Mental health courts gain popularity



Tali Walters Ph.D. believes there needs to be an alternative to criminal court for people with mental illnesses who find themselves in the court system. Walters is a founding partner in the forensic consulting practice Cambridge Forensic Consultants. (photo by Tom Croke)

By Jennifer Chase Esposito

Since the late 1990s, mental health courts have become a viable component of the criminal justice system. And their numbers are growing. According to the Bureau of Justice Assistance, in 1997 there were only four known mental health courts (MHCs) in the United States. By January 2004, 70 had opened in 29 states, and as of February of this year, there were 107 known courts in 34 states.

The reasoning behind MHCs is basic: to get criminally prosecuted offenders, who are mentally ill, into programs that can offer them the support services they need to treat their mental illness rather than shuffle them off to prison. This method not only cuts down on clients' frequency in the criminal justice system, but also protects the communities in which they live from their deviant behavior.

Currently there are no mental health courts in New England, though some states, like Rhode Island, have judges who are more understanding of the needs of a mentally ill offender and may prescribe treatment over prison. But it's a case-by-case situation. By the end of this summer, however, Maine could become the first state in the region to begin a pilot MHC program.

Leading Maine's effort is Supreme Court Chief Justice Leigh Saufley, who appeared before Maine Legislature's Judiciary Committee in May asking for project support. Superior Court Justice Nancy D. Mills and District Attorney Evert Fowle proposed the program.

Maine's pilot program would give offenders the option of accepting mental health treatment in lieu of going to jail. Most defendants would be required to first plead guilty, deferring jail with success in treatment. Some people may even have their criminal records expunged if they followed treatment.

Opponents feel that MHCs shouldn't provide offenders an out as simple as feigning mental illness in exchange for a get-out-of-jail-free card. But the overall goal of MHCs is to cut down on clients' frequency in the criminal justice system by treating them and not simply sending them into the prison system. It's a concept that some professionals in the region favor.

Tali Walters, Ph.D., is a founding partner in the forensic consulting practice Cambridge Forensic Consultants. Along with her associates, she offers psychological and psychiatric services in both criminal and civil cases throughout the United States.

"Because there are so many mentally ill people in Massachusetts who end up in the court system and that's their entry into treatment, there needs to be something more than criminal court," says Walters.

"I think [mental health court] is definitely a model to look at as an alternative to the current system. The current system is not working."

Like other psychologists who are pro-MHC, Walters names MHC's ability to possibly prevent crime as one of its biggest assets. But to be fair, she says, the criminal justice system was not designed to necessarily help mental health clients. Forcing them to take on that responsibility is misguided.

"I don't think it should be the criminal justice system's responsibility to take on treatment of the mentally ill," says Walters.

Nicki Sahlin, Ph.D., executive director of the National Alliance of the Mentally Ill-Rhode Island, agrees. "Let's give the police and the people working in prisons credit for doing what they're doing," says Sahlin. Too often, she says, the psychological community blames the criminal justice community for not understanding mental health problems or the people with mental illness. "But who even charged them with the responsibility?"

According to Sahlin, "every state would have a desire [to have mental health courts]," Rhode Island, especially. With only one central prison, "everyone, anyone with minor crimes goes to [Rhode Island's] big prison. Even people with mental illness - even down to trespassing," she says.

But funds aren't allocated properly to allow for treating the criminally accused, says Sahlin. The most expensive way to care for the mentally ill is by putting them in prison. Yet society wants to put people in institutions and [prison] is the only place left.

"Recently, in Rhode Island, we had a judge who wanted to send a man to get mental health care," says Sahlin. "But for lack of any bed, anywhere, the judge had to send the man to prison. Even if we have a high level of awareness, the problem is the severity."

Sahlin says Rhode Island needs a more organized mental healthcare system. And with judges and Attorney General John O'Neal having expressed a willingness to participate, she feels it could and should happen if only the money could come through.

"Mental health care is the number one area of healthcare, more than any other, that runs totally backwards and deems your level of illness get very severe before it's treated," says Sahlin. "And this is going to lead to criminal action in some circumstances. Early access means early treatment: Who ever heard of cancer treatment being contingent on the idea that you have a tumor the size of a pea, but on principle [doctors] are not going to treat you until it's the size of a golf ball?"

But there's also the argument that assuming mentally ill people cannot be criminals is wrong. "They can," says Walters. "The two things can go hand in hand. The problem with the theory of mental health court is 'how are you going to separate between the two?'"

In Massachusetts, there's a group associated with the University of Massachusetts Worcester working on policy that could direct the state on creating some semblance of a MHC system. Former District Court Judge Maurice Richardson, who is now retired from the bench and has joined the UMass Medical Center for Mental Health Services Research, heads the group.

In 2001, Richardson launched a "jail-diversion" initiative that would help get mentally ill offenders arrested for non-serious crimes into treatment and avoid prison. Since then, programs like the Framingham Jail Diversion Program, a privately funded partnership between the Framingham Police Department and Advocates Psychiatric Emergency Services, has helped police and psychiatric care workers ride with one another and ensure that people picked up for criminal activity who are suspected to have mental illness receive proper treatment rather than linger in the court system.

However, sporadic jail-diversion programs seem to be the closest Massachusetts has gotten to an organized MHC so far. According to Walters, "It doesn't come up," she says, when asked if alternatives to the current judicial system are often discussed by her peers. "I know there has been some movement," she says regarding altering the current system in some way. "But in terms of mental health courts, I don't think there has been any movement," she adds.

However, if Massachusetts announced a trial run of MHCs, she'd support it. Largely because for many, the feeling is MHCs could go a long way toward diversion or helping to prevent arrests. Establishing mental health court in Vermont has been discussed briefly, says Rosanna Czermak, executive director of the Vermont Psychological Association, largely because in the court system, people with mental illness are often tried as criminals rather than as mental illness patients.

"Sometimes, when crimes are committed, they aren't necessarily done as deviant behavior but as [part of] a mental health condition," says Czermak. "We have to be able to differentiate between the two, but also protect against those who have mental health issues."

Mental health courts gain popularity (July 2005 Issue)

Mental health courts gain popularity
(July 2005 Issue)