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May 01, 2015 Introduction

Mental Health Courts

By Judge Nannette A. Baker

Two years ago, the chief judge of our court asked if I would like to be involved with starting a specialized mental health court. I was intrigued, thinking that such a court might be able to reduce recidivism rates for those with mental illnesses. I volunteered to work along with a district judge and our probation office to develop a mental health reentry court in the U.S. District Court in the Eastern District of Missouri.

The goal of the Janis C. Good Mental Health Court is to give people with serious and persistent mental illnesses the support to stay in the community and not return to prison. In addition to judges and probation officers, our mental health court team includes the U.S. Attorney, the Federal Public Defender’s Office, and community treatment providers. Our court started in December 2013 with nine participants. We meet weekly with the participants and have had many successes as well as challenges. Two of the original nine have graduated, we lost one person to suicide, and four individuals are still participating in our court. We are adding participants on a regular basis and currently have 11 people in the program. I have found presiding over the mental health court to be the most frustrating and rewarding work of my 15-year judicial career.

The number of people with mental health problems in the criminal justice system has increased since the 1970s. That’s because, in the early part of the 20th century, mental health care was based almost entirely in institutions. In 1959, some 559,000 individuals with mental illnesses were housed in state mental hospitals. A shift to “deinstitutionalize” mentally ill persons had, by the late 1990s, dropped the number of people housed in public psychiatric hospitals to approximately 70,000. As a result, mentally ill persons are now more likely to live in local communities and many come into contact with the criminal justice system. In a 2006 Special Report, the Bureau of Justice Statistics estimated that 705,600 mentally ill adults were incarcerated in state prisons, 78,800 in federal prisons, and 479,900 in local jails. In addition, research suggests that people with mental illnesses are overrepresented in probation and parole populations at estimated rates ranging from two to four times the general population.

Because of the growing numbers of people in the criminal justice system with serious psychiatric disorders, jurisdictions across the country are developing problem-solving courts that focus on people with mental illnesses. These mental health courts are based on the model of drug courts, which have been effective as diversion programs for individuals with substance abuse problems. In this issue of The Judges’ Journal, we look at this “new” type of problem-solving court and explore its efficacy. Most mental health courts have been started within the last 15 years, so the research is limited, but preliminary studies show a decrease in recidivism. There are two articles in this issue that examine the development of mental health courts and research into the effectiveness of these courts and what the future holds.

This issue also features articles by judges who have firsthand experience in developing and running mental health courts. These include a municipal diversion court in Glendale, Arizona; a comprehensive mental health docket in Prince George’s County, Maryland; the District of Columbia mental health diversion program; and the first federal mental health court in the District of Utah. Each judge’s experience is unique, and the articles offer excellent information about how to start and successfully run a mental health court.

The judges’ articles contain some common themes. First, each of them details the challenges of coordinating efforts to develop the best approach for their jurisdiction and population. Second, these courts can take several forms. Some are diversion courts for individuals charged with minor, nonviolent offenses, while others are reentry courts for defendants who have served time for serious felonies. Third, it takes a village. Every mental health court depends on buy-in from prosecutors, the defense bar, mental health service providers, and the community. And, last but not least, the personal experience of presiding over a court that focuses on this vulnerable population can be very rewarding work. If you’re considering this type of specialty court for your jurisdiction, I hope this issue of The Judges’ Journal provides food for thought.