than half of them in the court-supervised treatment
process. Although Judge Cayce believes there are many more mentally ill
misdemeanor defendants in King County who could benefit from participation
in the Mental Health Court, the court has already begun to tap a potentially
large population and gained some operational experience. It has identified
resource and treatment needs in its first months of operation. In addition, the
court has revised some of its program requirements, including the policy that
required the loss of the treatment court opportunity to defendants who opted to
contest their charges at trial, and the requirement that the majority of the
defendants plead guilty in order to enter the program. The court is now open to
the return to treatment court of defendants who are convicted at trial, and the
option of deferred prosecution or deferred sentencing dispositions, with the
likelihood of a dismissal of the charges upon successful program completion, is
being more liberally granted. These adjustments will result in expanded
opportunities for defendants to enter into the treatment court program without
necessarily being penalized with a criminal conviction.

According to the Mental Health Court's mission, the principal measures of
success are to place participants in appropriate medical, behavioral health
treatment and related services, and to monitor, case manage and supervise
them through their involvement with the Court. With rare exceptions, the terms
of probation extend for 1 year. Thus, a negative measure of the court's
performance would be large numbers of participants who violate conditions of
probation, or suspended sentences, who then had to serve jail or probation
sentences outside of the control of Mental Health Court. These data are not
available at the time of this writing, particularly because the court is only about 1
year into its implementation. More difficult interim measures would seek to
indicate how well candidates had been placed into treatment, had stabilized and
were functioning. Because participants have different problems related to their
mental illnesses, an early measure would reflect forward progress in bringing
participants into stable settings and more normal life routines. The use of
probation as the principal vehicle for supervision by the court will provide data
for measures of compliance and progress at a later date. At this stage, with the
King County Mental Health Court still adapting and expanding, the most
relevant measures of success have to do with implementation of services and
reaching the intended target population.

----------------------------

Chapter 4

----------------------------

The Anchorage Mental Health Court

Target Problem and Rationale

A 1997 (Care Systems North) study of the incarcerated population in Alaska
found that about one-third of inmates suffered from serious mental illness, a rate
about twice as high as the estimated national average of 16 percent (Bureau of
Justice Statistics, 1999). That group included a large number of persons with
developmental disabilities and organic brain injuries. The study noted that the
Alaska Department of Corrections had become the largest provider of
institutional mental health services in the state. Against the background of efforts
to address institutional overcrowding, the challenge facing Corrections to
provide services for its mentally ill inmates was extraordinary, particularly in
Anchorage, one of the state's largest population centers. 

In 1998 the Criminal Justice Assessment Commission, formed to examine jail
crowding problems in Anchorage, identified the mentally ill and disabled as a
special population presenting difficult problems for the jail and local justice
system. One of the recommendations of the Decriminalizing the Mentally Ill
Subcommittee was to explore means of identifying mentally disabled offenders
for diversion away from the justice system into coordinated community
treatment services. A special jail-based program to provide placement in
community mental health treatment programs for inmates, the Jail Alternative
Services Pilot Program, was instituted during July 1998. The subcommittee also
recommended development of a mental health court, referred to as the Court
Coordinated Research Project (CCRP), to address misdemeanor defendants
and offenders with mental disabilities. During the planning stages, the
experiences of the Broward County and King County Mental Health Courts
were considered and adapted to the special problems of the local justice
system in Anchorage. Circuit Court Presiding Judge, the Honorable Elaine
Andrews, signed an administrative order that officially established the Court
Coordinated Resources Project in April 1999 and appointed Judges Stephanie
Rhoades and John Lohff to preside over the "specialty mental health court."

The two-pronged mental health court initiative went into operation in July 1998.
One component, the Jail Alternative Services (JAS) Program, established
alternative mental health programming in the community for specially targeted
mentally ill inmates. The other, the CCRP, established a court-centered
approach to identifying and treating mentally ill persons in the criminal caseload
in the Anchorage District Court. The mental health court process is presided
over by two District Court judges, the Honorable John Lohff, Deputy Presiding
District Court Judge, and the Honorable Stephanie Rhoades.

CCRP was designed to provide an alternative to jail and routine adjudication of
misdemeanor cases for persons with mental disabilities by instituting special
procedures that allow trained judges to address and treat mental illness and
create more effective linkages and coordination between the courts, other
justice agencies and mental health resources. Although the court-based initiative
was motivated by the pressing need to address problems associated with jail
overcrowding in Anchorage-hence the special Jail Alternative Services
Program initiative for persons in custody- CCRP aims at a broader population.
It accepts mentally ill persons in the misdemeanor population whether or not
they are confined. Although CCRP places some defendants in the JAS
Program, it draws upon a large array of community mental health and other
supportive services. While the aims of the Anchorage District Court's CCRP
initiative to link mentally ill defendants with community-based mental health
services are similar to those of other mental health courts, the court chose not to
call itself a "mental health court" to avoid the stigma that might be associated
with participation in a court designed to respond to the mentally ill.

Target Population

The jail-based component of the mental health court initiative, the JAS
Program, began on July 6, 1998 as a pilot project operated by the Alaska
Department of Corrections and funded through the Alaska Mental Health Trust
Authority. To be eligible for the JAS Program, defendants must be confined in
the Anchorage jail on misdemeanor charges (punishable by a statutory
maximum of 1 year in jail) and be found to suffer from a major mental illness
with a history of psychosis or an organic brain injury. Prior records of
convictions are anticipated by the mental health court. These restrictive criteria
ensure that the JAS Program is very selective. It is limited to 40 participants, 5
of which are to be defendants suffering from organic brain impairments. 

Eligibility criteria for participation in the District Court's mental health court
program (CCRP) also begin with the limitation that defendants-in or out of
custody-must be charged with misdemeanor offenses and defendants with prior
records are not excluded. Beyond these threshold criteria, CCRP criteria are
less restrictive than those that apply to JAS participants. Defendants diagnosed
with or showing obvious signs of mental illness, developmental disability, or
organic brain syndrome are considered appropriate candidates for the mental
health court program. However, there is no requirement of a history of
psychosis, as in the JAS Program, and the defendant need not have been in
custody, a JAS eligibility requirement as well. CCRP has not attempted to limit
enrollment to a certain number of participants. Candidates are referred to
Anchorage's CCRP by the correction department's jail staff, the attorneys
handling the case, other judges, family members, concerned friends or other
relevant sources. 

Anchorage Court Coordinated Resource Project (Mental Health Court)
Procedure

The Court Coordinated Resources Project operates in Anchorage's District
Court, which has jurisdiction over both state and municipal misdemeanor
offenses. (For an overview of the Anchorage Court referral procedure, see
Figure 3.) An arrestee who is charged with a misdemeanor will have an
arraignment before a judge within 24 hours. Persons detained after arraignment
are screened by jail staff. If they appear to be candidates for the JAS Program,
the JAS coordinator is notified. The JAS coordinator in turn notifies the court
and the court notifies the prosecutor and defense attorney. If the defendant is
interested in being a JAS participant, the JAS coordinator meets with the
defendant (and/or attorney) to conduct an assessment to determine JAS
Program eligibility. The coordinator explains the treatment program available
under JAS. If the coordinator determines that the defendant meets the eligibility
criteria and is willing to participate in the program, the coordinator submits a
brief report to the CCRP judge, indicating the defendant's treatment needs. The
report also proposes a treatment plan, with specific recommendations for
mental health and/or substance abuse treatment in the community, and, if
needed, provisions for medication and for monitoring the defendant's
medications, and provisions for addressing housing needs. This report is made
available to the judge and the attorneys at the mental health court hearing. If the
defendant is not eligible for JAS, but still appears to meet the criteria for
participation in CCRP, the jail staff refers the defendant to the court for CCRP
evaluation.

At their first appearance in mental health court, defendants must be stable and
competent to decide whether they wish to participate in the JAS or CCRP
court-supervised treatment programs. Because the arraignment hearings are
generally done so quickly, issues of competency often fail to arise at that point
unless defendants have obvious mental health problems that have an impact on
their ability to attend to even this cursory proceeding. Even if competency
problems are suspected, the arraignment judge often defers the examination of
the issue to the CCRP judge who has received special training in the recognition
and handling of mental health problems. Defendants who do not appear
sufficiently stable will have their first mental health court hearings continued to
give the corrections mental health staff time to improve stability. If the mental
health court judge believes that a defendant is incompetent, the judge will order
the defendant to the state hospital (the Alaska Psychiatric Institute) for a
competency evaluation.[19] If the defendant is found to be incompetent by the
state medical staff, the court must hold a hearing at which evidence is presented
on the issue of incompetence. 

If the defendant is found, by a preponderance of the evidence, to be
incompetent, the criminal proceeding will be stayed, and the defendant may be
committed to the hospital for treatment for a period of 90 days. In those cases,
at the end of the 90-day period, a hearing must be held before the mental health
court judge to determine whether competency has been restored. If the
defendant is still incompetent, he or she may be returned to the hospital for
treatment for an additional 90-day period. A defendant who remains
incompetent at the expiration of the second treatment period has the charges
dismissed without prejudice; unless they involved force against a person, the
defendant is a danger to others, or there is a substantial possibility that he will
regain competence within a reasonable period of time. If these conditions are
met, the defendant's commitment may be extended for an additional 6 months.
At the end of this period, defendants whose competency has not been restored
will have all charges dismissed without prejudice.[20]

At the first mental health court hearing, in cases when defendants are competent
and stable, the judge determines whether the candidate understands what the
mental health court (CCRP or JAS) treatment options involve and asks whether
the defendant wishes to participate. The defendant makes this decision with the
assistance of counsel and the court ensures that the decision to participate is
voluntary. To enter the program, in most cases, the defendant is required to
enter a plea of guilty or no contest to his misdemeanor charge in exchange for a
plea agreement that the sentence will not involve jail. In rare cases involving
very minor offenses and no prior criminal records, participants enter the mental
health court via deferred disposition, which involves court-ordered conditional
release of the defendant to community treatment prior to adjudication with court
monitoring for compliance. Defendants who successfully complete the court
program under these terms may be eligible to have their charges dismissed.

Once the plea has been entered and accepted, a sentencing hearing is
scheduled. Ideally, if an acceptable treatment plan has already been prepared
and approved and the participant is already in treatment and in an acceptable
supportive living situation, the sentencing may be held immediately after the plea
of guilty is accepted. If the defendant is assigned to the JAS Program, he will be
sentenced and released as soon as the appropriate interviews are completed
and the treatment plan set up. Due to a lack of separate funding available to
support treatment services in the mental health court, CCRP participants may
wait longer than JAS candidates before their treatment plan is prepared and
approved because they have to make arrangements for services themselves
through their attorneys and community mental health services. 

Defendants who are in custody remain there until a satisfactory treatment plan
has been approved by the judge, unless a reliable third party who is acceptable
to the judge steps forward to take on the responsibility of providing supervision
in the community during this interim period. When prospective participants are
in jail awaiting approval of their treatment plans, the court tries to expedite the
sentencing hearing so that the defendant can be released as soon as possible.
Typically, the adjudicated defendant receives a probationary term with a
suspended sentence, with treatment through CCRP as a condition of probation.
Although the probationary term for a misdemeanor conviction in Alaska can
extend up to 10 years, the probation sentence in mental health court is usually
between 3 and 5 years. Unlike the few deferred disposition defendants, these
defendants are not eligible to have their charges dismissed upon successful
program completion. Because many would have been subject to jail time in
normal court, the suspended sentence is thought to provide an incentive to
encourage participation in the mental health treatment process.

In the event that a defendant wishes to pursue pretrial issues or motions before
making a decision about entering CCRP, the motions may be heard before one
of the mental health court judges, Rhoades or Lohff, or may be heard by
another judge in the normal district court process. If a defendant is successful,
the charges may be dismissed. A defendant who wishes to litigate a pretrial
issue and loses may still decide to enter the mental health court treatment
process. Defendants who wish to proceed to adjudication, in the belief that they
will be found not guilty, may or may not have their cases heard before either of
the mental health court judges (both judges also preside over a normal criminal
caseload). Mentally ill defendants assigned to other criminal judges and found
guilty, may or may not be sent by the trial judge to the mental health court
judges for sentencing. 

In the event that a defendant qualifies for the selective Jail Alternative 
Services Program, the JAS coordinator, who also is the caseworker, is
assigned to link the defendant to community treatment, to oversee and facilitate
the treatment process and to report progress and potential violations to the
court. The coordinator/caseworker monitors the defendant to be certain that
their living situation is stable and that the participant is complying with
court-ordered conditions of probation. This involves meeting with the
participant on a regular basis; the frequency of the meetings varies from case to
case, from twice a week to once every 4 to 6 weeks. A status hearing before
the judge is scheduled after the defendant's release, with additional dates
scheduled on an as-needed basis. 

Minor violations of conditions of program participation generally result in
adjustments being made in the participant's treatment plan to better meet his
needs and to prevent future violations. Participants in the JAS Program who
have difficulty complying with program conditions or who pose higher risks of
violation may be scheduled for regular monthly status hearings at which they are
required to explain problems to the judge. If the defendant appears not to be
interested in cooperating after numerous chances, the caseworker may file an
affidavit of noncompliance and petition to revoke probation. The defendant
must then return to the CCRP court to answer for the noncompliance. As a last
resort, the order may be vacated and the defendant may be sentenced on his
original charges, with credit given for time served should the court determine
that jail time is appropriate. Participants who decide that the program is not
working for them have the option to drop out of the program. In such an
instance, the JAS coordinator will recommend to the judge that the JAS order
be vacated and the offender sentenced by the CCRP court. 

Mental health court candidates not qualifying for JAS, but qualifying for
treatment through the CCRP program, will be released on probation to follow
the court-approved treatment plan as a condition of release. Due to lack of
sufficient resources, CCRP participants are not supervised by a caseworker.
The participant is required to sign a release of information document that
permits the judge and the prosecutor to receive reports about compliance with
program conditions from the mental health facility or program to which the
defendant has been assigned. If violations occur, the prosecutor will file a
petition, and a status hearing will be scheduled. In addition, compliance is
monitored through regularly scheduled review hearings. 

Unfortunately, as of this writing, there is no separate funding available to hire a
court monitor or a caseworker to support the CCRP program. As a result, the
burden of coordinating services falls mainly upon the judge, who recommends
programs for the defendant and his attorney to explore, but who relies heavily
upon the defense attorney for developing suitable treatment options. In addition,
there is no staff person assigned to supervise or case manage the participant
once he is released on an acceptable treatment plan. Supervision is
accomplished by the monitoring of the prosecuting attorney and the court
through regular review hearings.

CCRP participants who violate conditions of their participation in the treatment
process while on probation may be assigned sanctions that range from
counseling by the judge at the hearing and threats of jail time, to revocation of
probation and imposition of portions of the suspended sentence, to termination
from the program and imposition of the full suspended sentence. Judge Rhoades
notes that, for lack of compliance with program conditions, the court will not
penalize defendants for participating in CCRP and not employ sanctions for
noncompliance more severe than the standard sentence would be if the case had
been adjudicated through the normal misdemeanor court process. When a
mentally ill participant fails in the CCRP program, and ends up receiving a
"normal" sentence and then is rearrested, the new case will be flagged to return
to mental health court. At that time, depending on the seriousness of the new
charge (it must be a misdemeanor) the defendant may be given another
opportunity to enter the treatment services provided by the CCRP program.
Readmission can occur after careful evaluation by the court team to determine
whether circumstances or attitudes have changed and the candidate would be
more amenable to treatment this time.

The Treatment Approach in the Anchorage Mental Health Court

Like the other mental health courts, the Anchorage Court Coordinated
Resources Project places the court at the center of a therapeutic process and
relies on a dedicated team model of staffing. Two judges are assigned to hear
the mental health court cases in addition to performing their normal criminal court
duties. Both judges have received specialized training in mental health issues.
Judge Rhoades carries the additional responsibility of coordinating existing
resources among corrections, the court, prosecuting and defense agencies and
community mental health providers to ensure appropriate community-based
treatment for the mentally disabled offender. 

Compared to proceedings in the normal misdemeanor criminal courtroom,
mental health court hearings take much longer to conclude. Rather than moving
the case expeditiously to its disposition, the aim of the mental health court
proceedings is to take the time to carefully explain options to defendants, who
may have difficulty understanding. The hearings aim to encourage participant
entry into treatment. This may include finding a suitable community treatment
alternative to jail. The Anchorage mental health court proceedings are much
more informal than normal adversarial proceedings in criminal cases, and follow
after the fashion of drug courts. Once the person has reached the court (has pled
guilty, etc.) the mental health court supports the mentally ill offender in treatment.
The ad-versarial process resumes when it appears that a participant risks
termination from the program and faces violation of the conditions of sentence
with the possibility of serving time in confinement. 

With the therapeutic aims in mind (and the related emphases to support the
participant in treatment in the community), the Anchorage mental health court
maintains a special concern for public safety and avoids any arrangement that
will place the community at risk from participant behavior. The prosecutor
wields considerable influence in setting the terms of the plea for candidates who
are accepted in the program and in reacting to reports of noncompliance. The
judge has the final say in accepting or rejecting candidates for participation in the
two-pronged mental health court program. In the courtroom, the prosecutor
supports the treatment process, while considering the implications for public
safety. The defense attorney is also more flexible in mental health court than in
traditional misdemeanor court, allowing direct dialogue between the defendant
and the judge after the fashion of the drug court model. In addition, much more
input is encouraged and allowed from participants' family members and others
supportive of the treatment process. Counsel will consult with a participant's
legal guardian, when appropriate. Once the participant has been sentenced and
is in the program, the court and the dedicated staff become closely involved in
monitoring his or her progress. 

Initially, review hearings are scheduled 1 month from sentencing; then they are
held as needed to ensure that the conditions of CCRP or JAS participation are
being adhered to. At the hearings, the judge discusses the participant's progress
in treatment with him or her directly, identifies any problems, and encourages
continued participation. Defendants are encouraged to maintain contact with the
court and to return at any time, particularly if something is not working and they
need assistance in solving treatment-related problems. Again, following the drug
court model, defendants who have passed important milestones or have good
reviews may receive praise from the judge and even applause from other
participants seated in the courtroom. Thus, as a therapeutic tool, the courtroom
is intended to provide positive incentives and support for the treatment process
and to help establish the boundaries for acceptable behavior. 

The courtroom staff includes a designated member of the municipal prosecutor's
office, as well as attorneys from the two defense firms who contract with the city
and the state to provide legal services to the indigent. The JAS
coordinator/caseworker handles eligibility assessments, treatment plans and
supervision of all JAS participants. All inmates booked into custody receive
medical and mental status screening by the nursing staff within 24 hours of arrest.
When mental illness or psychiatric symptoms are detected, inmates are referred
to the correction department's mental health clinician who will research their
records, conduct a diagnostic evaluation and make recommendations for
treatment or behavior management. The JAS case coordinator works with the
clinician to identify all mentally ill misdemeanants in custody, assess their current
mental status and determine whether they may benefit from participation in
mental health court. The purpose of the dedicated team model is to develop
expertise in working with the mentally ill, create familiarity with the specific cases
and defendants being processed through the court and contribute to a smoother
and more efficient court operation conducive to dealing with the mentally ill and
disabled.

JAS Program participants are placed on probation on the condition that they
follow the treatment plan submitted by the JAS coordinator. Most JAS clients
are placed in supportive living situations and are required to attend a day
treatment program on a daily basis. Only the state hospital, with limited capacity,
is available to meet the needs of participants requiring in-patient treatment
services. For JAS mental health court participants, an important aim is to reduce
the level of supervision and structure provided to the clients over time as their
level of independence increases, and to develop strong links to treatment so that
treatment will continue after the probationary period and mental health court
involvement.

Very few of the defendants have a place to live when they are placed in the
Anchorage CCRP or JAS Program. Most need assisted living with varied levels
of structure and support to enable them to function appropriately in the
community, ranging from 24-hour staff availability to apartment settings with staff
available to look in on them once a day. Chronically ill and/or
personality-disordered defendants or those with ongoing substance abuse
problems are more difficult to place in available programs. Some programs are
reluctant to accept JAS participants because of the risk they pose to other
clients or the potential to be disruptive to the overall treatment programs.
Unfortunately, for such individuals there are few resources available to provide
the living situation and services needed. Instead, JAS participants are forced to
make use of two unsupervised shelters in the Anchorage area; or they are placed
on the "hotel plan" under which they are placed in an inexpensive hotel, and
closely monitored by the caseworker and the staff at the day treatment center
they attend. They are essentially "wrapped" in services that take them through
the weekdays from morning until night, and provided with assisted living as
needed for their day-to-day functioning (preparing meals, buying groceries,
managing money). 

Staff views these housing arrangements as less than ideal. Staff have no control
over other potential residents who tend to frequent these living quarters. Neither
the unsupervised shelters nor the inexpensive hotels are viewed as desirable
settings for JAS participants, who require supportive services. Attempts are
made to compensate for the poor housing situations by providing JAS
participants with day treatment services, an aggressive outreach component, and
case managers who check in on them and respond to their needs on a daily
basis. A small percentage of JAS clients have supportive home situations and do
not require structured housing.

Day treatment is supplied to the JAS program mainly by the South Central
Counseling Center, which provides substance abuse treatment, training in social
and independent living skills, daily medication dispensing, and vocational training.
Each defendant is assigned to a team based upon individual treatment needs.
Most of the JAS defendants require an intensive level of treatment accompanied
by an aggressive outreach component. (Staff will go out in the community to
look for them if they fail to appear for group sessions or medication.) The JAS
program also contracts with the South Central Foundation in Anchorage, which
works primarily with the native Alaskan population. That program provides day
treatment programs as well as cultural links and activities, some outreach, and
limited housing. While most JAS clients require day treatment, at least at first,
some are stable enough, or become stable enough, to be placed in vocational
programs or to take on part-time jobs. Unfortunately, only a small percentage of
JAS clients have the ability to ever hold a job.

At least in its initial stages, the JAS program has not been able to draw on good
options for placing dually diagnosed participants in treatment. Substance abuse is
common among the mentally disabled JAS participants, with an estimated 82
percent having significant substance abuse issues.21 With only 2 facilities and a
combined capacity of 25 beds, this lack of treatment resources is most acutely
felt when dealing with clients with personality disorders or who display severe
symptoms of mental illness, and who need, but are unable to function in, the
available in-patient programs. When their criminal histories are also taken into
consideration, this type of participant is not usually eligible for most treatment
programs. As a result they are placed in out-patient MICA groups with regular
monitoring and drug screening, supplemented by day treatment with "aggressive"
outreach activities. JAS staff believe that this approach is unlikely to address the
treatment needs of the dually diagnosed participants.

JAS clients who have organic brain impairment are placed with agencies
specifically dedicated to addressing their problems, some of which are
permanent in nature and do not respond to treatment. These agencies provide
services including daily living assistance and maintenance. The clients are
assisted, for example, in getting their food and cooking meals. Daily activities are
structured to meet their levels of functioning. These placements are intended to
be permanent in that the clients can stay there even after the jurisdiction of the
court has ended.

In contrast to the more structured approach of the selective JAS Program
available to some mental health court participants, CCRP participants do not
enter a structured program, staffed and supervised by the court. Rather,
candidates must set up their own treatment plans through their attorneys. This
task is difficult and time-consuming, and results in different arrangements for
different participants based on the attorney's ability to pull together an effective
treatment plan, and the defendant's financial situation. However, there is no
accessible, integrated mental health treatment network for defense attorneys to
draw on in designing an appropriate treatment plan for their clients and some
attorneys do not have experience in developing such a plan. As a result,
treatment plans for their mentally disabled clients vary in scope and potential
effectiveness, ranging from simply attending AA meetings for substance-abusing
mentally ill, to more comprehensive coverage that can be accessed only by
defendants who have the means to pay for them.

At this stage, the Anchorage CCRP is supported by fewer resources than the
other mental health courts (and far fewer resources than required for adequate
operation). However, it is one of the emerging mental health court sites that,
despite its limitations in case management and supervision, provides treatment
and an alternative to jail for mentally ill or disabled defendants who otherwise
would face confinement (many have significant prior criminal histories). The
judicial supervision of the misdemeanor participants far exceeds the attention that
would be paid to these defendants in a state in which misdemeanor probationers
are not supervised. Thus, the judicial supervision that the defendant receives
from CCRP is quite valuable. Participants, who may receive little assistance in
accessing services and following up on services and treatment, are nonetheless
provided with a treatment plan. The plan must meet court approval and is
supervised by the treatment program's case manager, with follow-up provided
by the district attorney in the case of noncompliance, and by the court at
scheduled review hearings. At this stage of the its development and on limited
resources, the Anchorage Mental Health Court provides therapeutic intervention
in cases that otherwise would receive few services and result in jail terms.

Success and Failure in the Anchorage Mental Health Court

In its first year and a half, the mental health court in Anchorage's District Court
has attempted to identify mentally disabled misdemeanor defendants who would
more appropriately be dealt with through supportive care and treatment than by
the normal adjudication process. The Court Coordinated Resources Program
has relied on the central participation and supervision of Judges Rhoades and
Lohff to link candidates with treatment services when possible and to monitor
and assist the treatment process, usually as part of a probation sentence. Since
its inception in July 1998, CCRP accepted approximately 129 participants
during fiscal year 1999 on the basis of a guilty plea and a sentence to probation
with a suspended jail term. Data are not available at this stage describing CCRP
participants, their progress, services employed, or case outcomes. Early failures
from the program would be indicated by revocation of probation and imposition
of suspended sentences. Most would not have completed probation yet in any
case. 

Some data are available for the specially funded JAS Program option from its
early period of operation. From July 6, 1998, to June 30, 1999, 138 defendants
were identified as eligible to enter the JAS Program. Only about 26 percent
decided to enter the treatment program, however. This low rate of enrollment
initially was apparently due to the large number of eligible defendants who were
sentenced or released before they could be assessed for the program and
processed by the JAS coordinator. As of February 2000, there were 49
participants, of whom 71 percent are male and the average age is 31. The
population is composed mainly of native Alaskans (39 percent), Caucasians (39
percent), and African-Americans (20 percent). Most have co-occurring
substance abuse problems. JAS participants have fairly extensive prior criminal
histories, averaging 7 prior convictions, and almost all have a history of
psychiatric hospitalization, averaging nearly 10 prior admissions. Early program
information suggests that about half of the JAS participants, like those sentenced
in the normal fashion, were rearrested for new offenses during the recent 12
months. Of the 49 individuals who have entered the JAS Program since its
inception, 17 individuals have been rearrested on new misdemeanor charges,
and only one has been rearrested on a felony charge.
                                        
----------------------------

Chapter 5

----------------------------

The San Bernardino (California) Mental Health Court

Target Problem and Rationale

In California, as in other places, deinstitutionalization of the mentally ill from state
institutions and the inability of the community-based mental health system to
provide sufficient resources to meet treatment needs has contributed to more
mentally ill persons being found among the homeless, drug-addicted and criminal
justice populations (Whitmer, 1979). San Bernardino's Mental Health Court was
established to respond to the large numbers of mentally ill persons found in the
local jail population, recently estimated by corrections officials to account for 12
percent of the inmate population. At the same time, the Honorable Patrick
Morris recognized the challenges posed for treatment by substance-abusing
offenders with mental illness as a co-occurring disorder through his experience
presiding over San Bernardino's drug court. In 1998, a health and justice system
task force was formed of representatives from the justice system, the mental
health system, and city council to examine the problems of the mentally ill
offender. As a result of its recommendations and with initial funding from the
Department of Behavioral Health, the Mental Health Comprehensive Offender
Umbrella for Release and Treatment (MH COURT) began as a pilot program in
the San Bernardino Superior Court in January 1999, with the Supervised
Treatment After Release (STAR) Program as its principal component.

Target Population

The San Bernardino Mental Health Court differs from the other mental health
courts in its admission of defendants charged with nonviolent lower level felonies,
punishable by up to 6 years in prison, as well as defendants facing misdemeanor
charges, punishable by up to 1 year in jail. Some defendants charged with violent
offenses may be considered for the program, on a selective, case-by-case basis,
if it is clear from an examination of the facts that it was not a truly violent
incident, despite the seriousness of the charge, and that the offense was linked to
mental illness. Because one of its aims is to address the jail-based or jail-bound
population of mentally ill offenders, all candidates are in custody at the time of
their referral to the Mental Health Court. In addition, the San Bernardino court
limits eligibility for the STAR Program to defendants with previously diagnosed
and persistent mental illness and a history of recidivism that would make jail
terms likely. Candidates for Mental Health Court must live in the San 
Bernardino area and be eligible for SSI benefits or be employed, so some
contribution to the costs of treatment is possible. To date, few participants have
been employed and most have been eligible for SSI benefits because of their
previous diagnoses. Participants who are not receiving benefits at the time of
admission to Mental Health Court are supported in treatment until their benefits
are applied for and received.

San Bernardino Mental Health Court Procedure

Most potential candidates are identified for the San Bernardino Mental Health
Court while in detention in the West Valley Detention Center by jail mental
health staff, subsequent to arraignment, which must occur within 48 hours of
arrest. (For an overview of the San Bernardino Court procedure, see Figure 4.)
The staff consists of two clinicians with PhDs in psychology, and one licensed
clinical social worker. These clinicians also function as case managers, who
provide supervision for the participants who are admitted into the program. At
that time, they are interviewed and screened by a mental health clinician who
explains the Mental Health Court program and confirms that the defendant has
been diagnosed as having a history of an Axis I category of mental illness.[22]
Candidates who appear eligible for the Mental Health Court sign a waiver
permitting information to be conveyed to the court relating to the mental illness
and indicate they wish to participate in the treatment process. Once candidates
request admission to the program, screening information is passed on to the
probation officer, the prosecutor and the public defender assigned Mental Health
Court duties. The practice of considering only candidates who have requested
admission to the treatment program helps ensure that resources are focused on
persons who will enter the program and engage in treatment once admitted. 

The defendant-candidate will make a first appearance in Mental Health Court
about 2 or 3 weeks after arraignment. The period between referral (after
arraignment) and first hearing in Mental Health Court is used to develop
background information about the candidate's mental health and criminal history
and to stabilize the individual on medication, if necessary. This is done so that
participation is meaningful in the first hearing, and the candidate can comprehend
the proceedings and make an informed acceptance of the program conditions.
Because the Mental Health Court purposely targets persons who would be
spending time in jail upon conviction, the criminal histories of participants are
often significant, although violent prior offenses might preclude participation in
the program. 

Admission to the Mental Health Court requires consensus of all members of the
court team. If any member of the team, including the defender, the prosecutor,
the mental health caseworker, or the judge objects, the defendant will not be
accepted into the program. The probation officer performs an intensive interview
of the defendant and reviews his prior criminal record. If the defendant is
believed to be appropriate for the program, the probation officer will complete a
pre-sentence investigation and prepare written terms and conditions that outline
specific requirements that the defendant must adhere to for his treatment to be
effective. The prosecutor also checks into the defendant's criminal history.
Crimes of violence are checked to ascertain their actual circumstances and
seriousness. True violent offenders are not eligible for the program. If a
consensus is reached and the defendant is approved, the case is listed for Mental
Health Court. Prior to the hearing, the prosecutor and the defense attorney
engage in plea negotiations, so that they are prepared to present an agreement to
the court at the defendant's first appearance, assuming the defendant is
competent.

San Bernardino Mental Health Court hearings are held once a week on
Wednesdays. The court team meets to discuss the case prior to the hearing, as
well as any issues that should be addressed in court. As in the other courts, the
first issue addressed in the San Bernardino court is competency. Felony
defendants who are thought to be incompetent are returned to the jail and the
court will order that they be assessed by a licensed psychologist or a psychiatrist
for competency. A hearing on the issue will then be held. Defendants found to be
incompetent are examined by a therapist from the county Department of Mental
Health to determine appropriate placement. If hospitalization is deemed
appropriate, the defendant may remain in the hospital while steps are taken to
restore competency. In fact, that process may take up to 3 years, or the
statutory maximum associated with the crime charged, whichever is less. In
misdemeanor cases, the court will attempt to avoid hospitalization, which can
cost approximately $350 per day. It is more likely that the misdemeanor
defendant will be placed in a public or private treatment facility approved by the
Department of Mental Health or in a community-based program, in an attempt
to restore competency. The criminal proceedings are suspended pending the
restoration of competency, up to a period not to exceed the statutory
maximum.[23] Defendants who are unstable when they enter the jail are
generally stabilized during the 2- to 3-week detention period while being
considered for treatment court. Unstable defendants must consent to treatment
while in jail in order to qualify for Mental Health Court, so that while they are
housed in the psychiatric wing, they can be stabilized with therapy and
medication. Most unstable defendants are ultimately denied program admission
due to their inability to cope with the highly structured nature of the treatment
program. 

Assuming that a defendant is competent, he or she enters a guilty plea as a
condition of entry into the program. The defendant is placed on probation for a
period of 2 years in misdemeanor cases or 3 years in felony cases, with
participation in Mental Health Court treatment ordered as a condition of
probation. Each participant must also sign an individualized treatment contract
that specifies the mental health services to be provided, the frequency of those
services (and the required attendance), and any other activities required of the
participant. Upon successful completion of the program, the plea may be
withdrawn, the charges against the defendant may be dismissed, and the
participant may also petition the court to have the record expunged. 

Once the treatment plan has been agreed to, most participants are released into
an augmented board-and-care residential treatment facility. (There are presently
24 beds allotted to the Mental Health Court program.) The case managers
transport the participant to the facility and then visits the client several times a
week to ensure compliance, providing intensive supervision to assure that he is
attending psychiatric counseling, stabilizing on medication and abiding by the
terms of his probation. Upon request, the probation officer will intervene if the
client becomes disruptive or uncontrollable at the facility, and will arrange for
transport back to court for a hearing before the judge. Clients who fail to
cooperate or comply with program standards, or who otherwise are in violation
of probation, will have sanction recommendations made for them by the mental
health clinicians. 

A small number of participants may have the family support and stability to allow
them to be supervised from their homes. The case manager will conduct home
visits two times per week, to determine that the living conditions are appropriate,
and that clients are not in possession of any illegal or inappropriate items that
would impede their progress in treatment, and to perform urine analysis testing
for illegal substances. When the conditions in the residence are found to be
unsuitable, the officer will find new arrangements for the participant. When a
participant is found to be in violation, the officer will recommend sanctions. 

Status hearings are held every 3 to 4 weeks to track the level of compliance by
the participant and to address any problems that may arise. Noncompliance
sanctions range from an in-court reprimand from the judge and loss of privileges,
to increased restrictiveness of placement that includes more meetings with the
case manager and more meetings in the 12-step program, or community service,
and even jail time (usually a weekend, or more for continued violations). The
noncompliant participant will also be reevaluated to ascertain if changes in
treatment and/or living arrangements are necessary to aid them in attending to
program rules. Serious and willful recurring violations may result in program
termination and a return to traditional court. San Bernardino differs from the
other early mental health courts in its close adaptation of the drug court model to
the mental health court treatment process, including the use of jail as a sanction.
If the defendant commits a new minor crime, he or she will probably be
sanctioned with jail time, but may not be terminated from the program. An arrest
for a new, more serious crime will result in termination. The benefits of
compliance are privileges granted at the treatment facility.

The Treatment Approach in the San Bernardino Mental Health Court

The treatment process centers on the Mental Health Court judge and the court
team. After the initial court session during which a participant formally enters the
treatment program (STAR), participants attend court for status reviews as
frequently as needed but average every 3 to 4 weeks. Prior to a court session,
the treatment team reviews each case, including its problems and progress, with
the judge who makes notes about the issues that need to be addressed. The
team includes the judge, the prosecutor, the public defender, the probation
officer, the case manager, the day treatment provider and sometimes the housing
service manager. In the courtroom, the Mental Health Court resembles a drug
court. The San Bernardino court sessions are very carefully organized and
prepared. The judge discusses each participant's situation, problems and
progress, and encourages, reprimands, sanctions or modifies the treatment plan.
Participants are treated differently depending on their symptoms, illness or stage
of treatment. For some, the judge's message is stern and a jail sanction may be
applied. For others, the judge may be very supportive of small steps taken in a
constructive direction. One of the reasons the Mental Health Court seems similar
in style to the drug court is that most participants also suffer from serious
substance abuse problems. 

Nearly all of the participants in the San Bernardino Mental Health Court are
initially placed in one of four augmented board-and-care facilities, the Redwood
Guest Home, Fontana Board and Care, North End Board and Care and Linda
Villa. These facilities receive funding that enables them to provide additional
services tailored to the needs of the mentally ill offender. The facility supervisor
must be at least a licensed clinician, who is qualified to dispense medications and
provide individual and group treatment on site if necessary. These gateway
facilities not only provide a temporary place to live, but also an array of
supportive services to help the participant begin the treatment process. These
include 24-hour supervision, group therapy, dispensation of client medications,
assistance in helping with finances through the teaching of budgeting skills,
assistance in spending money in appropriate ways, and transportation to the day
treatment program that provides treatment services. 

Because this type of care is expensive, the number of beds allotted to the
treatment program is limited to 24 beds. As clients progress and become more
stable, they are moved to one of the six regular licensed board-and-care facilities
with which the court has contracted, and finally to basic room and board or
other independent living situations. Only very stable clients are initially released
into a regular, licensed board-and-care facility, where, in contrast to the
augmented-care facilities supportive services, day treatment and dispensation of
medications are not included in facility services (and the educational level
required for staff is not as high). A small number of participants may be released
directly to their family when family support is sufficient to facilitate the treatment
process.

San Bernardino Mental Health Court participants generally receive day
treatment from the Pegasus program which was run by Mental Health Systems,
Inc., and tailored to fit the needs of the Mental Health Court. Pegasus began
servicing the Mental Health Court in February 1999. Although Pegasus also
takes referrals (of mainly individuals with some form of criminal justice
involvement) from the other courts and agencies, the majority of its clients are
participants in the Mental Health Court. 

Defendants attend the day treatment program 5 days per week, from 8:30 a.m.
until 1:00 p.m. The services provided include anger management, socialization
skills, psychotherapy, medication therapy, and chemical dependency treatment,
which includes a "12 + 5" step program specifically geared toward the dually
diagnosed client, as well as drug testing. (Most San Bernardino Mental Health
Court participants also have serious substance abuse and self-medication
problems.) Pegasus also provides prevocational training, which is meant to
prepare participants for educational or work programs. Participants also receive
individual case management; regular conferences are held to discuss client needs
and progress. The program will transport participants to scheduled doctor's
appointments. 

The day treatment component is intended to last for 1 year, at which point
participants who have made satisfactory progress will be considered for
vocational or educational training, or full- or part-time employment. Participants
are referred to the state vocational rehabilitation department to receive training.
Court (STAR) participants move from one level of care to another as a result of
recommendations made by clinicians to the judge and the attorneys at periodic
treatment meetings.

The mentally ill offenders grant is being used to fund two new programs: STAR
LITE and SPAN. STAR LITE is an intermediate level treatment program
designed to cover a similar mentally ill population to the one covered by STAR,
but with Less Intensive Treatment Episodes. It offers services and case
management for defendants who have less need for supervision; however, these
participants will still be on supervised probation and be subject to specific
medication and treatment requirements. They are also required to meet regularly
with their case managers. Review hearings will be held approximately every 3
months. SPAN, which stands for San Bernardino Partners for Aftercare
Networking, was designed to provide case management and augmented services
to in-custody defendants who had not been previously diagnosed, but rather
were diagnosed with an Axis I illness in jail,[24] and who are not chronic
offenders. Lower level services are offered to these defendants, and only regular
board-and-care referrals are available for homeless participants. SPAN
participants may not have probation terms and conditions relating to taking
medications and treatment. There are no regularly scheduled review hearings
required for them. Rather, they are tracked through brief meetings with a case
manager and a counselor who will check in on them to assure that they are
stable.

From the San Bernardino Mental Health Court's inception in January 1999
through November 16, 1999, 181 referrals were made to the Court. Of these,
106 were actually evaluated, resulting in the acceptance of 25 participants and
the rejection of 81 candidates. The majority of the rejections came from the
office of the District Attorney. Most of those accepted were placed in the
Pegasus program, with the majority of these housed in augmented
board-and-care facilities. Sixty percent of entering participants were remanded
to jail at least once during their treatment period, with 40 percent remanded
more than once. Six participants were terminated from the Mental Health Court
program, half due to AWOL status, and half due to serious or persistent
violation of terms and conditions. Nineteen participants were active in the
program as of November 19, 1999.

Success and Failure in the San Bernardino Mental Health Court 

The San Bernardino Mental Health Court accepts participants facing
misdemeanor or felony charges who have serious mental health problems based
on past history and current diagnosis of Axis I conditions. All participants plead
guilty and are sentenced to probation for 2 or 3 years, depending on the offense.
The STAR Program aims to place mentally ill offenders in appropriate services
and to move them to different and less intensive levels of care when success is
demonstrated in various stages. An overriding goal is to place participants in
treatment programs and to link them with the appropriate services so that, when
their participation is concluded, they continue to make use of these resources,
which will assist them to function normally and not to return to the criminal justice
system. A related goal is to maintain the mentally ill offenders in the community
and to avoid their confinement in the local correctional facility. Participants who
are successful move from intensive services to more independent and
self-sufficient living situations, complete probation successfully and have their
pleas withdrawn, their charges dismissed, and their arrests expunged. The
program's first graduation is expected to occur in June 2000, when it is
anticipated that up to six participants will have successfully completed the
program. 

After entering the Mental Health Court, participants who cannot comply with the
requirements of the treatment process are sanctioned, much as in Judge Morris'
drug court. They often receive stern lectures and reprimands, sometimes
resulting in sitting in the jury box during the court proceedings, possibly being
placed in a more restrictive and structured treatment setting, and, occasionally,
being returned to jail until further plans can be made. Court staff considers the
use of the jail appropriate in a therapeutic not a punitive sense, helping some
participants see the consequences of their actions and encouraging them to
refocus their efforts. Unsuccessful participants may be terminated from the
Mental Health Court, have probation revoked and face serving terms of
confinement in jail or a state prison facility.

----------------------------

Chapter 6

----------------------------

Early Mental Health Court Initiatives: Common Themes and Emerging Issues

Common Origins and Objectives

The nation's first mental health courts have much in common with the
problem-solving courts that preceded them. Drug courts, community courts,
domestic violence courts and related court-centered treatment and social service
strategies were motivated by similar problems, severe local correctional
crowding and court delay, dramatically growing caseloads of substance abuse
offenders, and a shared sense that traditional methods of case disposition were
inadequate and unsatisfying. Drug courts "broke the mold" in searching for a
more effective response to substance abuse in the criminal justice population,
with subsequent problem-solving or specialized courts adding to the substantive
agenda of problems, including domestic violence and community quality-of-life
issues that could be addressed by adapting the drug court approach. 

In part, the subject matter of special courts diversified as courts discovered first
hand that substance abusers often suffered from co-occurring disorders or were
struggling with other critical life problems linked to the substance abuse, such as
housing, unemployment, domestic violence, educational, vocational and health
issues. Thus, to succeed at restoring offenders to sobriety and functionality in the
community, multifaceted treatment approaches were necessary and new service
delivery partnerships were created. Special court approaches of the last decade
prioritized different problems and different target populations and selectively
adapted the methodology and lessons of the drug court model to address them
and added unique new dimensions of intervention and operation. Each special
court initiative has faced the challenge of dealing with participants who were
mentally ill. The first mental health court initiatives took on that challenge.

The four pioneering mental health court initiatives described in this report grew
from efforts to respond to three basic critical problems. These problems
included: the public safety risk posed by mentally ill offenders; the difficulties
associated with housing the mentally ill in local jails; and the inadequacy of the
criminal process in dealing with mentally ill defendants in all matters. These
judicial strategies were based on the recognition that mentally ill offenders were
handled poorly in the criminal justice system generally, as well as in the criminal
courts in particular. Many offenders-particularly mentally ill defendants charged
with low-level offenses who were nevertheless competent-were routinely
processed through the misdemeanor system with meaningless responses and
ineffective penalties, including fines that would never be paid and time served for
days already spent in jail.

A very clear aim in each site was to devise an alternative to holding and treating
mentally ill defendants in jail. Although each jail was attentive to the issues of the
mentally ill offender, the jails faced serious crowding problems and were
ill-equipped to provide more than temporary care for the mentally ill. Resources
were too scarce, facilities were inadequate, and the numbers of inmates were
too great. Moreover, each mental health court strategy was premised on a belief
that, in most cases, jail was the last method that should be employed to address
the problems of the mentally ill offender. Not only were jails generally unable to
provide adequate care, confinement was often a stressful ordeal for the mentally
ill, causing crises and a variety of problems that might otherwise be avoided. The
designers of these mental health court innovations saw the growing problem of
the mentally ill in jails as evidence of the failure of mental health treatment and
other social service systems in the community.

The early courts also share common origins and aims because they draw on the
example and experience of the nation's first mental health court in Broward
County. Each of the succeeding efforts has considered and adapted the
pioneering Broward County Mental Health Court model in some fashion. Once
established, the early mental health courts have shared lessons and challenges
among themselves and-as communication and geography would permit-have
continued to learn from their different experiences. Moreover, each of the early
courts now receives visitors from other courts interested in addressing the
problems of the mentally ill in their justice systems.

Common Features

The mental health courts we examined share a number of common attributes,
some adapted from the earlier models of problem-solving courts, some unique to
the mental health populations they address.

Target Problems and Populations

The early mental health courts focus their efforts on the relatively low-level
mentally ill offender who is found in the criminal justice population. All of the
courts place a primary emphasis on the mentally ill defendant or offender held in
jail, seeking ways to find supportive treatment in the community as an alternative
to confinement. The courts differ slightly in their criminal justice and mental health
eligibility criteria. Each of the courts accepts misdemeanor defendants but has a
varying period of court supervision. The Broward County Mental Health Court
is limited to 1 year of supervision of participants, the extent of misdemeanor
jurisdiction in cases that are sentenced. (Broward defendants are not on
probation during their participation in Mental Health Court.) The other sites
require disposition of the charges prior to entering treatment.

In King County, a guilty plea was required under the original program rules.
Currently, however, charges are increasingly more likely to be resolved through
deferred adjudication or a deferred sentence. The participant's period of
probation is limited to 2 years, unless the defendant is charged with DUI, in
which case probation may last up to 5 years. The Anchorage Court requires a
guilty plea and, while the probationary term in Anchorage for the misdemeanor
charges may extend to up to 10 years, the supervisory term is typically set at 3
to 5 years. In San Bernardino, misdemeanor probation is limited to 2 years;
felony terms may last up to 6 years, but are generally limited to 3 years in the
program. Despite the different periods of court supervision that are employed in
each of the locations, a noncompliant misdemeanor participant who faces serving
a term of confinement can serve no more than 1 year of jail time. Felony
participants in San Bernardino can face considerably longer terms. 

The mental health court approaches also differ with regard to the type of charges
that are acceptable for entry into treatment court. The Broward Court excludes
from Mental Health Court DUI and domestic violence charges, for which
separate court programs exist; battery charges are acceptable only with the
victim's consent. The King County Mental Health Court, in contrast, does not
limit the type of misdemeanor charge that is eligible. The Anchorage CCRP does
not eliminate specific misdemeanors from consideration for program admission;
instead, the screening element focuses more on prior record as an indicator of
dangerousness to the public. San Bernardino is the only court to accept felony
defendants, some facing relatively serious charges. There the prosecutor looks
beyond the actual charges filed and into the facts of the case to determine the
true seriousness of the criminal acts alleged, in addition to factoring in the mental
illness as a cause of the act before making the eligibility decision. Truly violent
criminal defendants are not eligible for program admission. In San Bernardino
there is no limitation on admission based upon the type of misdemeanor charged.

All of the mental health courts accept individuals with extensive criminal histories,
based on the knowledge that few mentally ill or disabled defendants will be
first-time offenders and that many often find themselves in and out of the criminal
justice system for a variety of usually minor offenses. San Bernardino is the only
site that actually requires that the defendant have a criminal history in order to be
admitted to the program. All of the other programs accept both new and repeat
offenders, although the majority of the participants in each of the locations have
had prior contacts with the criminal justice system.

Although each mental health court focuses on defendants who show signs of
mental illness as they enter the process, the clinical eligibility criteria also differ
slightly from court to court. In Broward County, candidates must be diagnosed
with an Axis I mental illness,25 have an organic brain injury or head trauma, or
be developmentally disabled. In King County, misdemeanor candidates must be
found to suffer from a significant mental illness, organic brain impairment, and/or
a developmental disability that is directly or indirectly connected to the crime
charged, and for which the person is in need of treatment and that, unless
treated, greatly increases the probability of future criminal recurrence. The JAS
Program in Anchorage and the STAR court in San Bernardino have the strictest
mental health criteria. In Anchorage, the JAS Program deals with defendants
who have a major mental illness with a history of psychosis. (Eligibility
requirements for CCRP are less stringent, requiring serious mental illness,
developmental disability or organic impairment, but not psychosis.) The San
Bernardino Court requires that participants have been previously diagnosed with
one of the six Axis I illnesses. The defendant must have a documented history of
mental illness to be eligible for treatment through the STAR Program. Both of
these programs are relatively low volume, having access to a small number of
treatment beds, and both focus on confined defendants who are seriously
mentally ill.

Judge-Centered Court Treatment Process 

Each of the mental health courts is built around the main feature of the
problem-solving court strategy pioneered by the Miami Drug Court and carried
over into other substantive areas, such as community courts and domestic
violence courts. Under this approach, the judge sits at the center of the court
treatment process and plays a variety of roles, formal and informal. The judge
represents authority and has responsibility for all actions of both legal- and
treatment-related natures to be taken. The judge presides formally over any legal
matters at the entry and completion stages of the process and may adjudicate
cases of participants who opt out or fail in the program. Perhaps most
importantly, the judge plays a hands-on, therapeutically oriented and directive
role at the center of the treatment process. The judge deals with problems,
encourages progress and responds to poor performance by participants. The
judge deals and interacts with the participant directly, and assigns rewards and
sanctions as may be appropriate, including selective use of jail or changes in
placement options. 

New Working Relationship Between the Court and Mental Health Services

The new, multifaceted role of the judge and other courtroom actors is premised
on the development and implementation of a new working relationship between
the criminal court and mental health treatment and related support services. To
the mental health court, the presence in criminal justice (and particularly in jail) of
large numbers of mentally ill and disabled defendants is evidence that, on their
own, community mental health services have failed to engage citizens in the
treatment process. If they were effective in treating this population, such large
numbers would not be in the criminal justice system. Following the drug court
model, the mental health court redesigns the working relationship between the
court and treatment services, brings the redesigned partnership into the
courtroom and holds it accountable to the judge. The new working relationship
is seen in the special teams of courtroom personnel dedicated to staffing the
mental health courts, including the judge, probation officers, clinical supervisors
or coordinators, case managers, defense attorneys, prosecuting attorneys, jail
liaisons and other service providers dealing with the court participants. The new
relationship is reflected in the pre-court case staffing discussions and the in-court
collective problem-solving that assist the judge in directing appropriate actions in
individual cases. The authority and final decision making responsibility of the
judge holds the treatment process, as well as the participant, accountable and
requires continual communication between members of the mental health court
staff.

Special Courtroom Procedures, New Roles for Courtroom Staff

The special use of the courtroom associated with the early mental health courts is
reminiscent of the drug court conceptualization of the courtroom as part of the
therapeutic environment (a "theatre in the square") (Goldkamp, 1994a, 1994b;,
Goldkamp et al., 2000; Hora et al., 1999). The courtroom environment differs in
style in each of the settings studied, ranging from the full and busy meeting room
with many consultations going on in Broward County, to the quieter and slower
proceedings in King County, to the drug-court style of proceedings in San
Bernardino. Each of the courtrooms shares in common the attempt to present a
supportive environment in which participants have confidence that they can
speak and have their problems addressed. 

A full range of courtroom actors are called upon to participate at various stages
of proceedings to report on progress, interpret evaluations, discuss treatment
plans and help resolve problems. They include a mix of clinical and criminal
justice staff. In addition to the clinical supervisors, case managers, and defense
and prosecution attorneys, there is also a representative of the jail staff who
provides a critical link for the mental health court. 

The tempo of proceedings differs markedly from other courts. The mental health
court judge allows time for participants to speak; in some instances, defendants
may ramble and get confused in addressing the court, sometimes causing
proceedings to progress slowly. The style of the courtroom varies as well in the
size and nature of the audience, often including people at various stages of
treatment and processing who may be experiencing a variety of problems. The
mental health court courtroom is intense, emotional and demanding of all staff, as
problems are identified and solutions are devised.

Range of Treatment and Supportive Services

Each of the courts seeks to link their participants with appropriate treatment
services, some in residential or other supportive housing placements, but most
ultimately in the community. Thus, each mental health court approach has
involved drawing together whatever appropriate services are available to
assemble a network of services that can be responsible to the court. In Broward
County, this includes two mental health providers responsible for covering
different parts of the county with slightly different services available. Participants
there are supervised by facility case-managers as well as the mental health court
monitor. In Seattle, the King County Court partners with a managed care
provider who oversees the county's mental health treatment programs.
Participants are supervised by the probation department. In San Bernardino
services are provided by private, nonprofit providers for augmented board and
care facilities and a day treatment program that draws upon a range of services.
Supervision is provided by jail mental health staff, who also function as case
managers, and by the probation department. In Anchorage, the selected
participants from the jail population are placed in residential settings with
supervision provided by treatment facility case managers, with careful oversight
by the JAS case coordinator. In the Anchorage CCRP, non-jail misdemeanor
defendants are required to arrange adequate treatment services themselves
through public and/or private means and are monitored only by facility case
managers, who provide progress reports upon request to the Municipal
Prosecutor, and the judge through in-court status reviews. The early mental
health courts differ in the kinds of treatment resources they have available to
serve their participants. The courts share common difficulties identifying sufficient
treatment resources, because of limited local treatment capacity, and funding to
support the needed services for the difficult populations they have engaged. 

Multiagency and System Support

The four mental health courts described in this report are at various stages of
development, ranging from the oldest and most established in Broward County
(about two and a half years of operation), to the newest in San Bernardino and
King County, opened in January and February 1999, respectively. Regardless of
stage of development, however, a critical element in each of the strategies is
multiagency and systemwide support in both planning and operation. This is
reflected in the planning task forces producing the recommendations for the
mental health courts and in the collaboration required in the day-to-day
operation of the court and the work of the court team. In Broward, the Public
Defender's office, State Attorney's office, Broward County Sheriff's Office,
community treatment providers, and the local hospital have supported the
development and operation of the mental health court. In King County, the court
operates with the support and cooperation of the Prosecuting Attorney's office,
the Public Defender's office, the Probation Department, the King County Jail,
and United Behavioral Health, which provides case management. In San
Bernardino, participating agencies include the Department of Behavioral Health,
the Public Defender's office, the District Attorney's office, the Probation
Department, and private providers. In Anchorage, the court draws on the
cooperation and support of the Department of Corrections, the Alaska Mental
Health Trust Authority, the Municipal Prosecutor's office, the Public Defender's
office, and treatment providers and is seeking to broaden its base of support and
cooperation.

Differences in the Approaches of the Four Mental Health Courts

Although the four mental health courts we describe share common elements,
they also differ in their adaptation of a problem-solving court model to their
particular systems. These differences include the timing and method of resolving
the underlying criminal charges, the responses to noncompliance by participants,
and the effect of a defense request for a trial.

Stage of Intervention

As the first site to design a special court approach addressing the mentally ill and
disabled in the criminal justice population, the Broward County Mental Health
Court laid the groundwork for the efforts that followed. One of the features of
the Broward court that none of the other sites chose to adopt was its
pre-adjudicatory emphasis. Defendants who choose to enter the Broward
program are not required to answer to their charges until their treatment is
completed. Criminal charges are held in abeyance for a period of up to a year,
while the participant's mental health needs are addressed. At the conclusion of
the treatment period, the defendants' adjudication is often withheld, depending
on the seriousness of the charges and their criminal histories. This approach was
adopted in Broward County based upon a therapeutic rationale that the mental
health court should be as nonthreatening and nonpenal as possible. In addition,
the Broward model seeks to divert the mentally ill person from the formal
adjudication process. Other jurisdictions adopted a conviction-based approach,
partly because of prosecutorial preferences and partly because of constraints of
criminal procedure.

Mental Health Court Versus Normal Trial: Second Chances?

In each of the jurisdictions, a candidate's participation in the mental health court
is based on a voluntary decision. The courts differ in their policies regarding
mentally ill defendants who decline to enter mental health court and choose to
have their charges adjudicated instead of either entering treatment prior to
adjudication or pleading guilty and being placed on probation in the mental health
court. In King County, defendants must waive their rights to a trial in return for
admission to the mental health court treatment process. Defendants who choose
to go to trial and are then found guilty are not accepted back into the mental
health court. None of the other sites has a strict policy against accepting
individuals who have declined the program, chosen adjudication, been convicted
and then requested admission to the mental health court. However, admission is
far from ensured and is decided on a case-by-case basis. The San Bernardino,
Anchorage and Seattle Mental Health Courts operate as sentencing courts, or at
least as courts dealing with persons serving sentences but not as trial courts for
practical and philosophical reasons. (They were seeking to concentrate
resources on mental health treatment.) Thus, they may have little control over
adjudication and sentencing in other courts, should candidates select the normal
adjudication route.

Methods of Case Disposition

The four mental health court sites also differed in their methods of resolving the
criminal charges. Successful participants in the Broward Mental Health Court
may, as a result of withheld adjudication or an outright dismissal of charges with
the consent of the prosecutor, have no conviction on their records. In King
County, there is an increasing likelihood that charges will be resolved through
deferred prosecution or deferred sentence, resulting in a dismissal of the charges
upon successful program completion. In Anchorage, however, the requirement
of a guilty plea (or of a nolo contendere plea) ensures that a conviction generally
results, whether or not the participant is successful. Withheld adjudication or
deferred prosecution dispositions are only rarely employed in this location. In
San Bernardino, where a plea is also required, successful completion may result
in withdrawal of the plea and dismissal of charges. Because many of the mentally
ill or disabled persons who enter the mental health courts may have fairly
extensive records of prior convictions, the question of whether or not a
conviction is recorded for the current offense may be of little practical
significance. Defense counsel, especially in King County, have expressed
discomfort with the policy requiring conviction and suggested that the guilty plea
requirement might serve as a disincentive to some eligible defendants wishing to
enter treatment. 

Use of Sanctions for Participant Noncompliance

The four mental health courts appear to differ as well in the way they respond to
noncompliance by participants in the mental health treatment process. In
designing its approach, each court has recognized the challenges associated with
engaging and maintaining the target populations in the treatment process. Thus,
while each court expects problems with compliance in its client population, they
vary in the way they impose sanctions, a basic element of the drug court model
adapted by each type of problem-solving court. Short of termination from the
program (with the attendant legal consequences), one of the most severe
sanctions is the imposition of jail confinement. The use of jail as a sanction seems
least common in the Broward County Mental Health Court and the Anchorage
Mental Health Court, and somewhat more likely in the King County Court. It is
used most common in the San Bernardino Mental Health Court, which operates
most closely to a drug court model. 

This difference in the use of sanctions generally, and of jail in particular, is not
explained mainly by judicial philosophy-which likely accounts for some
differences-but may be linked instead to differences in the type of candidates
admitted to the courts. For example, in contrast to its peer courts, the San
Bernardino Mental Health Court focuses on felony defendants as well as
misdemeanants and deals with serious substance abuse as a co-occurring
disorder in most of its cases. Differences in target populations notwithstanding,
officials interviewed in the King County and San Bernardino Mental Health
Courts acknowledge that the threat of jail may serve as an important motivator
for candidates considering whether to enter the mental health court and a useful
tool for ensuring compliance among participants.

Emerging Issues

Early Identification of Mental Health Court Candidates

Problem-solving courts of different types share the need to identify their target
population candidates as early in criminal processing as possible. The original
drug court model was premised on the assumption that intervention with
addicted offenders should occur shortly after arrest when individuals may be
most open to the possibility to maximize the opportunity to begin treatment. In
domestic violence courts, there is urgency to correctly assess the risks posed to
victims and implement options for treating or otherwise dealing with the
offenders before further harm can occur. To be effective, mental health courts
share that critical need to identify mentally ill or disabled candidates at the
earliest possible stages of processing to avoid the damaging experience of arrest
and confinement, to intervene medically to stabilize offenders and then to situate
them in an appropriate placement process. 

Like the other types of courts, however, the mental health court model faces
serious challenges in identifying appropriate candidates early through appropriate
and effective screening and evaluation procedures. Collectively, the early mental
health courts employ informal and formal methods for identifying possible
candidates and assessing them in some depth before detouring them from the
normal adjudication process. These methods may include informal referrals at
arrest, arraignment or jail admission of persons appearing to suffer from mental
illness or disabilities. They are followed by more in-depth clinical interviews at
the jail or in court to assess the eligibility of defendants for the mental health
court programs. 

Fair, appropriate and effective screening procedures face three principal
challenges: timeliness, accuracy, and confidentiality. Each of the courts has
established procedures that identify mentally ill or disabled candidates as early as
possible in the criminal process to maximize the opportunity to intervene and
assist. The need to identify and assess the conditions of candidates quickly
potentially conflicts with the need to conduct the thorough clinical assessment
required for a reliable diagnosis on the basis of which processing in the mental
health court can begin. To put it simply, it is hard to rush such an assessment and
still have it be accurate and complete. This may be particularly true because of
the difficulty associated with communicating with some mentally ill defendants. 

Early intervention by the mental health court depends on timely and accurate
information about the defendants' criminal justice and mental health
backgrounds. However, the goal of early intervention and prompt treatment
conflicts in part with the need for confidentiality and for consent by the
defendants to share the mental health information with the court staff. Devising
workable procedures that both enhance early intervention and enrollment of
mentally ill offenders in the mental health courts and respect confidentiality
pertaining to sensitive personal information represents one of the difficult
challenges facing the mental health court approach.

Voluntariness

Some observers see special courts as vehicles for "coerced treatment," a term
with favorable and unfavorable connotations. The favorable use of the term
suggests that the judicial role and application of sanctions and rewards contribute
a valuable tool for keeping participants in treatment and increasing the chances
of successful outcomes (Anglin and Hser, 1990; Anglin, 1988). The unfavorable
reference alludes to the problems associated with forcing treatment upon
individuals who have not voluntarily consented, from a due process perspective
and from the perspective that treatment cannot be effective unless it is wanted
and the offender is "ready."26 In fact, most problem-solving courts are premised
on voluntary participation by candidates, with the exception of some
sentenced-based approaches (in which judges may simply sentence a person to
treatment in court). This is especially true in diversion-based courts. Certainly,
courts requiring guilty pleas from participants for admission must demonstrate
that a plea was made knowingly and voluntary on the record. Even when
appropriate procedures are observed to safeguard voluntariness in special
courts, some critics argue that the choice (between, for example, drug court and
jail) is a coerced choice.

The question of voluntariness is even more difficult for mental health courts.
Although all the same legal issues dealt with in drug courts, domestic violence
courts and community courts exist for persons entering the mental health courts
examined in this report, they must also confront questions about a person's
mental capacity and ability to comprehend the proceedings and the options being
provided. Competency is a threshold issue that must be decided before an
individual can be considered as a mental health court candidate in each of the
courts. However, even among those deemed competent to stand trial, serious
questions may be raised about the ability of persons really to understand the
choices being presented and the consequences of those choices (e.g., going to
trial or participating in the mental health court in one of several possible legal
statuses). 

If a requirement for voluntary participation in the special courts is not only
competency as legally defined, but also an ability to understand and make
reasonable decisions, then achieving voluntariness among mentally ill or disabled
treatment candidates is a challenging proposition indeed. In the mental health
courts, it means that sufficient time must be taken by defense counsel and by the
court itself to make certain that the candidate's decision to enter the mental
health court is in fact voluntary. This means having a grasp, beyond the threshold
question of competency, of a defendant's mental condition. The potential fear is
that defense counsel and/or the court may make decisions in the candidate's best
interest when in fact the candidate, though competent, is thoroughly confused
and afraid.

Conflict Between Criminal Justice and Mental Health Treatment Goals

A challenge in the design of each type of problem-solving court was the need to
craft an approach that resolved conflicts in values and goals inherent in criminal
justice and treatment orientations (Goldkamp, 1999). For example, when
substance abuse treatment professionals might stress tolerance for relapse and
erratic performance (or a positive drug test) by drug abusers as part of the
therapeutic process, criminal courts might normally be inclined to revoke
conditional release (probation) and impose sanctions. While the criminal process
may need to proceed expeditiously to adjudicate criminal charges, mental health
professionals require sufficient time to diagnose the mentally ill defendant's
condition, take immediate steps to stabilize the defendant and then to place the
defendant in appropriate supportive services so that treatment could then
proceed. From the perspective of mental health treatment, potentially the worst
experience for many mentally ill persons would be arrest, jail and formal
proceedings in the criminal court. In short, these conflicts in method, aims, values
and style pose a particular challenge in the emerging mental health court
initiatives to produce a hybrid model that attends to the basic requirements of
each.

Defining Success

Favorable progress in the drug court treatment process is measured by
completion of successive phases of treatment by participants on their way to
graduation. In the drug court instance, requirements for graduation were clearly
specified and typically included minimum periods of testing negatively for drugs
of abuse, completion of all treatment activities, payment of fees, etc. Drug court
participants therefore were able to chart their progress against clear expectations
and rules for completion of the program. When applying this kind of framework
of favorable progress to the mental health court approach, however, setting a
standard for success in treatment is more complex. 

Participants may suffer from a variety of symptoms and illnesses and, thus, lack a
common starting point. The steps necessary to stabilize participants and to
situate them in living situations that will maximize their effective functioning are
likely to differ considerably from individual to individual. While a goal for
substance abusers can clearly and measurably be abstinence within the
timeframe of the drug court treatment program, such a practical framework is
not so readily available in the treatment of mental illness. Courts cannot say, "be
cured within 12 months." They can expect that participants successfully follow
the steps to improved functioning outlined in a treatment plan agreed upon by the
participant and the mental health participants. Thus, the challenge for setting
achievable milestones for mental health court professionals is more complex and
the functional equivalent of graduation may differ considerably from individual to
individual.

Range of Responses to Participant Behavior/Performance

To an observer of other problem-solving courts, particularly drug courts where
some of the in-court techniques were first developed, the mental health court
model faces special challenges in devising responses to participant performance
in treatment. One might argue that the experience of drug courts in the United
States suggests that drug abusers respond well to a very structured system of
incentives and sanctions when moving through the treatment process toward
sobriety and improved functionality. These approaches are crafted based on
assumptions about the behaviors of addicted persons, including a belief that very
basic lessons and behaviors may have to be taught and retaught for substance
abuse treatment to be successful. Many drug courts have devised a rich range of
responses rewarding participants for forward progress through treatment stages
(until graduation). When these elements of the drug court model are applied to
the mentally ill and disabled in the criminal justice system, the translation of the
"rewards and sanctions" approach to mental health courts raises some difficult
challenges.  

To promote progress through treatment, the drug court model rewards good
behavior and discourages poor performance by participants through the use of
various types of sanctions. It is apparent that, because of the nature of mental
illness (as compared to substance abuse or domestic violence), judicial
responses have to be more generally encouraging and supportive as the court
process seeks to move mentally ill and disabled participants into treatment and
supportive services. Thus, depending on a defendant's illness, the judge's
repertoire may need to draw on a wider range of incentives and supportive
responses to participant progress than other problem-solving courts. 

The notion that mental health courts should also call upon sanctions for poor
performance is more difficult. In some cases, it may be clinically appropriate to
employ the kinds of sanctions employed by drug courts in responding to
noncompliance in treatment, including returning participants to earlier and more
restrictive treatment stages or, even, making use of jail in selective instances. In
others types of cases, however, it may be questionable as to whether sanctions
(based on assumptions of deterrence) are at all appropriate to produce the
improved mental health outcomes desired. Real questions, therefore, are raised
about how the coercive power of the courts can be channeled to promote the
goals of mental health treatment. Can a court sanction a defendant who fails to
take medication? Does a court sanction a defendant who has difficulty
functioning and understands little of the current circumstances or expectations
due to mental illness? 

Community Linkage and Resources

A critical element of the emerging mental health court model involves
identification of the necessary treatment and related services in the community,
and the development of an effective working arrangement between the courts
and the service providers that helps place participants in appropriate services
and moves them out of jail. Moreover, the model is premised on a working
relationship as represented by the dedicated team approach that facilitates
ongoing supervision and case management. Courts considering a mental health
court approach face two important problems. 

First, if it is true that the court system finds itself having to address the needs of
the mentally ill population, it is at least partly because existing institutions and
services in the community (at least outside of criminal justice) have failed to serve
this population. There is some irony, then, in designing a program that uses the
court to place mentally ill and disabled participants in those very systems.
Secondly, if the rationale for making use of these existing services is that the
mental health court creates a new, synergistic relationship that improves both the
court and treatment approaches, then the actual availability of these services and
the resources to support them becomes a critical concern. A mental health court
approach with a large population of persons in need of treatment but few
services available in the area may have great difficulty in delivering treatment.
Moreover, even when services are available and enthusiastic about the
court-based mental health treatment approach, effective identification of
candidates in the criminal justice population risks placing a new and large
demand on existing treatment resources.

Each of the mental health courts described in this report has identified a
potentially large population of mentally ill and disabled defendants who are in
need of mental health and treatment-related supportive services. Each has also
found that treatment resources and funding are insufficient for the populations
they are serving and plan to serve in the near future. When resources exist, they
do not adequately provide the type or range of services the mentally ill and
disabled persons in the criminal justice population require.  

Mental Health Courts as a Community Justice Initiative

The mental health court strategy shares with prior problem-solving court
undertakings the fact that a difficult problem has not been adequately dealt with
through community institutions and services. Presumptively, effective community
interventions could prevent the need to find and treat mentally ill citizens in the
criminal justice system. The crime behaviors of the mentally ill range from
nuisance and quality-of-life levels to more serious offenses that endanger
themselves or others. Although there are a range of behaviors associated with
the mentally ill and disabled, it is highly unlikely that they have gone unnoticed in
the community until their encounters with the criminal justice system. 

Because other community networks or institutions have not effectively treated
and supported the mentally ill-due to the failure of community-based safety
nets-they enter the justice system, usually involved in minor, nuisance, and
quality-of-life offenses. Often, by then, they have other serious problems-such as
alcohol or other drug addiction, housing, employment and physical health
problems-that also have not been addressed. In many instances, the mentally ill
or disabled find themselves in criminal justice primarily because of their mental
illness and their inability to connect with or stay in supportive community-based
treatment services.

Like the other special court approaches, the mental health courts described in
this report attempt to address the problems of their target populations on two
levels: 

o By dealing with their problems in the criminal justice system. 

o By building linkages to community services and support structures that have
for a variety of reasons failed to reach them prior to their criminal justice
involvement. 

Each of the mental health courts discussed has developed strategies for
identifying mentally ill and disabled offenders at the earliest stages of processing,
sometimes involving contacts from police officers at the arrest stage. Each
jurisdiction has taken steps to implement early screening procedures to evaluate
candidates for the court treatment process as soon as possible so that
unnecessary delay, criminal justice processing, and jail confinement can be
avoided. Each of the courts began with a primary focus on defendants entering
the criminal process shortly after arrest and being held in jail. But they expanded
to accept referrals from other courts, and other sources, such as attorneys,
police, friends, relatives or other community contacts aware of individuals caught
up in the justice system who were mentally ill or disabled. Each of the courts
established a close link to the local jail, so that mentally ill inmates could be
identified and admitted to the mental health court treatment process, at whatever
stage of processing in the criminal justice system. In short, consolidating justice
procedures to identify and enroll candidates in treatment has been an aim of
these first pioneering mental health courts.

In each case, the in-house approach is closely tied to a focus on community
treatment resources and linkages. Depending on the kinds of illnesses evidenced
and the types of resources available in their locales, each of the early mental
health courts takes steps to place participants in community-based treatment
services, either immediately or after initial crises are addressed and individuals
are stabilized. Each court emphasizes the importance of proper and timely
diagnosis and of placement in proper treatment and supportive care services,
where they exist. Each court builds the treatment process around court
supervision as a critical, core element ensuring both that enrolling participants
cooperate and that appropriate services are indeed provided. At the core of the
mental health court approach is a newly established working relationship
between the supervising court and community mental health treatment and
related services.

Mental health courts, in this regard, represent important court-based community
justice initiatives. They are strengthening the effectiveness of community mental
health treatment approaches by offering their close attention and supervision.
They are returning mentally ill persons from custody and processing in the
criminal justice system to the community to function there. They are encouraging
community-based justice and health approaches that would prevent mentally ill
and disabled individuals from entering the justice system in the first place. Thus,
successful court strategies would ideally put themselves out of business: they
would find far fewer mentally ill persons in criminal justice, because such persons
would be more effectively and appropriately dealt with through improved
community intervention, services and support mechanisms.

----------------------------

References

----------------------------

Abram, Karen, and Linda Teplin. "Co-Occurring Disorders Among Mentally Ill
Jail Detainees: Implications for Public Policy." American Psychologist. 46
(1991): 1036-45.

American Bar Association. Criminal Justice Mental Health Standards. (1986). 

Anglin, M. Douglas. "The Efficacy of Civil Commitment in Treating Narcotics
Addiction." The Journal of Drug Issues. 18/4 (1988): 527-45. 

Anglin, M. Douglas, and Yih-Ing Hser. "Treatment of Drug Abuse." In Drugs
and Crime, Michael Tonry and James Q. Wilson, Eds. 393-460. Vol. 13.
Chicago: University of Chicago Press, 1990. 

Beeley, Arthur. The Bail System in Chicago. Chicago: University of Chicago
Press, 1927 Reprint, Chicago: University of Chicago Press, 1966.

Care Systems North. Mental Health Needs Assessment for Offenders in
Custody and Under Supervision of the Alaska Department of Corrections.
Juneau, Alaska: Care Systems North, 1997.

Ditton, Paula M. "Mental Health and Treatment of Inmates and Probationers."
Bureau of Justice Statistics Special Report. Washington, DC: U.S. Government
Printing Office, 1999.

Fosdick, Raymond, R. Smith, H. Ehrmann, A. Bettman, H. Burns, B. Lewis, H.
Adler, A. Kales, M. Wisehart, F. Frankfurter, and R. Pound. Criminal Justice in
Cleveland. Cleveland, Ohio: The Cleveland Foundation, 1922.

Goldkamp, John S. "Miami's Treatment Drug Court for Felony Defendants:
Some Implications of Assessment Findings." The Prison Journal. 73/2 (1994a):
110-66. 

Goldkamp, John S. Justice and Treatment Innovation: The Drug Court
Movement: A Working Paper of the First National Drug Court Conference.
Washington, DC: U.S. Department of Justice, Office of Justice Programs,
National Institute of Justice, 1994b.

Goldkamp, John S. "The Origin of the Treatment Court in Miami." In The Early
Drug Courts: Case Studies in Judicial Innovation. C. Terry. Beverly, Ed. Hills,
California: Sage Publications, 1999a.

Goldkamp, John S. "When Is a Drug Court Not a Drug Court?" In The Early
Drug Courts: Case Studies in Judicial Innovation. C. Terry. Beverly, Ed. Hills,
California: Sage Publications, 1999b.

Goldkamp, John S., Michael White, and Jennifer Robinson. Using Participant
Focus Groups to Inform the Research Agenda for Drug Courts: Lessons from
Drug Court Participants in Las Vegas, Portland, and Miami. Philadelphia: Crime
and Justice Research Institute, 1999.

Goldkamp, John S., Doris Weiland, Mark Collins, and James Moore. The
Implementation of the Philadelphia Treatment Court: A Descriptive Analysis of
Early Stages of Implementation. Philadelphia: Crime and Justice Research
Institute, 1999.

Goldkamp, John S., Michael White, and Jennifer Robinson. Retrospective
Evaluation of Two Pioneering Drug Courts: Phase I Findings from Clark County,
Nevada, and Multnomah County, Oregon. Philadelphia: Crime and Justice
Research Institute, 2000.

Harris, Victoria, and T. Koepsell. "Rearrest Among Mentally Ill Offenders."
Journal of American Academic Psychiatry Law. 26 (1998): 393-402. 

Henderson, D. "Gender Appropriate Mental Health Services for Incarcerated
Women: Issues and Challenges." Family Community Health. 21/3 (1998):
42-53.

Hochstedler Steury, E. "Criminology: Specifying "Criminalization" of the
Mentally Disordered Misdemeanant." Journal of Criminal Law & Criminology.
82 (1991): 334. 

Hora, Peggy F., William G. Schma, and John T. A. Rosenthal. "Therapeutic
Jurisprudence and the Drug Court Movement: Revolutionizing the Criminal
Justice System's Response to Drug Abuse and Crime in American." Notre
Dame Law Review. 74/2 (1999): 439-537. 

Matthews, Arthur R. Mental Disability and the Criminal Justice System.
Chicago: American Bar Foundation, 1970.

Mattick, Hans. "The Contemporary Jails of the United States." In Handbook of
Criminology. Daniel Glaser, Ed. Chicago: Rand McNally, 1975.

McFarland, B., L. Falkner, J. Bloom, R. Hallaux, and J. Bray. "Chronic Mental
Illness and the Criminal Justice System." Hospital and Community Psychiatry.
40/7 (1989):718-723. 

Mossman, Douglas. "The Psychiatrist and Execution Competency: Fording
Murky Ethical Waters." Case Western Reserve Law Review. 43/1 (1992):
19-21.

National Advisory Commission on Criminal Justice Standards and Goals,
"Corrections." Washington, DC: U.S. Government Printing Office, 1973.

National Commission on Law Observance and Enforcement. Report on Causes
of Crime. Vol. 1. George Wickersham, Chairman. Washington, DC: U.S.
Government Printing Office, 1931.

Smith, Juliette. "Arresting the Homeless for Sleeping in Public: A Paradigm for
Expanding the Robinson Doctrine." Columbia Journal of Law and Social
Problems. 29 (1996): 293. 

Snow, David, S. Baker, and L. Anderson. "Criminality and Homeless Men: An
Empirical Assessment." Social Problems. 36 (1989): 532-49. 

Solomon, P. Draine, J. Marcenko, and A. Meyerson, "Homelessness in a
Mentally Ill Urban Population." Hospital and Community Psychiatry. 43/2
(1992):169-71.

Steadman, Henry J., Treatment Services for Mentally Ill Detainees Diversion
and in the King County Correctional Facility. Policy Research Associates, Inc,
for the State of Washington, Department of Corrections, (1991).

Steadman, Henry J., and Bonita M. Veysey. Providing Services for Jail Inmates
With Mental Disorders. Washington, DC: National Institute of Justice, 1997.

Teplin, Linda A. "The Prevalence of Severe Mental Disorder Among Male
Urban Jail Detainees: Comparison with the Epidemiologic Catchment Area
Program." American Journal of Public Health. 80 (1990): 663-9. 

Wexler, David, and Bruce Winick. "Therapeutic Jurisprudence as a New
Approach to Mental Health Law Policy Analysis and Research." University of
Miami Law Review. 45 (1996):979. 

Whitmer, Gary E. "From Hospitals to Jails: The Fate of California's
Deinstitutionalized Mentally Ill." American Journal of Orthopsychiatry. 50
(1979): 65-75. 

Wolff, N. "Interactions between Mental Health and Law Enforcement Systems:
Problems and Prospects for Cooperation." Journal of Health, Politics, Policy
and Law. 23 (1998): 133-74. 

Winnick, Bruce. "Reforming Incompetency To Stand Trial And Plead Guilty."
Journal of Criminal Law & Criminology. 85 (1995): 571.

----------------------------

Footnotes

----------------------------

1See, e.g., Ford v. Wainwright, 447 US 399 (1986) in which the U.S. Supreme
Court held that the eighth amendment prohibited the state from inflicting the
death penalty upon an insane prisoner; see also Mossman (1992).

2In 1998, law enforcement agencies nationwide made 14.5 million arrests for all
criminal infractions excluding traffic violations. UCR (1998) at p. 209.

3Sourcebook of Criminal Justice Statistics, U.S. Department of Justice, Bureau
of Justice Statistics, Washington, DC: USGPO, (1998), pp. 388, 431, 435.

4According to Ditton (1999), a majority of mentally ill inmates suffer from
co-occurring substance abuse problems.

5See Wexler and Winck (1996) for a discussion of therapeutic jurisprudence
and its application to the mentally ill in the justice system. See Hora et al. (1999)
for a discussion of drug courts from the perspective of therapeutic jurisprudence.

6For discussion of the evolution and impact of drug courts, see Goldkamp
(2000; 1999; 1994) and Hora et al. (1999).

7"The importance from the police viewpoint of a clear and expeditious
emergency detention procedure can scarcely be exaggerated. Emergency
detention offers the policeman a quick and simple method of dealing with
apparently disturbed persons who are unwilling or unable to go voluntarily to a
hospital or some other place where care may be had. If the police do not have
clear-cut authority to make an emergency detention on the grounds of apparent
mental illness, or if the emergency detention procedure is cumbersome, as it was
under the Illinois Code, the police fall back on the criminal arrest for disorderly
conduct..." (Mathews, 1970: 173-174).

8Mental Health Court Investigation. Grand Jury Report, 17th Judicial District.
Broward County, Florida. November 9, 1994.

9An important assumption of the Broward approach is that there are many
mentally ill defendants who are recycled through the justice system in need of
treatment who are not violent or dangerous. Untreated they represent a great
likelihood of posing criminal and other behavioral problems in the future.

10Axis I is primary mental heath diagnosis that is usually first diagnosed in
childhood, including schizophrenia, mood or anxiety disorders, certain impulse
control disorders, and major depression. American Psychiatric Association.
Diagnostic and Statistical Manual of Mental Disorders. Fourth Edition.
Washington, DC: American Psychiatric Association, 1994.

11Florida Statutes, Title XLVII, Criminal Procedure and Corrections, Chapter
916.17.

12The speedy trial "clock" does not begin to run until a demand for formal
discovery is made. Prior to this, the defendant's attorney is provided only
minimal informal discovery, in the form of police reports. Defendants who prefer
to challenge and litigate the charges may do so before the Mental Health Court
judge without losing the opportunity to be placed in mental health treatment. The
judge will hear the case and will still place them in treatment if they are convicted
but still need help.

13This information can be attributed to the District Court financial officer, Office
of the Administrator for the State of Washington, Caseloads at the Courts of
Washington (1999).

14The competence assessment is made informally on a preliminary basis,
pending a more in- depth evaluation to be done if so ordered by the court. The
jail has been given guidance on the legal definition of incompetence by the
prosecutor's office.

15For a more thorough explanation of this stature, see Washington State Rules
of Criminal Procedure, Title 10 RCW: Criminal Procedure, Section 10.77.090.
It provides, in relevant part, that: (1)(a) If at any time during the pendency of an
action and prior to judgement the court finds a defendant is incompetent, the
court shall order for the proceedings against the defendant be stayed. (d)(1) If
the defendant is:(A) Charged with a non-felony crime and has: (I) A history of
one or more violent acts, or a pending charge of one or more violent acts; or (II)
been previously acquitted by reason of insanity or been previously found
incompetent under this chapter with regard to an alleged offense involving actual,
threatened, or attempted physical harm to a person; and (B) Found by the court
to be not competent; then (C) the court shall order the secretary to place the
defendant: (I) At a secure mental health facility in the custody of the department
or an agency designated by the department for mental health treatment and
restoration of competency. The placement shall not exceed 14 days in addition
to any unused time of the evaluation under RCW 10.77.060 (which provides for
a period of time not to exceed 15 days for the purposes of a court ordered
competency examination).(ii) At the end of the mental health treatment and
restoration period...the defendant shall be returned to court for a hearing.
If...competency has been restored, the stay entered...shall be lifted. If
competency has not been restored, the proceedings shall be dismissed...(B) If
the defendant was in custody...at the time of dismissal, the defendant shall be
detained and sent to an evaluation and treatment facility for up to seventy-two
hours for evaluation for purposes of filing a petition under chapter 71.05 RCW
(which relates to the civil commitment of the mentally ill)...(e) If the defendant is
charged with a crime that is not a felony and the defendant does not meet the
criteria under (d) of this subsection, the court may stay or dismiss proceedings
and detain the defendant for sufficient time to allow the county designated mental
health professional to evaluate the defendant and consider initial detention
proceedings under chapter 71.05 RCW.

16This statute went into effect in March 1999, based upon the recommendations
made by the Mentally Ill Offender Task Force and in response to the incident
that resulted in the murder of Captain Stevenson by a mentally ill misdemeanant
who was released after a finding of incompetency.

17This may be based on the assessment and advice of counsel or despite it.
Some defendants may simply decide that the penalty, such as time served, will
be minimal and that they would rather be at liberty without the constraints
associated with the treatment plan.

18Deferred prosecutions can be used for misdemeanor charges, but there was
some confusion about whether a defendant would be limited to only one such
disposition in a lifetime. The public defenders would be reluctant to make use of
the deferred prosecution option for a mental health court charge. If they believed
that the defendant was likely to be arrested in the future for a DUI charge, they
did not want to take such an opportunity on a less serious offense.

19See Alaska Statutes, Code of Criminal Procedure, Section 12.47.100.

20See Alaska Statutes, Code of Criminal Procedure, Section 12.47.110.

21Status Reports To The Trust Authority, Alaska Department of Corrections,
February 2000. 

22See footnote 10. 

23See the California Codes, Penal Code Sections 1367-1375.5.

24For an expanded definition of Axis I, please see footnote 10.

25For an expanded definition of Axis I, please see footnote 10.

26It is a conventional wisdom in the substance abuse treatment literature that
treatment that is imposed without consent is "as effective" as treatment for which
a person voluntarily chooses to enter (Anglin 1988; Belenko 1998).

----------------------------

Sources for Further Information

----------------------------

For more information on Bureau of Justice Assistance programs, contact:

Bureau of Justice Assistance
810 Seventh Street NW.
Washington, DC 20531
202-514-6278
World Wide Web: www.ojp.usdoj.gov/BJA

Bureau of Justice Assistance Clearinghouse
P.O. Box 6000
Rockville, MD 20849-6000

1-800-688-4252
World Wide Web: www.ncjrs.org

U.S. Department of Justice Response Center
1-800-421-6770 or 202-307-1480

Bureau of Justice Assistance Information

General Information

Callers may contact the U.S. Department of Justice Response Center for general
information or specific needs, such as assistance in submitting grants applications
and information on training. To contact the Response Center, call
1-800-421-6770 or write to 1100 Vermont Avenue NW., Washington, DC
20005.

Indepth Information

For more indepth information about BJA, its programs, and its funding
opportunities, requesters can call the BJA Clearinghouse. The BJA
Clearinghouse, a component of the National Criminal Justice Reference Service
(NCJRS), shares BJA program information with state and local agencies and
community groups across the country. Information specialists are available to
provide reference and referral services, publication distribution, participation and
support for conferences, and other networking and outreach activities. The
Clearinghouse can be reached by:

Mail
P.O. Box 6000
Rockville, MD 20849-6000

Visit 
2277 Research Boulevard
Rockville, MD 20850

Telephone
1-800-688-4252
Monday through Friday 8:30 a.m. to 7 p.m.eastern time

Fax
301-519-5212

Fax on Demand

1-800-688-4252

BJA Home Page
www.ojp.usdoj.gov/BJA

NCJRS World Wide Web
www.ncjrs.org

E-mail
askncjrs@ncjrs.org

JUSTINFO Newsletter
E-mail to listproc@ncjrs.org
Leave the subject line blank
In the body of the message, type: 
subscribe justinfo [your name]