Judges, Psychiatrists Trained to Share Education About MH in Justice System

When Clay Pavlis, M.D., explained to a room full of judges and psychiatrists in Washington, D.C., what common mental disorders that people involved in the criminal justice system may have, he pointed out the window behind his co-presenter, Judge James Power, J.D. There, prominently situated on the side of the International Spy Museum, was the word “Spy” in huge red block letters.

“If I have paranoia and the word ‘Spy’ is behind the speaker, that would make me really nervous,” Pavlis said. “It would be really hard for me to concentrate after seeing that. So, in your courtrooms, you can be on the lookout for anything that could cause that kind of anxiety for someone with schizophrenia.”

Pavlis and Power were presenting during the Judges and Psychiatrists Leadership Initiative’s (JPLI) Train-the-Trainer program in September. Over the course of the three-day event, they, along with 30 other judges and psychiatrists from across the country, were equipped with the tools and knowledge necessary to bring JPLI’s curriculum back to the judges in their own states.

Katie O’Connor

JPLI is a partnership between the APA Foundation, the Council of State Governments Justice Center, and the National Center for State Courts. The initiative has been conducting its training for over 10 years, and it has partnered with the National Judicial Task Force to Examine the State Courts’ Response to Mental Illness to enhance the content of the training by addressing substance use disorders (SUDs) as well. The Train-the-Trainer program was also supported by the American Academy of Addiction Psychiatry and the Opioid Response Network.

JPLI’s curriculum is titled “Judicial Work at the Interface of Criminal Justice and Behavioral Health.” It helps judges make well-informed decisions when mental and substance use disorders are a factor in criminal cases—which, quite often, they are. According to JPLI, while only about 4% of the U.S. adult population has a serious mental illness (SMI), approximately 17% of adults booked into jail have an SMI.

“This work helps us to really provide justice to the communities we’re serving,” said Judge Steven Leifman, J.D., co-chair of JPLI who, along with his fellow co-chairs Michael Champion, M.D., and Sarah Vinson, M.D., delivered JPLI’s three-hour curriculum to the Train-the-Trainer participants. Champion is medical director of the Hawaii Department of Health’s Adult Mental Health Division and an associate clinical professor of psychiatry at the University of Hawaii. Vinson is founder and principal consultant of Lorio Forensics and an associate professor of psychiatry and pediatrics at Morehouse School of Medicine in Atlanta.

Over the course of their training, the judges and psychiatrists were taught effective adult learning strategies that they can use while presenting the three-hour curriculum at state judicial education conferences. They were also assigned topics on which they presented as state pairs, receiving feedback from their colleagues on what worked and what needed improvement in their presentations to hone their skills before delivering the curriculum at conferences.

The presentations covered numerous topics, such as what to keep in mind while interacting with people with SMI and SUD in a criminal justice setting; the social determinants of health; racism, implicit bias, and equitable outcomes; and how to address cases involving substance use. Participants received tips that can be used in a courtroom or other criminal justice settings, such as creating safe spaces for people with SMI and SUDs and how to consider the ways that a person’s history and current living situation may impact the ability to succeed with court-ordered treatment.

Throughout the presentations, the presenters often stressed that they are not asking judges to work as psychiatrists and diagnose defendants. Tanuja Gandhi, M.D., touched on this while presenting on trauma-informed courts and procedural justice, explaining that judges should keep the concept of trauma in the back of their minds. “You can ask yourself, ‘How can I make this easier and prevent retraumatizing this person and keep them showing up to court?’ ” said Gandhi, an assistant professor of psychiatry and human behavior at Brown University. “This approach can promote participation while addressing the issue with respect and dignity.”

Siu Ping Chin Feman, M.D., explained that judges should have fair and realistic expectations of people with SUDs. “Addiction changes the brain, and there are setbacks during recovery for all chronic illnesses,” she said. “Just like with hypertension or asthma, chronic illnesses can get better and worse. Relapse is part of recovery, and responding to that in a compassionate, productive way can be a huge challenge. But incarceration is not always the answer to relapse.” Chin Feman is a voluntary assistant professor of psychiatry in the Division of Addiction Psychiatry at UMass Chan Medical School and the medical director of homeless services at Eliot Community Human Services.

The curriculum can also be presented as a 90-minute program, and JPLI’s ultimate goal is for all judges in the nation to receive the training so they can feel equipped to work with people with mental and substance use disorders both in the courtroom and the community. So far, the training has been presented to more than 1,000 judges from 22 states and Washington, D.C.

“You’re really part of a huge moment,” Leifman told the participants while he, Champion, and Vinson made their concluding remarks. “I’m convinced that in 10 years, we’re going to look back and know that this was the beginning of a major sea change in the U.S.” ■