These courts have myriad goals, including to provide treatment and community support services based on individualized treatment plans; enhance the quality of life for those with mental health conditions; reduce recidivism; reduce jail and court costs and case processing time; and raise understanding among community members, practitioners, and policymakers about the experiences of individuals with mental illnesses and their families.
Mental health courts involve collaboration between the criminal justice system and mental health professionals. Multidisciplinary team members include judges, defense attorneys, prosecutors representing the district attorney’s office, probation or parole officers, case managers, mental health representatives, and court coordinators. Referrals to mental health courts can come from anyone, including prosecutors, defense attorneys, jail staff, law enforcement, or family members, and can occur as early as the time or arraignment or later after being detained in jail. Each program has its own eligibility requirements, but all participants must have a serious mental illness and agree to participate in the program.
How these courts operate varies from jurisdiction to jurisdiction. “When you have seen one mental health court, you’ve seen one mental health court, as they vary,” Britton said. Some mental health courts take on a variety of charges, including felonies and violent crimes, while others consider only those charged with misdemeanors or nonviolent crimes.
Typically, participants follow individualized case plans and attend regularly scheduled court hearings. “When not in court, participants are regularly engaging in mental health and substance use treatment,” Britton said. Members from the criminal justice and behavioral health systems monitor the participant’s treatment and compliance with supervision conditions and share their progress with the court. Programs can range from six months to two years depending on the criminal charge and design of the program.
Participants who successfully complete (graduate) the program may have their charges dismissed (diversion), sentences reduced, or judgements vacated. They are engaged in treatment and connected to services that allow them to remain in the community. By contrast, participants who do not complete the program return to the normal processing of their criminal case for sentencing or imposition of a suspended sentence.
According to Hallie Fader-Towe, Director of Justice and Health Initiatives, Behavioral Health at The Council of State Governments (CSG), “mental health courts bring together elements that have been shown to improve health and justice outcomes, and when these interventions are aligned with identified needs associated with health and justice-system involvement, it makes sense that mental health courts have positive outcomes.” However, she believes that “there are things every court can do to identify mental health needs and connect people to appropriate treatment and supports, even outside participating in a specific program.”
Britton sees these positive effects firsthand. “I witness recovery every single time I hold court and love supporting and praising participants who rarely in their life have ever received a congratulations, let alone from a judge. My experience is that our graduates are happier and healthier than non-participant defendants in my court.”
One of Beaverton Behavioral Health Court’s (BHC) “graduates,” who wrote to the Commission on Disability Rights on condition of anonymity, said: “I can only describe my life prior to mental health court by saying I was white knuckling almost each day. … Beaverton’s Behavioral Health Court was my saving grace. They worked closely with me and my support system to connect me with services and [kept] me accountable in my healing journey without judgement or shame.”
Yet, some have been critical of mental courts. According to an American Psychiatric Association report, among the criticisms is that the very existence of these courts may imply a link between mental health conditions and crime, thereby worsening the stigma associated with mental illness. Furthermore, the Bazelon Center for Mental Health Law points out that these courts “do not solve the systemic problems that cause people with mental illnesses to be arrested and incarcerated in disproportionate numbers.” The Center also contends that these courts can “inadvertently create incentives to arrest people to get them into services” and “lead mental health authorities to prioritize scare resources to be delivered at a late state, as part of a system that involves coercion.” They believe that “the best approach to avoiding the criminalization of people with mental illnesses is not to create new courts, but to ensure timely access to the services that are crucial to people with serious mental illness.”
Other advocates, attorneys, clinicians, and researchers assert that such programs are often expensive and resource-intensive, are selective, and serve fewer than 1% of the more than 2 million people who have a serious mental illness and are in U.S. jails each year. They also point out that participants may feel coerced to take plea deals, viewing the programs as the only way to get the care they need or avoid prison time. They highlight the lack of conclusive evidence on the long-term impact of these courts.