Introducing Mental Health Courts

CREDIT: AP Photo/Charles Rex Arbogast

A shortage of in-house mental health services for a growing mentally disabled population, variations in the definition and management of psychological ailments, and lack of support for former inmates has created a national criminal justice system that has shortchanged millions of mentally ill inmates, a new Urban Institute report says.

Released by researchers at the D.C.-based think tank earlier this week, the nearly 60-page document shows that more than half of inmates in jails and state prisons struggle with a mental illness, particularly depressive disorder, bipolar disorder, and schizophrenia. However, only one-third of state prisoners and one out of six jail inmates in that large group reportedly receive mental health services upon their release.

But, according to the report, there may be some hope in mental health courts and other diversion services that aim to provide mentally ill offenders with alternatives to incarceration that tackle the root of why they committed crime in the first place. The Urban Institute research team said mental health courts, many of which have popped up since the turn the turn of the century, have some moderate success.

“Mental health courts have been effective. Studies show that they can mitigate the strain on the mental health care system to provide care,” Miriam Becker-Cohen, an author of the Urban Institute report, told ThinkProgress. “That was our major finding. Another way of addressing mental illness in the justice system is through effective reentry programs. That’s a critical time for all offenders. If they’re getting the necessary services they need in regards to housing, employment, and other things, that could affect their potential to return to the system.”

Since the Reagan Administration deinstitutionalized mental health services, prisons have turned into de-facto treatment centers where the mentally ill go once they come into contact with law enforcement. Between 1998 and 2006, the mentally ill prison population has more than quadrupled, with Rikers Island in New York City and Cook County Jail in Illinois serving as homes to the largest number of offenders with psychological issues.

Prison systems, however, haven’t been able to provide obligatory treatment that meets the needs of an increasing subpopulation of prisoners. Making matters worse are cuts to mental health care spending in states trying to remain fiscally solvent. Between 2009 and 2012, states slashed more than $4.35 billion in public mental health funds. Inside some jails and prisons, the results of lackluster mental health care have been disastrous. A 2014 New York Times investigation shed light on the culture of violence on Rikers Island with more than 100 reports of physical abuse of inmates, many of whom suffered from a mental illness.

In North Carolina, there’s little clarity about how long an inmate went without his medication before becoming dehydrated and dying in 2013. Reports say that officials at the maximum-security facility kept the inmate in handcuffs five days leading up to his death. The prison later blamed the incident on a “cascading failure by individuals in the custody, medical and mental health staffs to properly care for an inmate serving more than 30 years as a habitual felon.”

This particular issue with repeat offenders isn’t specific to North Carolina’s correctional system; recidivism rates among the mentally ill stand at more than 50 percent, according to research compiled by a team at the Mandel School of Applied Social Sciences. Becker-Cohen told ThinkProgress that the revolving-door-like fashion that the mentally ill return to prisons may be indicative of the need to provide services outside of those institutions for offenders.

“Many jails and prisons have limited capacity to provide the services to people with mental illness and that’s why diversion programs could be helpful because they get offenders into the treatment they need that the justice system can’t necessarily provide,” Becker-Cohen said. “Our country’s mental health laws are lagging behind our physical health laws. We hope those findings lead policy makers and practitioners to create uniform policies and following research is used to evaluate quantitatively and qualitatively help people who are suffering from mental illness.”

The Urban Institute report comes on the heels of a study released by the Seattle’s Law Enforcement Assisted Diversion program that showed the benefits of connecting low-level offenders — particularly those with mental health issues — with community health care programs, drug aversion resources, and job training. The study showed that those who took advantage of the program cut their chances of getting arrested again by 60 percent.

Some lawmakers seem to be getting the message. Last month, lawmakers in South Carolina unanimously voted to expand the state’s mental health courts for nonviolent offenders. In December, New York City Mayor Bill DeBlasio announced the launch of a multi-million dollar project that improves mental health screening for offenders before arraignment, restarts Medicaid for mentally ill inmates upon their release, and expands supervised pretrial programs and community services for 4,000 inmates.

“I think this is what criminal justice looks like in the 21st century,” Elizabeth Glazer, the mayor’s criminal justice coordinator, told the New York Times. “Preventing crime is about more than the police and more than about prosecutors and defense lawyers and courts,” said Glazer, also a co-chairwoman of a task force of city officials and community leaders that released a report.

However, questions remain about the effectiveness of jail diversion programs in reducing the mentally ill prisoner population. First, two out of three courts use jail time to punish those who don’t follow through with their treatment, a factor that could potentially exacerbate the problem. Experts say that the stigmatization of mental illness coupled with the assumption that the subpopulation has vastly different needs than their counterparts makes incarceration a recurring narrative.

A review of offender-focused and jail diversion programs in 2011 found that while community treatment initiatives reduced symptoms of mental illness in ex-offenders, they didn’t decrease rates of recidivism among that population. The study also determined that mentally ill inmates shared the same diagnoses, treatment needs, and risk factors — including antisocial behavior, family discord, a lack of recreational activities, and low work performance — with their counterparts who didn’t enter the justice system. Researchers concluded that clinicians should group returning citizens with mental ailments not by their offenses, but by their needs that, if left unaddressed, could lead to the commission of another crime.

Even so, people like KiDeuk Kim, another Urban Institute researcher and an author of the recent study, believe that diversion programs show potential, especially if states can synchronize standards of care and definitions of mental illness. “The purpose of the mental health court is not to strengthen mental health services in prisons,” Kim told ThinkProgress. “Hopefully, we can use them to divert the mentally ill from the prison system so that we can treat them better and help them reintegrate into society.”