Municipal Courts: 

An Effective Tool for Diverting 

People with Mental and 

Substance Use Disorders from 

the Criminal Justice System

Municipal Courts: An Effective Tool for Diverting 

People with Mental and Substance Use Disorders 

from the Criminal Justice System

U.S. Department of Health and Human Services

Substance Abuse and Mental Health Services Administration
ACKNOWLEDGMENTS

This report was prepared for the Substance Abuse and Mental Health Services Administration (SAMHSA) by 

Policy Research Associates, Inc. under SAMHSA IDIQ Prime Contract #HHSS283200700036I, Task Order 

#HHSS28342003T with SAMHSA, U.S. Department of Health and Human Services (HHS). David Morrissette, 

Ph.D., served as the Contracting Officer's Representative.

DISCLAIMER

The views, opinions, and content of this publication are those of the author and do not necessarily reflect the 

views, opinions, or policies of SAMHSA or HHS. The listing of non-federal resources is not all-inclusive, and 

inclusion on the listing does not constitute endorsement by SAMHSA or HHS.

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RECOMMENDED CITATION

Substance Abuse and Mental Health Services Administration. Municipal Courts: An Effective Tool for Diverting 

People with Mental and Substance Use Disorders from the Criminal Justice System. HHS Publication No. 

(SMA)-15-4929. Rockville, MD: Substance Abuse and Mental Health Services Administration, 2015.

ORIGINATING OFFICES

Office of Policy, Planning, and Innovation, Substance Abuse and Mental Health Services Administration, 1 Choke 

Cherry Road, Rockville, MD 20857. HHS Publication No. (SMA)-15-4929.

Printed in 2015
1

Introduction

The Sequential Intercept Model (SIM) is a tool that 

enables communities to create coherent strategies to 

divert people with mental and substance use disorders 

from the criminal justice system. The mapping process 

associated with SIM (see Figure 1) focuses on five 

discrete points of potential intervention, or “intercepts” 

(Munetz & Griffin, 2006): 

 Intercept 1: Law enforcement;

 Intercept 2: Initial detention/first court 

appearance; 

 Intercept 3: Jails/courts;

 Intercept 4: Reentry from detention into the 

community; and 

 Intercept 5: Community corrections, probation, 

and parole.

Much has been written about 

four of these intercepts. 

For example, the Crisis 

Intervention Team model has 

been disseminated broadly 

as a strategy to improve law 

enforcement interventions at Intercept 1. Mental health 

courts, drug courts, and other treatment courts have 

become an increasingly common part of the judicial 

landscape and define much of the conversation at 

Intercept 3. Reentry from jail or prison, Intercept 

4, has become a core topic in general discussions 

regarding correctional policies at the federal, state, 

and local levels. SAMHSA's SSI/SSDI Outreach, 

Access and Recovery) (Dennis & Abreu, 2010) ease 

reentry on release from jail or prison. And while many 

communities lack much in the way of resources at 

Intercept 5, a literature has emerged that discusses 

specialized probation as a strategy to ensure longer 

community tenure (Skeem & Manchak, 2008). 

While each intercept presents opportunities for 

diversion, Intercept 2 may hold the most unexplored 

potential. This is because it is at Intercept 2 (initial 

detention and first court appearance) that the vast 

majority of individuals who come into contact with 

the criminal justice system appear. Many of these 

individuals have a mental illness and co-occurring 

substance use disorders; these are the individuals 

whom communities often try to divert. However, for 

a variety of reasons discussed below, this intercept 

is often overlooked. The purpose of this document is 

to turn community attention to the possibilities that 

Intercept 2, especially when the first appearance is at 

a municipal court, presents 

for diversion. The optimal 

diversion strategies that are 

most often overlooked and 

involve municipal courts are at 

first appearance (Intercept 2).

Municipal Courts: Definition and 

Caseloads

Most people who are arrested appear before a 

“municipal court” or its equivalent. Municipal courts 

are courts of limited jurisdiction. The National 

Center for State Courts defines a “court of limited 

jurisdiction” as a court with “legal authority over 

very specific subject matter, cases, or persons 

for the imposition of limited jail times or limited 

financial sanctions” in contrast to courts of “general 

jurisdiction,” which may hear any type of case 

... the optimal diversion strategies 

that are most often overlooked and 

involve municipal courts are at first 

appearance (Intercept 2).

Figure 1. The Sequential Intercept Model

SSI/SSDI Outreach, Access and Recovery (SOAR) is supported by SAMHSA to 

expedite access to Social Security disability benefits – Supplemental Security 

Income (SSI) and Social Security Disability Insurance (SSDI) – for eligible 

adults who are homeless and who have serious mental illnesses and/or cooccurring disorders.
2

(Cornell, 2012). There are many types of limited 

jurisdiction courts, including courts addressing minor 

criminal charges, courts that impose limited fines for 

different violations of municipal codes, and courts 

such as mental health and drug courts that focus their 

docket on a particular type of case or defendant.

It is estimated that there are 14,000–16,000 courts 

of limited jurisdiction in the United States, and 

that in 2009 such courts handled approximately 70 

million (or 66 percent) of the 106 million cases that 

were handled by state trial courts (Cornell, 2012). 

At the same time, according to the Bureau of Justice 

Statistics at the United States Department of Justice, 

the number of limited jurisdiction courts declined from 

1980 to 2011, in part because of the consolidation of 

different types of courts. In 2011, California, Illinois, 

Iowa, Minnesota, and the District of Columbia had no 

limited jurisdiction courts (Malega & Cohen, 2013). 

Sixty-one percent of all judges continue to sit in courts 

of limited jurisdiction. 

The National Center for State Courts defines a 

municipal court as a “stand-alone trial court of limited 

jurisdiction that may or may not provide jury trials and 

that is funded largely by a local unit of government 

... the principal and most common 'case' types of 

these courts include traffic and ordinance violations, 

small claims cases, domestic cases, misdemeanor 

offenses, and other preliminary proceedings in felony 

cases” (National Center for State Courts, n.d.). For 

the purposes of this paper, “municipal courts” refer to 

courts of limited jurisdiction that hear low-level cases 

regardless of how these courts are named in different 

states (e.g., county court, district court, municipal 

court, magistrates court, justice of the peace court). 

Available data suggest that many states have very large 

numbers of municipal courts and that those courts in 

the aggregate handle an enormous volume of cases. 

For example, data from the Bureau of Justice Statistics 

show 315 municipal judges in Alabama (versus 144 

Circuit judges who are general jurisdiction judges); 

266 municipal judges in Mississippi (versus 53 general 

jurisdiction Circuit judges); and 1,531 municipal 

judges in Texas (versus 456 general jurisdiction district 

judges) (Malega & Cohen, 2013, Appendix 2). 

As to caseload, the Court Statistics Project of the 

National Center for State Courts provides data by type 

of court (Court Statistics Project, n.d.). In 2010, the 

Project showed that municipal courts in Arizona had 

1,463,389 incoming cases, while city and parish courts 

in Louisiana had 1,050,562 incoming cases. New 

Jersey’s municipal courts had more than 6 million 

cases (versus 1.4 million in its general jurisdiction 

superior courts). However, not all municipal courts 

have large caseloads. This stands to reason, given the 

vastly different populations of U.S. municipalities. 

For example, the City of Boston’s municipal court 

handled more than 35,000 criminal cases in 2010 

(Massachusetts Judicial Branch, n.d.). In contrast, in 

the State of Missouri, there were 847,000 case filings 

in that state’s municipal courts in 2003, but nearly 

one-half of those responding to a survey on judicial 

independence among municipal judges worked in 

courts that had fewer than 1,000 filings in the same 

year (Myers, 2004).

This varied case distribution is similar to the 

distribution of jail populations. The American Jail 

Association (AJA) divides jails in the United States 

into four categories: “mega jails” (1,000-plus beds), 

large jails (250–999 beds), medium jails (50–249 

beds), and small jails (1–49 beds). According to the 

AJA, small jails make up the largest percentage of 

local correctional facilities (American Jail Association, 

n.d.). This is important because in thinking about 

municipal courts (or jails) in the context of diversion, 

it is essential to take into account caseload (or number 

of beds) as a potentially important variable. 

A handful of states, such as Florida, do not have 

municipal courts but have “county courts” that handle 

case types similar to those handled by municipal courts 

(for example, traffic offenses, misdemeanor criminal 

offenses, and small monetary disputes). Delaware is 

one of several states that have “justice of the peace 

courts” with jurisdiction over landlord-tenant matters 

as well as minor criminal offenses. Pennsylvania 

refers to the lowest level of its court system as “minor 

courts,” which include municipal courts in cities 

such as Pittsburgh and Philadelphia. Such courts 

are relevant to this discussion because of their large 

caseloads and because they handle cases like those 

within the jurisdiction of a municipal court.
3

Municipal Courts as a Venue for 

Diversion of People with Mental and 

Substance Use Disorders

Municipal courts make a good potential vehicle 

for diverting people with mental and substance use 

disorders for several reasons, including volume of 

cases; high prevalence of mental and substance use 

disorders among those appearing before municipal 

courts; the risk of increased jail time for arrestees with 

mental illness, most with co-occurring substance use 

disorders; and perceptions of community risk based on 

offense type.

Volume

Municipal courts handle 

thousands of cases each year. 

In Boston alone, the municipal 

court handled approximately 

35,000 criminal cases in 2010 (Massachusetts Judicial 

Branch, n.d.). While the sheer number of cases may 

present a significant challenge to using a municipal 

court for diversion, the quantity suggests that to ignore 

such courts in discussing diversion is to ignore the 

majority of the justice-involved population.

Prevalence of Mental and Substance Use 

Disorders

In a recent report by the Center for Behavioral Health 

Statistics and Quality at SAMHSA, data from the 

2008 and 2009 National Survey on Drug Use and 

Health were analyzed to examine the prevalence of 

mental illness and substance use among respondents 

who reported being arrested in the prior 12 months 

(Glasheen, Hedden, Kroutil, Pemberton, & Goldstrom, 

2012). For people without a substance use disorder 

or mental illness, the past-year rate of arrest was 1.2 

percent. For people with only mental illness, the arrest 

rate was 4.1 percent. At the high end were people with 

a mental illness and a substance use disorder, at 16.1 

percent arrested in the past year.

In addition, the rates of mental and substance use 

disorders are higher among jail inmates. A study of 

four jails determined that 14.5 percent of men and 31.0 

percent of women incarcerated in jail had a serious 

mental illness (Steadman, Osher, Robbins, Case, & 

Samuels, 2009). Sixty-eight percent of jail inmates 

have a substance use disorder (Karberg & James, 

2005).

Given the number of cases handled by municipal 

courts, it is reasonable to conclude that many of these 

individuals present to municipal court, creating a large 

pool of individuals who are frequently the targets of 

diversion efforts.

Risk of Increased Jail Time for People with 

Mental and Substance Use Disorders Who Are 

Arrested

Individuals with mental illnesses and co-occurring 

substance use disorders often stay in jail longer than 

individuals who were arrested for similar offenses 

but who do not have a mental 

illness or substance use 

disorder. People with mental 

or substance use disorders are 

less likely to make bail and 

are more likely to experience 

significant delays in case processing (Council of 

State Governments Justice Center, 2012). In addition, 

homelessness, unemployment, and a lack of family 

stability are common among individuals with mental 

illnesses and co-occurring substance use disorders. 

These factors have been implicated as risk factors 

for re-arrest, and in some cases a court may decide to 

incarcerate the individual briefly rather than return him 

or her immediately to the street. Diversion may be a 

more tenable strategy for such individuals. 

Offense Type and Community Perception of Risk

Many people with mental illness and co-occurring 

substance use disorders who come into contact with 

the criminal justice system have been arrested for 

minor offenses such as trespassing, public intoxication, 

and other “nuisance” offenses (Fisher, et al., 2006). 

Often these individuals are arrested multiple times, 

with the risk for arrest exacerbated by factors such 

as substance use, homelessness, and unemployment. 

Early mental health courts often limited their caseloads 

to individuals charged with misdemeanors or felonies 

not involving physical harm to others, in part as a 

concession to concerns regarding community safety 

(Almquist & Dodd, 2009).

The fact that municipal courts handle less serious 

charges can make them an attractive venue for staging 

diversion efforts. While the comparative seriousness of 

a criminal charge is not a strong proxy for individual 

Municipal courts make a good 

potential vehicle for diverting people 

with mental and substance use 

disorders
4

dangerousness, perceived risk by the community may 

be low, and many communities welcome efforts to 

address the needs of individuals whose behaviors, 

while not necessarily dangerous, may be thought to 

detract from the quality of community life. 

Challenges to the Use of Municipal 

Courts for Diversion

Several issues may pose challenges to the use of 

municipal courts as points of diversion. They include 

the volume of cases, the lack of leverage over the 

individual, the brief amount of time available to 

address what may be complex individual needs, and 

issues arising from the very nature of municipal courts. 

Case Volume

As noted above, the fact that municipal courts are the 

primary venue for handling legal matters in the United 

States makes them an attractive site for diversion. 

Case volume can be a detriment; if a court's caseload 

is heavy, it may be difficult to consider an intervention 

that requires spending more time on individual cases. 

However, not all courts have unmanageable caseloads. 

As the example of Missouri, noted above, illustrates, 

municipal courts fall into various tiers when it comes 

to size of caseloads, and there are courts where the 

caseload permits consideration of a special docket.

Time Constraints and Lack of Leverage

More pressing and common issues may be the lack of 

leverage over the individual created in part by the less 

serious nature of charges handled by municipal courts 

and the limited amount of time the individual is under 

the court’s jurisdiction. 

Treatment courts rely on various forms of leverage, 

such as status hearings, the threat or use of jail, 

and other sanctions, as tools to induce adherence to 

treatment and other conditions. In addition, avoiding 

lengthy jail time in exchange for participating in a 

treatment court may be an incentive for the individual 

to choose to participate. However, many of these 

forms of leverage and incentives may not exist in a 

municipal court setting where the individual is charged 

with a minor offense, faces brief jail time at most, 

and may not be under the court’s jurisdiction for an 

appreciable time period unless he or she chooses to 

enter a treatment court. As a result, many individuals, 

if adequately informed about their options, may simply 

choose the less intrusive resolution of a plea. However, 

interventions that rely upon a proportional response 

(i.e., the treatment requirement is no longer than the 

maximum possible incarcerative sentence) have been 

implemented with success in many jurisdictions. 

The three programs described in detail below offer 

examples of how limited interventions can be effective 

in reducing recidivism and engaging people in 

behavioral health services. Some programs operate 

without any leverage, as the person's placement into 

the program results in a dismissal of the criminal 

charges, while pre-trial supervised release and 

misdemeanor treatment courts may not adjudicate the 

charges until the person has completed the program.

The Nature of Municipal Courts

Municipal courts were created in part to permit 

“local” resolution of various types of legal disputes. 

In many jurisdictions, those presiding over the courts 

did not have to be lawyers, and the process was 

often informal. Over time, there have been efforts 

to increase the professionalism of municipal courts. 

However, there is evidence that municipal courts may 

not easily fit within a jurisdiction’s overall judicial 

system.

For example, in Missouri, a study noted above 

concluded that there were “significant structural and 

attitudinal barriers to judicial independence” of the 

state’s municipal courts (Myers, 2004, p. 26). In 

Nevada, a dispute has arisen between a municipal 

judge and higher level judges regarding the transfer 

of inmates with mental illnesses to the county jail 

(DeHaven, 2014). In Atlanta, a report recommended 

reducing the number of judges in Atlanta’s municipal 

court on the ground that the court was “wasting time” 

(Atlanta City Auditor's Office, 2011). 

Another consideration is the difference in the 

backgrounds of municipal court judges. There are vast 

differences in states concerning judicial qualifications, 

such as an academic degree or a license to practice 

law. For example, in West Virginia, a college degree 

is not required. Further, there are major differences 

in continuing education requirements and degree of 

oversight by state administrative offices of the courts.

These examples are not indicative of the overall 

condition of municipal courts in the United States but 

are cited only to suggest that there may be political and 
5

other constraints on the ability of a municipal court to 

adopt diversion as a strategy. 

What Are the Essential Elements for 

Effective Diversion?

To understand what pieces must be in place for a 

municipal court to achieve effective diversion, it is 

useful to review explicitly what we mean by diversion. 

SAMHSA's GAINS Center (2007) defines diversion as 

the avoidance or radical reduction in jail time achieved 

by linkage to community-based services. Christie, 

Clark, Frei, & Ryerson (2012) point out that in many 

cases, where charges are minor and sanctions are quite 

limited, people may be linked to community-based 

services without a “radical reduction” in jail time or 

even any reduction in jail time. On the other hand, 

some defenders are not open 

to presenting any information 

regarding mental health and 

substance use needs to the court 

prior to arraignment. Defenders 

may fear that such information 

could result in delayed release 

due to bias about defendants 

with mental illness and co-occurring substance use 

disorders or could even inadvertently prejudice the 

outcome of the case. 

Early screening and prompt engagement at 

arraignment is key to minimizing penetration into the 

justice system, even to avoid a relatively short jail stay. 

Even short jail stays can be very disruptive to people 

with mental illness. Incarceration can interrupt contact 

with providers and access to medication and other 

services and result in loss of housing or employment. 

As noted above, the following procedural and 

structural barriers can impede diversion in municipal 

courts:

 Case volume;

 Time constraints;

 Leverage; and

 Nature of municipal courts.

In spite of these barriers, strategies and programs 

have emerged that enable diversion at arraignment 

and enhance post-arraignment diversion in municipal 

courts. Essential elements of municipal court diversion 

can be extrapolated from these programs. The essential 

elements, below, have been extracted from reviews 

of municipal court program evaluations or program 

descriptions and from observations of the SAMHSA's 

GAINS Center when consulting on diversion programs 

across the country. The focus of these elements is 

to promptly identify, screen, and assess people with 

co-occurring disorders and link them to appropriate 

treatment and recovery services. 

Identification and Screening 

As justice and mental health collaborators improve 

data matching and sharing technology, opportunities 

for identification and screening are being enhanced. 

Pima County, Arizona, and the states of Illinois 

and Maryland have implemented criminal justice–

behavioral health information-sharing systems to 

provide routine identification 

and assist with placement into 

treatment (Petrila & FaderTowe, 2010).

In addition, the VA is piloting 

the Veterans Referral Support 

Service, which links justice 

databases to the Department of 

Defense Database, to identify people who have served 

in the military. 

Identification and screening for co-occurring disorders 

in early diversion programs is challenging due to 

the high number of cases processed in municipal 

courts and the short time between arrest and 

arraignment. Even in communities with police Crisis 

Intervention Teams, behavioral health information 

obtained at arrest is not reliably passed along to 

the courts. High volumes of cases, inadequate 

staffing, and space limitations inhibit staff at initial 

detention from screening for mental illness and 

co-occurring substance use disorders and eligibility 

for diversion. Many communities merely identify 

potential candidates for referral to specialty courts or 

appropriate community-based treatment at arraignment 

and lack capacity to divert individuals with cooccurring disorders at arraignment. 

To initiate prompt and timely diversion, resources 

must be devoted to identification and screening as 

early as possible following arrest. The following 

In spite of ... barriers, strategies 

and programs have emerged that 

enable diversion at arraignment and 

enhance post-arraignment diversion 

in municipal courts.
6

stakeholders can serve as strategic and effective 

screening entities:

 Pre-Trial Services

In many communities Pre-Trial Services is 

either under the auspices of the local probation 

department or a contracted agency. The main 

objective of Pre-Trial Services is to assess bail 

risk, the likelihood that someone will return to 

court. As noted above, justice-involved people 

with mental illness are more likely to have 

more bail risk factors: lack of employment, lack 

of personal relationships, and most importantly, 

A Municipal Court Achieving Effective Diversion: Seattle Municipal Mental 

Health Court1

The Seattle Mental Health Court (MHC) was established in 1999 and was among the first MHCs 

in the United States. The court's recent evaluation notes that its goals have remained consistent 

throughout its years of operation: improve public safety; reduce jail use and justice involvement 

for people with mental disorders; connect participants to services and increase treatment success; 

improve access to housing and other community supports; and enhance participants’ quality of life.

Because this is a municipal court, all participants have been charged with misdemeanors. 

Defendants with a serious mental illness that is related to their criminal behavior are eligible for 

the Seattle MHC. Some defendants with post-traumatic stress disorder (PTSD), autism spectrum 

disorders, or developmental disabilities may also be eligible. There is a “no wrong door” referral 

process, with MHC referrals coming from all parts of the justice system and from families.

There were 899 participants in the Seattle MHC program from 1999 to 2011 (year of the evaluation). 

Among the group who started the MHC, 439 (49 percent) graduated, 407 were terminated for 

various reasons, and 53 were administratively removed because of legal or personal issues. Early in 

the program, participants who eventually graduated spent close to 2 years in the program. That time 

gradually has declined, due in part to growing confidence by the MHC team that participants can 

graduate earlier when they demonstrate consistent program success.

The MHC team includes dedicated staff from the judiciary, court, probation, defense, and 

prosecution. The team also includes two court liaisons and a defense social worker who conduct 

assessments, conduct case planning, and connect defendants to services.

One interesting feature of the Seattle MHC is the range of its sentencing options. Depending on 

the severity of the case, the prosecutor can recommend that the defendant’s case be set aside 

until completion of the program, resulting in no record; that the defendant plead guilty with the 

charges dismissed upon completion of the program; or that the defendant plead guilty with charges 

remaining.

The evaluation has demonstrated that all MHC participants, regardless of whether they completed 

the program, increased their utilization of mental health services, especially during their time in the 

program. While program participants who were high utilizers of crisis services were less likely to 

graduate, there was still a reduction in crisis contacts after MHC involvement, indicating the success 

of the MHC in providing stability in the community. The program was also successful in meeting 

its criminal justice goals, in particular for those who completed the program. Jail bookings and 

days declined for the graduates both during and in the 2 years after program completion. All MHC 

participants had a decline in police contacts both during and after program involvement, regardless 

of whether or not they completed the program, with the sharpest decline being for graduates. 

1. From DuBois, L., & Martin, T. (2013). Seattle municipal mental health court evaluation. Portland, OR: Law and Policy Associates, FLT Consulting. Retrieved 

November 21, 2014, from http://www.seattle.gov/courts/pdf/mhreport2013.pdf
7

lack of an address. Consequently, likelihood of 

incarceration for people with mental illness is 

high at arraignment. 

Pre-Trial Services is uniquely positioned to be 

a partner in early diversion programs. Adding a 

screening instrument (e.g., the Brief Jail Mental 

Health Screen) to the bail assessment will help 

to identify potential 

candidates for early 

diversion. In addition, 

Pre-Trial Services often 

provides a pre-trial 

supervision component. This added supervision 

component can allay concerns of the court and 

prosecutors by providing reliable monitoring 

and feedback to the court. To be effective in 

this role, Pre-Trial Services needs established 

linkages to community-based services. 

 Counsel

Defense counsel is the next strategic entity 

to interview the defendant. By incorporating 

a behavioral health screening into the initial 

interview, diversion candidates can be identified 

by attorneys, and the merits of diversion 

versus usual case processing can be discussed. 

Many public defender offices employ social 

work staff to provide clinical assessment 

and diversion coordination for defendants; 

for example, the New York City Legal Aid 

Society (MAP Program), Shelby County (TN) 

Public Defender, and Travis County (TX) 

Mental Health Public Defender. Focusing the 

efforts of clinical staff at arraignment allows 

for identification and referral to diversion 

services and enhances prompt referral to postarraignment diversion programs. 

 Court-Based Clinicians

When clinicians are present in court, there 

is added capacity for screening for diversion 

opportunities. Court-based clinicians may be 

employed by the court, local behavioral health 

departments, or contracted providers. Courtbased clinicians face challenges regarding 

interview space, case volume, and time. Larger 

municipal courts often operate seven days per 

week from morning to evening, and providing 

clinical coverage for all hours of court 

operation may not be feasible.

 Veterans Justice Outreach Specialists

The U.S. Department of Veterans Affairs 

(VA) initiated a Veterans Justice Outreach 

(VJO) initiative in 2009. VJO specialists are 

tasked with providing diversion alternatives 

for justice-involved veterans 

eligible for VA services. 

VJO specialists may not 

have the capacity to service 

all municipal courts in their 

region, but where available, VJO specialists are 

effective in screening and identifying veterans 

for diversion programs, offer consultation 

regarding the most effective strategies for 

screening veterans, and provide access to VA 

services (Christie et al., 2012).

 Judge and Court Staff

Even without clinical training, municipal 

court judges and their court staff are in a great 

position to identify defendants who seem to 

be struggling in the courtroom. Particularly 

in smaller jurisdictions, judges are familiar 

with repeat defendants and their families and 

have a sense about an individual’s behavioral 

health needs. Recognizing this, there is interest 

among municipal court judges in gaining skills 

to recognize behavioral health needs from the 

bench and respond appropriately. 

Court-based Clinician—The Boundary SpannerLinkage Component

The role of the court-based clinician is to provide both 

screening and assessment, as described above, and 

initial engagement and linkage. Once identification 

through a screening process is accomplished, 

assessment is required to determine clinical eligibility 

and treatment needs. Often there are few clinical 

records available, so assessment relies heavily on 

screening/assessment tools, psychosocial history, 

and mental status examination to determine clinical 

eligibility. An individual may be familiar to justice 

staff or the clinician from past contact, but justiceinvolved people with mental illness and co-occurring 

substance use disorders often are not actively engaged 

in treatment, and skilled clinical assessment is 

Pre-Trial Services is uniquely 

positioned to be a partner in early 

diversion programs.
8

A Municipal Court Achieving Effective Diversion: Midtown Community Court—

New York, NY2

The Midtown Community Court, established in 1993, hears cases where defendants are charged with 

misdemeanor offenses, such as prostitution, illegal vending, graffiti, and possession of marijuana. 

Midtown sentences offenders to community service to pay back the neighborhood in which they 

committed their crime and provides them with social services to address their underlying needs. 

Most of Midtown's cases do not involve people with mental illness and co-occurring substance use 

disorders, but many do.

Midtown is located in one of the busiest commercial districts in the United States. The catchment 

area, which includes four police precincts, is home to approximately 750,000 people. More than 3 

million commuters work in the area. 

In 2013, Midtown heard 21,683 cases (10,045 misdemeanor cases and 11,638 summonses). The 

most frequent misdemeanor charges were stolen property, trespassing, panhandling, and marijuana 

drug possession. 

Research indicates that, as compared with the downtown criminal court, for cases disposed at 

arraignment, Midtown decreases the extremes of jail on one hand (14 percent vs. 19 percent) and 

time-served sentences on the other hand (3 percent vs. 21 percent). 

In 2013, 80 percent of defendants at Midtown completed their community service mandates, 

compared to an estimated 50 percent of defendants who were processed at the downtown criminal 

court. Furthermore, research indicates that although Midtown is less likely to use jail as an initial 

sentence, Midtown is more likely than the downtown criminal court to impose jail as a secondary 

sanction on those offenders who fail to comply with initial court orders. 

As part of its mission to address low-level offending, Midtown Community Court offers a number of 

social services to defendants who come through the court, frequently as part of a court mandate. 

Defendants may also receive voluntary services, and members of the community who do not have 

cases at the Midtown Community Court are invited to access services. Midtown staff also provide 

referrals to community-based organizations, government agencies, and case management services. 

Midtown’s clinical staff recognize that underlying social service needs often lead to a person’s 

involvement in the criminal justice system. Staff utilize evidence-based techniques and curricula 

such as Seeking Safety, Motivational Interviewing, cognitive behavioral therapy and other traumainformed practices to engage individuals and motivate them to make changes in their lives. The 

court has developed specialized group counseling programs and individual services that address a 

number of problems and populations.

Midtown offers two approaches to substance use. For defendants with more extensive criminal 

histories, staff assess, place, and monitor the individual in community-based long-term drug 

treatment. 

The Treatment Readiness Program (three sessions) and Treatment Readiness Program II (six 

sessions) are offered to individuals who have had less contact with the criminal justice system. Both 

programs use cognitive, behavioral, interpersonal, and case management principles to assist clients 

in exploring the relationship between trauma and stress to substance use. Each program aims to 

encourage voluntary enrollment in long-term treatment.

2. From Midtown Community Court: Documented results: http://www.courtinnovation.org/sites/default/files/documents/MCC_fact_sheet.pdf and http://www.

courtinnovation.org/social-services
9

essential. Standardized screening/assessment tools 

are often used to ensure systematic assessment. 

Increasingly, court-based clinicians are able to access 

electronic health records, which provide real-time 

access to treatment history. 

If an individual is offered a diversion program, there 

must be prompt identification of treatment resources, 

referral, and linkage/engagement. A clinician must be 

available to escort the individual from the courtroom 

for more in-depth assessment; psychiatric assessment 

if required; and development of the initial treatment 

plan, which will include compliance with any court/

supervision mandates. Peer specialists can be 

especially effective in providing this linkage function 

because they share the experience of having overcome 

many of the obstacles faced by diversion candidates. If 

participants are being supervised by Pre-Trial Services, 

monitoring and reporting to the court must be 

coordinated to ensure program efficiency and eliminate 

duplication and role confusion. 

Depending on volume and available resources, the 

court-based clinician, another clinician, or peer may 

provide the linkage component.

Recovery-based Engagement Strategies

Recovery-based engagement strategies that focus on 

low-demand treatment engagement strategies have 

been successful for a variety of programs, such as 

the Transitional Case Management program in New 

York (Policy Research Associates, 2012), that are not 

able to rely upon judicial leverage. These engagement 

strategies include the following:

 Recovery-Oriented Services

The central tenets of recovery are health, home, 

purpose, and community (Substance Abuse 

and Mental Health Services Administration, 

2012). These dimensions suggest there is more 

to recovery than treatment compliance and 

medication. While treatment strategies are 

significant to successful recovery, focusing 

holistically on the multiple needs and 

circumstances of justice-involved people is an 

important aspect of engagement. 

 Direct-Linkage (Warm Handoff)

The term “warm handoff” has evolved 

from improving practices in integrated care 

systems where primary care physicians 

directly introduce patients to behavioral health 

specialists. The person-to-person handoff is 

seen as improving engagement and follow-up 

outcomes. Outcomes include improvement 

in keeping follow-up appointments, lower 

rates of readmission to hospital, and lower jail 

readmission rates. 

Direct linkage from the court to community 

providers and services is critical. It may 

be necessary over the first days following 

release to provide direct linkage for multiple 

services, such as psychiatric assessment, benefit 

applications, and housing providers.

 Low Demand and Accessible Services 

Functional levels of people with mental illness 

vary, as does capacity to take responsibility 

for following through with court/supervision 

mandates and treatment plan goals. An 

individual experiencing homelessness may 

still be using alcohol and drugs or may be at 

risk for relapse, and psychiatric conditions 

may deteriorate. Basic subsistence and 

survival needs must be addressed. Optimally, 

institutional barriers to care are minimal. Ondemand access, where clients are welcomed 

even if they are late or miss appointments, is 

an example. Frequency of contact by linkage 

staff should be based on individual need and 

urgency. 

 Utilization of Peers

Peers are utilized increasingly at key 

transition points in health care and criminal 

justice programs to promote engagement in 

services. Peers offer hope and comfort, having 

themselves faced similar challenges. The 

effectiveness of peer services in promoting 

treatment engagement, health, and public safety 

has been demonstrated in several studies, 

notably Randall and Ligon (2014).
10

Proportional Response

While the seriousness of charges and criminal 

sanctions varies in municipal courts, usually the 

charges are for quality of life crimes, small quantity 

drug possession, minor thefts, and nonviolent crimes 

where criminal sanction may be limited. In some 

communities, incarceration for misdemeanors is 

reserved only for chronic misdemeanants or where 

there is an element of violence. Consequently, there is 

limited court leverage for an individual to participate 

in a program with extended court monitoring. A 

proportional response must be no greater than the 

maximum possible incarcerative sentence. In general, 

the maximum possible incarcerative sentence for 

a misdemeanor is 12 months minus time served in 

pre-trial detention. There must be a proportionality 

of response for diversion, or there may be little 

incentive for a defendant to participate. For example, a 

defendent may not be willing to submit to 6 months or 

even a year of court monitoring when jail sanctions are 

A Municipal Court Achieving Effective Diversion: Misdemeanor Arraignment 

Diversion Project—New York, NY3

In 2010, The Legal Aid Society piloted the Misdemeanor Arraignment Project (MAP) in New York 

City Criminal Court. This is not a specialty treatment court, but rather a program working in general 

criminal courts. The Project aims to better identify, assess, and represent individuals with mental 

illness and co-occurring substance use disorders facing criminal charges at the earliest possible 

stages after arrest. 

MAP is an early intervention model that seeks to decrease the frequency of arrest and shorten jail 

sentences for individuals with mental illness. MAP enhances the ability of a community to serve 

people with mental illness and provides them with continuous community-based mental health 

treatment, appropriate housing, and supports.

The interdisciplinary team includes the attorney and paralegal assigned to the case and a MAPlicensed clinical social worker. The attorney is responsible for providing legal representation in 

arraignments. He or she works with the other team members to distinguish how and when screening 

and assessment information should be used in legal advocacy to assist in the successful resolution 

of the case. The licensed clinical social worker is responsible for identification and assessment of 

detained clients awaiting arraignment, treatment planning, and court advocacy. The social worker 

is also responsible for organizing collateral contacts with family, significant others, and community 

providers. He or she also offers referrals to community treatment and accompanies clients in 

emergency/crisis situations when necessary.

MAP served 250 clients between July 2010 and April 2012. A majority of the clients were male 

(72 percent). About half of the clients were African American (49 percent), followed by Hispanic 

(28 percent), Caucasian (15 percent), and other ethnicities. Mood disorders (38 percent) and 

schizophrenia and other psychotic disorders (34 percent) were the most frequently seen diagnoses 

in clients. Overall, 57 percent of clients had co-occurring mental illness and substance use issues; 22 

percent dealt only with mental illness; and 14 percent were missing diagnoses. 

The crime that preceded enrollment in MAP was most frequently larceny (29.6 percent), followed 

by controlled substance offenses (12.4 percent), assault and related offenses (11.6 percent), other 

offenses relating to theft (10 percent), and burglary and related offenses (9.2 percent).

Between July 2010 and April 2012, MAP completed 223 pre-arraignment assessments and 27 postarraignment assessments. Of the 223 individuals assessed pre-arraignment, 149 were determined to 

be jail divertible at arraignment. Eighty-eight people (59 percent) were diverted at arraignment.
11

Misdemeanor Arraignment Court Diversion Project continued

Of the 27 people assessed post-arraignment, 16 (59 percent) were diverted, for a total of 104 people 

diverted. Of the 104 clients diverted between July 2010 and April 2012, 52 percent had no arrests, 16 

percent had one arrest, 13 percent had two arrests, 12 percent had three arrests, and 7 percent had 

four or more arrests in the year after their diversion.

Four keys that staff identified for program success were:

Education and Engagement of the Judiciary. Judicial buy-in and appreciation of the goals of MAP 

are essential to its success. Focus groups held prior to the initiation of MAP and subsequent follow 

up with judges as to their perception of the success and usefulness of MAP are key to evaluating 

potential and ongoing success of the program. Judicial feedback may indicate potential modifications 

to procedures in the courtroom. In addition, judicial endorsement of MAP is an incentive for 

prosecutorial cooperation and overall success.

Attorney Engagement and Endorsement. Attorneys have not generally referred matters to social 

workers during arraignments but have waited until subsequent appearances to have social workers 

assist. Continuous education of attorneys, both new and experienced, through presentations by the 

social worker will help foster understanding of the overall arraignment defense strategies that can 

utilize social workers.

Assertive Assessment and Engagement of Clients Throughout Arraignment. The social 

worker in this role must have a skill set suited to working with many different personalities (clients, 

attorneys, judges) in a fast-paced environment, which can often be highly charged for the client. 

Social workers must screen files before the attorneys do and take the initiative to suggest to the 

attorneys that a client could be diverted to treatment or back to treatment. The social worker in the 

MAP project has to be on the lookout for appropriate clients in all ways—reviewing files, discussing 

with the attorneys, and assessing clients visually and through initial interaction. Some clients do not 

want to speak to anyone without an attorney. The skill of the social worker in making clients feel at 

ease in a difficult and potentially traumatizing situation is essential.

Ability to Establish Data Collection Systems Prior to Program Initiation and Conduct 

Accurate Follow Up. This is a labor-intensive part of the project. If it is possible to secure outside 

help to conduct extensive data analysis and program evaluation, either through collaboration with a 

university or other outside source, this might be ideal.

3. Excerpted from Policy Research Associates. (2013). Creating an indigent defense diversion team: The Manhattan arraignment diversion project. Delmar, NY: 

Author.

minimal. Even modest court leverage can be effective 

in facilitating service engagement.

Where pre-trial supervision is available, adding a 

behavioral health pre-trial release component can 

reassure the court and prosecutors that there will be 

monitoring of release conditions and prompt notification 

to the court regarding compliance.

Programs have had success with only clinical 

monitoring. The EXIT program, a New York City– 

based arraignment diversion program, required 

participants to attend a three-hour services orientation 

session immediately following release from 

arraignment. The purpose of the session was to explain 

available services and to assess participant needs. 

Following the three-hour session, approximately 70 

percent of participants had at least one voluntary 

contact with the program (Foley & Ruppel, 2008).

In Manhattan, the Center for Alternative Sentencing 

and Employment Services' START program (formerly 
12

Transitional Case Management) required chronic 

misdemeanants to participate in three to five case 

management sessions after which participants could 

voluntarily continue in the program for up to 3 months. 

Outcomes for participants included an 82 percent 

program completion rate and a 32 percent reduction 

in arrest rates. Eighty-five percent of those who 

completed the program chose to continue program 

participation voluntarily (Policy Research Associates, 

2012).

Legal Aid Society's Misdemeanor Arraignment Project 

(MAP), described in depth on page 10, targets people 

with co-occurring disorders who are at risk of being 

arraigned and released without supportive services, 

a jail sentence, or being held in jail pending a court 

appearance (Policy Research Associates, 2013). Nearly 

60 percent of the 149 participants were diverted. 

Fifty percent of those were released on their own 

recognizance, and the remaining received conditional 

discharges or had charges dismissed. Follow-up 

data showed that the MAP cohort had a 24 percent 

reduction in arrest when compared to non-MAP 

diverted clients.

Summary

Municipal courts that implement these four essential 

elements—Identification and Screening, CourtBased Clinician, Recovery-Based Engagement, 

and Proportional Response—are in the position to 

minimize the criminal justice system involvement 

and reduce unnecessary incarceration of people 

with mental illness and co-occurring substance 

use disorders as well as facilitate engagement or 

re-engagement in mental health and substance 

use disorder services. Municipal courts provide 

an enormous opportunity to fill a gap in diversion 

strategies at Intercepts 2 and 3 of the Sequential 

Intercept Model. In the aggregate they are, by far, the 

primary case resolution forum in the United States. 

The individuals who enter municipal court fit the 

profile of a population that might benefit most from 

diversion: individuals with mental and substance use 

disorders, frequently arrested for minor offenses, 

living in communities with few behavioral health 

services, and at high risk for homelessness and 

unemployment. While there are challenges, there are 

a number of examples in different parts of the country 

that illustrate how municipal courts can in fact become 

an essential part of the landscape as efforts at diversion 

move forward. 

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14

Contributors

This report was prepared for the Substance Abuse and Mental Health Services Administration (SAMHSA) by 

Policy Research Associates, Inc., under SAMHSA IDIQ Prime Contract #HHSS283200700036I, Task Order 

#HHSS28342003T with SAMHSA, U.S. Department of Health and Human Services (HHS). Numerous people 

contributed to the development of this publication, and SAMHSA would like to acknowledge the individuals 

below.

Policy Research Associates

Henry J. Steadman, PhD

Chanson D. Noether, MA

Dan Abreu, MS, CRC, LMHC

Lisa Callahan, PhD

Council of State Governments Justice Center

Hallie Fader-Towe, JD

University of South Florida College of Public Health

John P. Petrila, JD, LLM

Substance Abuse and Mental Health Services Administration

Pamela S. Hyde, JD

Larke N. Huang, PhD

Kenneth W. Robertson

David Morrissette, PhD, LCSW

(SMA)-15-4929

Printed in 2015