Well-intentioned mental health courts can struggle to accomplish their goals

Mental health courts connect people to treatment and keep them out of prison. But they also often come at the price of a guilty plea, and participants say it feels like coercion.



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More than 2 million people booked into US jails each year have been diagnosed with a serious mental illness. In recent decades, programs have sprung up across the country to divert people from incarceration and connect them to help keep them out of prison. They are called mental health courts. Sam Whitehead with our partner KFF Health News reports that well-intentioned courts can struggle to fulfill those goals.

SAM WHITEHEAD, BYLINE: It’s an early December afternoon and Donald Brown (ph) is nervously waiting for the start of a mental health court hearing in Gainesville, Ga. In just a few minutes, the 55-year-old will find out if he has been kicked out of the diversion program for failing to fulfill work and community service obligations and possibly back in jail.

DONALD BROWN: I’m a little lost for words. I’m so scared. I mean, I don’t want jail. So I tasted going out. Coming back is just hard.

WHITEHEAD: Brown struggled with depression. Last year, he threatened her life with a gun. His family called 911 for help, police arrived and Brown was arrested and charged with felony firearm possession. After months in jail, Brown was offered access to court. If he pleads guilty, he will be connected to services and avoid jail time if he completes the program.

BROWN: You know, you were there for 10 1/2 months. You have no idea how you’re going to get out. It’s just like compulsion, you know? Here, sign these papers, you’ll get out of jail.

WHITEHEAD: Brown said the diversion program helped him stay sober and get medication for his depression, but keeping up with the program’s requirements was also stressful. If he gets fired, Brown worries he could face years in prison.

BROWN: I learned a new way of life. You know, instead of just getting high, you know, I’m learning to feel things now and make an effort to try and improve myself. For it to be locked up, it’s like a kick in the gut.

WHITEHEAD: You can find mental health courts in over 650 communities. There is no set way to run them, but generally participants receive treatment plans and access to counseling and medication. Judges and mental health clinicians oversee their progress. Lea Johnston is a law professor at the University of Florida. He said jails and prisons are no place for mentally ill people.

LEA JOHNSTON: But I’m also not sure that mental health courts are the solution.

WHITEHEAD: Johnston said the programs could distract policymakers from more meaningful investments.

JOHNSTON: The bigger problem is that they take attention away from more important solutions that we should be investing in, like community mental health care.

WHITEHEAD: Nearly 60% of participants completed programs in 2019, according to the National Treatment Court Resource Center. Researchers there say there is little evidence whether diversion programs improve mental health outcomes or affect recidivism in the long term. Kristen DeVall manages the organization. He said the courts cannot function properly when the social safety net is full of loopholes. Stable housing, counseling and recovery services can be difficult to find in many communities.

KRISTEN DEVALL: If all these other supports that are needed are not invested, then it’s kind of a wash.

WHITEHEAD: Critics of mental health courts say participation shouldn’t be paid for by a guilty plea. Raji Edayathumangalam, a licensed clinical social worker with New York County Defender Services, said judges are often not trained to make informed decisions about the care of participants.

RAJI EDAYATHUMANGALAM: Inappropriate. We are all licensed to practice in different professions for a reason, right? I can’t show up for a hernia operation just because I read about it or sit next to a hernia surgeon for 10 days.

WHITEHEAD: Some mental health court participants have praised the programs for helping them get their lives back on track. At a recent hearing in a mental health court in metro Atlanta, several participants personally thanked Judge Shana Rooks Malone. But one woman came out of the courtroom crying. He was sentenced to just seven days in jail for being dishonest about whether he was taking court-required medication. Malone, a lawyer by training, said he doesn’t want to go to jail.

SHANA ROOKS MALONE: But that particular contestant had some challenges. I’m rooting for her, but all the little punishments didn’t work.

WHITEHEAD: The last straw, Malone said, was to cut him out of the program entirely and send him to prison. Meanwhile, Donald Brown worries that it will ultimately be his fate. He avoided jail on an early December day. A hearing on whether he can remain in mental health court is expected in the coming weeks.

MartNEZ: That’s Sam Whitehead with our partner KFF Health News.

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