About 30 American communities have established mental health courts to offer people with mental illness a treatment alternative to jail or prison.
While everyone agrees that jails and prisons are not therapeutic environments, the results of a survey presented in a new report show that mental health courts carry their own risks.
The report, "The Role of Mental Health Courts in System Reform," was released in January by the Bazelon Center for Mental Health Law, a mental health advocacy organization in Washington, D.C.
Mental health courts have a separate docket with a judge, prosecutors, and defense attorneys who have some training to deal with defendants with mental illness. Treatment plans are drawn up in conjunction with community mental health professionals. Defendants live in community settings and may have their charges dropped when they complete treatment.
The Bazelon Center authors conclude from a survey conducted last year of 20 mental health courts that some use "coercive tactics similar to the controversial intervention outpatient commitment."
Co-author Tammy Seltzer told Psychiatric News, "People with mental illnesses should be aware of the conditions imposed by mental health courts in exchange for treatment. About 50 percent of the courts surveyed required a guilty plea, which waived the defendant’s right to a trial. About 40 percent reported that the defendant was supervised by the court far longer while in treatment than possible jail or prison time [they would have gotten] for a similar offense."
The report criticizes the use of guilty pleas because "they add a conviction to the person’s record, which impedes the individual’s ability to obtain and maintain housing and employment, which is so necessary for long-term mental health treatment, community tenure, and management of a long-term psychiatric disability."
In addition, "If a defendant without a mental illness would typically have the charges dismissed, it is discriminatory to require a person with a mental illness to plead guilty to access services and supports."
Only 30 percent of the courts surveyed dismissed the defendants’ charges once they successfully completed treatment. The authors said that all courts should dismiss charges upon treatment completion.
About 64 percent of the mental health courts used jail time as a sanction for noncompliance, and 18 percent reported they might drop the individual from the treatment program for noncompliance, the report notes.
Defendants who decide not to complete the prescribed mental health court treatment should be allowed to "withdraw without prejudice." This means withdrawing their guilty plea or being able to contest it at trial, explained Seltzer. However, 56 percent of the courts surveyed prohibited this, and one court allowed the judge to impose a harsher sentence if the defendant didn’t complete mental health treatment, said Seltzer.
"These actions are particularly unhelpful if the issue is one of normal relapse and the ups and downs of recovery from mental illness," the authors wrote.
They recommended that a defense attorney be appointed for a person identified as a mental health court candidate when charges are pressed. The attorney should explain all options to resolve the case to the defendant and the consequences of a transfer to mental health court.
Mental health courts traditionally have limited access to people with mental illness who commit misdemeanor and nonviolent felonies. Although 80 percent of the courts reported that they consider cases involving violent acts, 40 percent of those required a special process before accepting those cases, for example a victim’s consent or a review of specific charges, according to the report.
"We would like to see all mental health courts serve people who commit serious felonies, excluding murder. Most traditional courts already have mechanisms to divert people charged with misdemeanors including alternative sentencing and pretrial diversion to treatment," said Seltzer. "We believe those options should be made available to all defendants regardless of their mental health status."
The authors also recommended collaboration between mental health professionals and police officers to identify people with mental illness charged with "nuisance" misdemeanors such as disturbing the peace or trespassing. This would result in fewer arrests and incarceration.
Mark Munetz, M.D., chief clinical officer of the Summit County Alcohol, Drug, Addictions, and Mental Health Services Board in Akron, Ohio, said, "Our municipal mental health court serves only people with misdemeanors. I would hate to see them have access only to traditional court diversion options, which we found results in less treatment referrals than through the mental health court."
Munetz added, "Another reason our mental health court is more effective than traditional court is that there are graduated sanctions for treatment noncompliance including jail time. I believe this is necessary given that we are dealing with people who have a history of noncompliance with treatment."
He acknowledged that this creates "a tension between the defendant’s voluntary entry into mental health court treatment and coercive compliance measures."
The Bazelon Center report advocates a comprehensive community mental health system to serve people with mental illnesses rather than relying primarily on mental health courts to serve that function.
Gregory Peterson, M.D., director of clinical services for Community Support Services Inc., which provides services to the local mental health court in Akron, Ohio, said, "I agree with the report that the mental health courts are not a panacea for the problems of mentally ill individuals. The courts must function in the context of a community mental health system that has the resources and the will to serve these people."