Mental Health Courts: Essential Elements and Data Collection

1. Mental Health Courts:Essential Elements and Data Collection Lauren Almquist (Council of State Governments Justice Center)

2. Presentation Overview • Current state of the mental health court field • 10 essential elements of a mental health court • Mental health court research and data collection

3. Mental Health Court Field • There are currently over 200 MHCs across the country, possibly as many as 250. • Juvenile mental health courts are also emerging, with approximately two dozen at this time, with many more in the planning process. • MHCs are diverse, with some courts accepting only misdemeanors, some focusing on felonies, and others taking both types of charges. • MHCs also differ in the adjudication model used, with most, but not all, requiring a guilty plea before accepting individuals with felony charges.

4. Mental Health Court Field • The majority of MHC participants nationally have an Axis I mental health diagnosis, as well as a co-occurring disorder. • A number of states have developed mental health court grant programs or legislation, and others are moving forward on plans to go statewide. • At the federal level, the Bureau of Justice Assistance (BJA) provides grants to a number of jurisdictions planning or expanding a mental health court, through the Justice and Mental Health Court Collaboration Program (JMHCP).

5. Essential Elements of a Mental Health Court • Modeled on National Drug Court Institute’s 10Key Components • Reflects the consensus of criminal justice/mental health experts from across the country • Designed to identify key characteristics of mental health courts but allow for flexibility and differences in court models and procedures

6. 1. Planning and Administration A broad-based group of stakeholders representing the criminal justice, mental health, substance use treatment, and related systems and the community guides the planning and administration of the court.

7. 2. Target Population Eligibility criteria address public safety and consider a community’s treatment capacity, in addition to the availability of alternatives to pretrial detention for defendants with mental illnesses. Eligibility criteria also take into account the relationship between mental illness and a defendant’s offenses, while allowing the individual circumstances of each case to be considered.

8. 3. Timely Participant Identification and Linkage to Services Participants are identified, referred, and accepted into mental health courts, and then linked to community-based service providers as quickly as possible.

9. 4. Terms of Participation Terms of participation are clear, promote public safety, facilitate the defendant’s engagement in treatment, are individualized to correspond to the level of risk that the defendant presents to the community, and provide for positive legal outcomes for those individuals who successfully complete the program.

10. 5. Informed Choice Defendants fully understand the program requirements before agreeing to participate in a mental health court. They are provided legal counsel to inform this decision and subsequent decisions about program involvement. Procedures exist in the mental health court to address, in a timely fashion, concerns about a defendant’s competency whenever they arise.

11. 6. Treatment Supports and Services Mental health courts connect participants to comprehensive and individualized treatment supports and services in the community. They strive to use—and increase the availability of— treatment and services that are evidence-based.

12. 7. Confidentiality Health and legal information should be shared in a way that protects potential participants’ confidentiality rights as mental health consumers and their constitutional rights as defendants. Information gathered as part of the participants’ court-ordered treatment program or services should be safeguarded in the event that participants are returned to traditional court processing.

13. 8. Court Team A team of criminal justice and mental health staff and service and treatment providers receives special, ongoing training and helps mental health court participants achieve treatment and criminal justice goals by regularly reviewing and revising the court process.

14. 9. Monitoring Adherence to Court Requirements Criminal justice and mental health staff collaboratively monitor participants’ adherence to court conditions, offer individualized graduated incentives and sanctions, and modify treatment as necessary to promote public safety and participants’ recovery.

15. 10. Sustainability Data are collected and analyzed to demonstrate the impact of the mental health court, its performance is assessed periodically (and procedures are modified accordingly), court processes are institutionalized, and support for the court in the community is cultivated and expanded.

16. Mental Health Resources Criminal Justice / Mental Health Consensus Project Report Navigating the Mental Health Maze Judges’ Guide to Mental Health Jargon (JLI)

17. Mental Health Court Resources Guide to Mental Health Court Design and Implementation Coming soon! Mental Health Courts: A Primer for Policymakers and Practitioners BJA Mental Health Court Learning Sites

18. Effect on Recidivism A study comparing San Francisco BHC participants with group of people with mental illnesses booked into the county jail during the same period found that by 18 months BHC participants had a 26% lower risk of new criminal charges and a 55% lower risk of new criminal charges for violent crimes than the group of comparable individuals Participants in a North Carolina mental health court had a re-arrest rate of roughly half the rate of a comparison group, made up of individuals with mental illnesses who went through the traditional court system in the year before the mental health court began. Some studies found no great difference in jail time between mental health court participants and a control group of people in the traditional court system with mental illnesses, but have also found that MHC participants are LESS likely to incur new charges but more likely to serve jail time for a probation violation or sanction Mental Health Court Research

19. Mental Health Court Research Effect on Recidivism (cont) Studies found that graduation matters, people who participated in MHC but did not graduate did not have significantly different rates of rearrest than those in traditional court system. Effect on Mental Health Outcomes MHCs have been found to be effective in connecting participants to mental health treatment and the mental health of participants improves significantly, compared to before the program. However, the mental health outcomes are not always significantly different that people who receive treatment through the traditional system, both groups usually show improvement.

20. Mental Health Court Research Cost Effectiveness A study of the Allegheny County MHC found that the program did not substantially increase costs, at least in the short term, over traditional court adjudication and processing and in the second year of participation, there was the potential for cost savings. The study also found that as the seriousness of a person’s charge and the severity of the mental illness increased, so did the potential for cost savings through MHC participation.

21. Data Collection in MHCs • Guide to Collecting Mental Health • Court Outcome Data • Justice Center’s Data Entry System • currently being piloted by 6 Ohio MHCs • Goal of data entry system is to provide MHCs with an easy to use system of collecting standardized data on participants in order to: • Understand the effectiveness of court practice on key outcomes • Use data to sustain and expand MHC programs

22. MHC Data Entry System

26. To download the Essential Elements, visit http://consensusproject.org/mhcp/essential.elements.pdf For more information on mental health courts or to receive hard copies of materials, contact Lauren Almquist (lalmquist@csg.org; 646-383-5743). http://justicecenter.csg.org/