Mental health courts: a workaround for a broken mental health system.

AuthorAppelbaum, Paul S.
PositionSpecial Report on Mental Health

In the mid-1990s, Florida's Broward County had a problem. With a paucity of available mental health programs, police often had no alternative to arrest for people who were behaving bizarrely on the streets. Growing numbers of defendants with serious mental illnesses were appearing in criminal court, charged with crimes such as trespassing that often seemed driven by their disorders. After a short jail stay, usually without treatment, their charges would be dismissed or sentences reduced to time served by judges who knew that their reappearance in court was almost inevitable.

Judges around the country, usually with no background in mental health, faced dockets clogged with similar cases. Epidemiologic surveys of jails and prisons found that 14 to 24 percent of inmates suffered from serious mental illnesses, conditions more often neglected than treated during confinement. With little public interest in funding adequate services, the problem of how to deal with persons with mental disorders was being left to the already overburdened criminal justice system. Broward County, though, decided to do something to try to tackle the problem: it established the first mental health court (MHC) in the United States.

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Drawing on the earlier model of drug courts, aimed at treating rather than punishing addicts, MHCs were designed to divert defendants with serious mental illnesses from the criminal justice system. Models differ across jurisdictions: some MHCs intervene before trial, others only after a finding of guilt; misdemeanants are the exclusive focus of the Broward court, but defendants accused of felonies are also eligible in some places; most MHCs don't control their own treatment resources, but a small number--like the Miami-Dade program in South Florida--do. Violent or sexual offenders are often excluded from participation, and some jurisdictions impose other limitations. What they have in common is the ability to offer defendants the opportunity to avoid jail or prison time if they agree to follow a court-approved treatment plan. MHC participation is always voluntary, but participants who complete the program will have charges dropped or sentences suspended. However, failure to abide by the terms of the program can result in a return to the criminal justice system and the prospect of doing time.

MHCs are often paired with other reforms aimed at keeping the mentally ill out of jail. In Allegheny County, Pennsylvania, where...

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