Mental Health Courts are a recent innovation in the integration of mental health and criminal justice services and are based on the model of therapeutic justice exemplified by the drug courts. The Council of State Government's Criminal Justice/ Mental Health Consensus Project XII (June 2002), found that "people with mental illness are falling through the cracks of this country's social safety net and are landing in the criminal justice system at an alarming rate." Often, these individuals are overlooked, "turned away or intimidated by the mental health system" and "end up disconnected from community supports." Id. This disconnection leads to increased recidivism and eventual criminalization of individuals with mental illnesses. In fact, one report found that over one-quarter of the inmates with mental illnesses in local jails were incarcerated for minor offenses. Bureau of Justice Statistics, US Dept. of Justice, Pub., No. N U 174463, Mental Health Treatment of Inmates and Probationers 1 (July 1999).
Consequently, a disproportionate number of individuals with mental illnesses are incarcerated for minor offenses, contributing to the overcrowding of county jails. Based on available data, the outcomes of these incarcerations and associated costs have been the opposite of what was intended; rather than leading to remediation, the data shows that incarceration of mentally ill individuals increases recidivism and criminal acting out.
Mental Health Courts address this issue by integrating the criminal justice and mental health world, requiring collaboration and consideration from both sides for the benefit of all involved. Based on the premise that these individuals act out criminally secondary to their mental illness, mental health courts embrace a "therapeutic justice" stance geared toward enforcing mental health treatment and medication compliance.
Extrapolation of national data suggests that of the more than 13,000 bookings annually in Utah County, about 1,000 individuals booked suffer from a mental illness. Thus, at any given time, about 88 inmates in the Utah County jail would have a mental illness and approximately half of those would report at least one admission to a hospital for psychiatric reasons.
In Utah County, Wasatch Mental Health (our county community health center), in collaboration with the Fourth District Court, the Utah County Attorney's Office, city prosecutors, and the defense bar launched a Mental Health Court in early 2004. The Mental Health Court focuses on the following goals:
- Divert participants from the Criminal Justice System
- Keep the community safe (through decreased recidivism)
- Avoid the revolving door at inpatient facilities and jails
- Enhance the participants quality of life
- Use limited available funds in the most effective way
- Increase treatment compliance with difficult to treat clients
Admission into the Mental Health Court Program is a two-step process. First, the individual's mental health status and the charged offenses are reviewed by the prosecutor's office to insure only appropriate candidates are referred to the program. The second step occurs when a referred individual is screened by a therapist at Wasatch Mental Health.
If accepted into the program, the participant is assigned a case manager, a therapist and a medical doctor as needed. Participants are monitored on a weekly basis by both Wasatch Mental Health and the Court to ensure the participant's compliance with their treatment plan. A typical treatment plan is designed to be completed within one year, but may be adjusted based upon the participant's responsiveness to treatment and therapy.
After more than six years of operation, the Mental Health Court has been a huge success. Ninety percent (90%) of the participants successfully complete and graduate from the program. The number of jail days saved (as compared to a similar population not in Mental Health Court) accounts for a cost reduction of more than $600.00 per client per year, saving the Utah County Jail (and our tax dollars) approximately $62,000 per year in jail bed days. Additionally, a recent study indicates that the likelihood of mental health court graduates recidivating was approximately 22% lower than mentally ill persons who received treatment alone, and their likelihood to commit a violent offense was approximately 50% lower. Dale E. McNiel and Renée L. Binder, Effectiveness of a Mental Health Court in Reducing Criminal Recidivism and Violence, Am J Psychiatry 164:1395-1403, September 2007.