Researcher, Office of Criminal Justice Services.
Studies conducted nationwide show the disproportionately large number of individuals with a severe mental illness currently held in our jails and prisons.1 There is a growing need to identify and divert this growing population out of the criminal justice system and into the mental health system where those individuals can receive proper treatment. In 1999, Akron, Ohio took steps to respond to this need by establishing a mental health court, the first of its kind in Ohio. According to its mission statement,
[t]he Akron municipal mental health court is dedicated to diverting persons with mental illness from the local jail and the criminal justice systems. The Akron municipal mental health court offers a therapeutically jurisprudent approach to support a psychiatrically stable and crime-free lifestyle for persons with mental illness.
The Ohio Office of Criminal Justice Services (OCJS) is currently funding a project led by Dr. Christian Ritter (Kent State University), Dr. Karen Gil (NEOUCOM), and Dr. Mark Munetz (NEOUCOM, Akron ADM board) that addresses the court's impact on recidivism and other criminal justice and non-criminal justice measures. Given the relative newness of the court, and the potential impact its success or failure could have on the implementation of other mental health courts in Ohio, OCJS conducted a case study of the court. This study focused on the structure and function of the Akron mental health court, including how the court was initiated, what agencies and individuals are instrumental in the court's dayto-day operations, how collaborations among entities were developed and how they are sustained, and how the Akron mental health court functions as a whole to serve the client. The goal of this study is to provide feedback to the Akron mental health court so that the court can more effectively meet the needs of not only the clients but also the team members working within the mental health court system. An additional goal of the study is to provide information to other courts that are considering implementing a mental health court in their own jurisdictions.
The Akron mental health court is a specialty court designed to divert from jail individuals who, as a result of their illness, commit crimes. The court accepts as clients those individuals diagnosed with a severe mental disorder. The clients must meet the following requirements to be eligible for the program:
* The defendant must have a primary Axis I diagnosis of schizophrenia, schizoaffective disorder, or bi-polar disorder.
* The defendant must be charged with a non-violent misdemeanor offense. Fourth degree misdemeanors are not accepted unless they have multiple prior offenses that require them to be jailed for a minimum of ninety days. Violent offenders may be taken into the program only with the victim's consent. Sex offenders are not eligible.
* The defendant must be willing to take medication.
* The defendant must understand the requirements of mental health court and the consequences of failing to comply with the requirements.
* The defendant must be able and willing to comply with the orders set forth by the court.
* Repeat offenders are targeted for the program; however, first-time offenders who are otherwise eligible for mental health court are also considered.
Clients who enter the program plead no-contest with a finding of guilt to the crime for which they are charged, and they are placed on probation for a period of two years. The goal of the program is to transition the client from a highly restrictive environment involving intensive case management to a much less restrictive environment involving minimal case management. There are two phases to the program. Each phase consists of several steps that the client must progress through. In Phase I, the client's needs are assessed. In addition to receiving intensive case management, the client is provided with numerous services, including temporary housing placement, vocational and residential counseling, chemical dependency treatment, group and individual therapy, and medication monitoring. The client is expected to meet regularly with the judge, starting with weekly visits to the courtroom that decrease in frequency as the client demonstrates his or her responsiveness to the program. The client is expected to remain in Phase I for approximately a year, although this can vary from client to client. If the client demonstrates the ability to maintain significant periods of psychiatric stability, crime- free and drug-free behavior, stable housing, and participation in structured activities of daily living, the client is then transitioned to Phase II, in which he or she is paired with a more "traditional," less intensive case manager. Page 977 Successful completion of the two-year program culminates in the client's graduation from mental health court. The client's original charges are subsequently dropped.
Rewards and sanctions are a fundamental component of the mental health court. Positive behaviors are reinforced with public acknowledgment, certificates of achievement, gift certificates, and rewards such as hats and umbrellas. Typically, rewards are given as a person moves to a new step or phase of the program, although they may also be given for periods of sobriety and for faithfully keeping appointments. Sanctions are given for a variety of behaviors, including drug/alcohol use, foul or inappropriate behavior, and failure to keep appointments. The severity of the sanctions is graduated, such that repeated misconduct by the client results in a harsher sanction than an isolated or first-time incident. In the extreme case of noncompliance with mental health court rules, a person may be terminated from the program.
Discussion of the mental health court began in 2000. There was no real impetus for implementing the court, other than the growing awareness that severely mentally ill individuals were increasingly finding themselves caught in a "revolving door" in and out of the criminal justice system and were never able to receive the assistance they required. This growing awareness was partly attributed to the establishment of a drug court in Akron. A significant proportion of the clients entering drug court suffered not only from substance abuse but also from a mental disorder. At that time, Judge Elinore Marsh Stormer, the judge who initiated the mental health court, presided over the drug court. Other municipal court judges were also very aware of the significant number of individuals with mental illness who were passing through their courtroom. One judge estimated that more than fifty percent of the people he saw prior to the establishment of a mental health court had a substance abuse problem, a mental illness, or both.
Before the mental health court began, individuals suspected of mental illness had to wait up to six weeks in jail before a psychological assessment could be performed. For those individuals who were put on probation, one judge stated that he would try to pair the individual with a probation officer who was more knowledgeable of mental health issues, but doing so still did not provide the many services that a person with mental illness needs.
Meetings initially involved Judge Stormer and members of the Akron ADM board. The ADM board asked the National GAINS Center for People with Co-Occurring Disorders in the Justice System to do an evaluation of the courts and make recommendations. Several steps were taken on the basis of their recommendations. A forum was created to facilitate criminal justice treatment interactions (the Criminal Justice Page 978 Forum), a law enforcement Crisis Intervention Team (CIT) was formed, and a mental health court was initiated. The criminal justice forum came first, and CIT began shortly thereafter. Once it was determined that a mental health court should be developed and the concept was approved by the other Akron municipal court judges, those individuals and agencies who were determined to be critical to the court's implementation were brought in to meetings. These meetings began in May 2000. Other than Judge Stormer and members of the ADM board, these individuals included the chief probation officer and an additional probation officer who would later become chief probation officer of the mental health court, treatment providers and administrators from mental health agencies including CSS, Oriana House, Northcoast Behavioral Healthcare System, and Psycho- diagnostic Clinic, a representative from the defender's office, a member of law enforcement, and a representative from the Adult Parole Authority. This group met monthly until November 2000. At this point, Judge Stormer decided to begin implementing the program in January 2001.
Very few financial resources were required to...