Today, there are mental health courts in a number of U.S. cities, and many more mental health courts are in the planning stages. A recent study by the Crime and Justice Research Institute documented the practices of the first four mental health courts, highlighting a set of common procedures and goals that typify the mental health court approach.
Based on the success of the drug court model, a handful of jurisdictions across the country have developed specialized courts to address mental illness. Like drug courts, the central goal of mental health courts is to reduce the recidivism of defendants by providing them with court-monitored treatment. The first of these courts opened in June 1997 in Broward County, Florida.
Shortly after Broward opened its doors, several other municipalities began to plan mental health courts. Today, there are mental health courts in Seattle and Vancouver, Washington; San Bernardino, Santa Barbara and Santa Clara, California; Brooklyn, New York; Anchorage, Alaska; Marion County, Indiana; St. Louis, Missouri; Akron, Ohio; and Jefferson County, Alabama. A number of other mental health courts are in the planning stages. A recent study by the Crime and Justice Research Institute documented the practices of the first four mental health courts—Broward, King County (Seattle), San Bernardino and Anchorage (Goldkamp & Irons-Guynn, 2000). While each mental health court is unique, this study—and independent research on the other mental health courts—highlighted a set of common procedures and goals that typify the mental health court approach:
Mental health courts mark an attempt by court systems to address a systemic problem, taking a critical look at the issues that defendants with mental illness pose for the courts and crafting a new set of responses. Put simply, these courts are not satisfied with continuing with business as usual—standard case processing or out-sourcing the solution to some other agency. (Finkelstein & Brawley, 1997).
By responding to widespread concerns about how courts deal with defendants with mental illness, mental health courts attempt to shore up public trust and confidence in the justice system. Indeed, many mental health courts have been created in response to a specific local crisis involving mentally ill defendants—for instance, the murder of a retired firefighter in Seattle, Washington by a person with mental illness (Goldkamp & Irons-Guynn, 2000).
In linking defendants with mental illness to treatment alternatives, many mental health courts see themselves as practicing “therapeutic jurisprudence” (Lurigio et al., 2001; Lerner-Wren, 2001; Wexler & Winnick, 1996). In one way or another, mental health courts are testing the extent to which the law can be a therapeutic agent—a social force producing positive life changes for defendants.
Mental health courts develop new systems to identify defendants with mental illness. The point in the criminal justice process at which this intervention occurs varies by jurisdiction. Usually, identification takes place within 24 hours of arrest while defendants are still in custody. The primary sources of identification are jail staff, family members and defense attorneys.
After identification, each court has created eligibility criteria that target a certain type of defendant. Almost all programs require that defendants have symptoms of severe mental illness and face non-violent, misdemeanor charges. San Bernardino’s court has handled some non-violent felonies on a case-by-case basis. In general, mental health courts specify that the defendants’ mental illnesses must be “Axis I disorders” as designated in the Diagnostic Statistics Manual IV (American Psychiatric Association, 1994).
Each mental health court has a dedicated judge and some additional specialized staff. The specialized staff are usually mental health clinicians who screen cases for eligibility, prepare treatment plans, and report to the judge on defendants’ progress in treatment. In some cases, this staff is hired by the court system using new funding sources. In other cases, this staff is assigned from a collaborative government agency or from a local treatment provider. In general, mental health courts have been planned and overseen by interdisciplinary teams composed of a variety of criminal justice and behavioral health stakeholders. For instance, the Santa Clara Mental Health Court “team” includes the judge, district attorney, public defender, and mental health caseworkers (Santa Clara Bar Association, 2001). The team meets to discuss every case, with each representative providing input from their unique institutional perspective.
Mental health courts—like drug courts before them—have altered the dynamics of the courtroom, including, at times, certain features of the adversarial process. For example, in some courts defenders and prosecutors come together to discuss their common goals for each defendant. Mental health courts may engage judges in unfamiliar roles as well, asking them to convene meetings and broker relationships with service providers.
Participation in mental health court is voluntary—defendants must affirmatively “opt-in” to receive treatment. For instance, the King County Mental Health Court in Washington gives defendants two weeks in a treatment placement to help them decide whether to participate in the program or not (during this time, their attorneys can also investigate the strength of the case against their client) (Goldkamp & Irons-Guynn, 2000).
Once a defendant opts into a mental health court, one of two things happens: either prosecution is “frozen” and charges are dropped after the defendant successfully completes treatment, or a plea is taken and later vacated (or charges reduced) after treatment is completed. All of the mental health courts require a longer period of time in treatment than the defendant would have served in jail or prison if they had plead guilty to the crime charged, and most courts require participating defendants to spend a minimum of one year in treatment. The rationale behind this is two-fold. First, mandated treatment involves many fewer restrictions than being incarcerated (many defendants are even released to their own residences). Second, mental health courts are willing to invest in treatment only if there is real promise of reducing symptom severity (and thereby reducing recidivism). Experience indicates that it takes at least a year to successfully engage people with mental illness in treatment. Accordingly, many mental health courts reserve the right to extend offenders’ period of treatment in the event of non-compliance.
Mental health courts require participants to return frequently to court to enable the judge to monitor the progress of treatment. Court appearances are made less frequently as participants demonstrate consistent compliance over a sustained period of time.
Mental health courts seek to promote reform with partners outside of the courthouse as well as within. For instance, mental health courts have encouraged mental health and drug treatment providers to come together to improve service delivery for offenders.
American Psychiatric Association (1994). Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV). Washington, D.C.
Finkelstein, H. & Brawley, D. (1997). Introduction. Broward County Mental Health Court Status Report, 1(1). Ft. Lauderdale, FL: Broward County Public Defender. (Both authors are Chief Assistant Public Defenders). Available: http://www.browarddefender.com/mhealth/volume_i_mental_health.htm#Vol I, No. 1
Goldkamp, J. & Irons-Guynn, S. (2000). Judicial Strategies for the Mentally Ill in the Criminal Caseload: Mental Health Courts in Fort Lauderdale, Seattle, San Bernardino, and Anchorage. Washington, D.C.: U.S. Department of Justice, Office of Justice Programs, Drug Courts Program Office. Available: http://www.ncjrs.org/html/bja/mentalhealth/contents.html
Lerner-Wren, G. (2001). Letter from the Mental Health Court Judge. Third Annual Mental Health Court Progress Report. Ft. Lauderdale, FL: 17th Judicial Circuit, Broward County, Florida. Available: http://www.co.broward.fl.us/ojss/jsi00500.html
Lurigio, A., Watson, A., Luchins, D., Hanrahan, P. (2001). Therapeutic Jurisprudence in Action: Specialized Courts and the Mentally Ill. Judicature, 84(4), 184-189.
Santa Clara Bar Association (2001). Time for a Change: The Mental Health Court of the County of Santa Clara (Press Release of April 3, 2001) reprinted in Santa Clara Bar Association Legal Links. Santa Clara, CA: Superior Court of California, County of Santa Clara.