Macomb County, Mich., is launching a program to prevent the inappropriate incarceration of mentally ill, low-risk criminals by diverting them to treatment facilities instead of jail. Once the diversion program is established, a mental health court will be set up to let judges have more oversight over offenders while they are in treatment.

The new system is expected to lighten judicial caseloads, reduce jail overcrowding, and enable offenders to be seen only once in court. Both the diversion program and the mental health court are expected to be fully operational by the end of the year.

"I think that the Macomb program, coordinated with other pre- and post-jail diversion programs and other community mental health services, is a welcome addition to the services available to persons with mental illness and developmental disabilities in Michigan," Michele Reid, M.D., past president of the Michigan Psychiatric Society and medical director of Detroit/Wayne County Community Mental Health (CMH), told Psychiatric News.

Reid believes that mental health courts would be most effective if Michigan had outpatient commitment, as do most other states. At present involuntary commitment orders in Michigan must be initiated during a hospitalization, and only after discharge is there a period of mandated treatment. Without the ability to order treatment through the mental health code, she said, implementation will be less effective than it could be.

The driving force behind the new program and its main coordinator is Macomb County probate judge Kathryn A. George, a staunch advocate for improving the county’s mental health system.

"Right now the system is begging for changes," she said.

In 1999 a study of jails by the Michigan Department of Community Mental Health found more than half of all inmates in three counties suffered from mental illness, most commonly major depression, bipolar disorder, schizophrenia, and psychotic disorders

"Michigan has no mental health court with a prebooking option, so if Macomb starts one that would be very important because we need to see how such a court might work in a major Michigan county," Mark Reinstein, Ph.D., president and CEO of the Mental Health Association in Michigan, told Psychiatric News.

"This is not to suggest that mental health courts are the only steps that should be taken. Evidence indicates our state may have a virtual epidemic of persons with mental illness winding up in the justice system, and this problem needs to be attacked comprehensively across multiple fronts," Reinstein added.

Although the public mental health system in Michigan reports being involved in a host of diversion activities, Reinstein questioned whether diversion is being carried out to the extent that the system generally claims it is. In 2002, the first year that CMH programs were asked to report to the state, the number of individuals diverted was only 71. He said the low number may be due to underreporting.

Reid said that the mental health code and contract with each community mental health services require jail-diversion services to be available and that there are at least 47 programs serving Michigan’s 83 counties.

Neither Reid nor Reinstein believe that mental health courts are stigmatizing as some have contended or come too late in the process of helping mentally ill lawbreakers. They feel it is far more stigmatizing and dangerous for someone who has committed a minor offense due to lack of or inadequate treatment to wind up incarcerated. ▪