‘The Court of a Million Chances’

The Brooklyn (NY) Mental Health Court is an impressive example of how diversion to treatment and counseling can help the seriously mentally ill who run afoul of the law. But although such courts are spreading around the country, they represent only part of the solution.

In a snug Brooklyn, NY courtroom a few months ago, Frederick, a middle-aged Latino, was called up to the bench by presiding Judge Matthew J. D’Emic.

Striding forward confidently, Frederick reached up and shook the judge’s hand with a smile, and received a warm smile in return.

“How are you doing?” the judge asked.

“I’m great,” replied Frederick, handing the judge a business card, adding that he kept busy working as a counselor for men and women coping with mental illness.

Frederick probably knew as much about that as someone who had trained in the field for years.

He’s a participant in the diversion program operated by the Brooklyn Mental Health Court (BMHC), which allows seriously mentally ill defendants accused of a felony to accept a plea of guilty and receive treatment for up to 18 months in lieu of jail.

That October day, Frederick received both his graduation certificate and dismissal of all charges against him—and observers heard something not usually associated with a courtroom.

Applause.

“If I can do it, you can too,” Frederick called to those awaiting their turn as he left the court.

For advocates of mental health courts, the outcome of Frederick’s case was proof that problem-solving models like the BMHC, which combine patience and respect with aggressively monitored, long-term treatment, can successfully divert the mentally ill from jails and prisons that are otherwise only likely to worsen whatever conditions they have.

But the reality is much more complex. Many criminal justice experts argue that mental health courts are only one part of the solution.

Matthew D'Emic

Judge Matthew J. D’Emic. Photo courtesy mental illness police.org

Although their number has grown enormously since 1997, to almost 400 nationwide today, they are unlikely to be able to address the sheer scale of the problem, according to Dr. Fred Osher, Director of Health Systems and Services Policy for the Council of State Governments Justice Center.

“[Mental health courts] demonstrate that with appropriate supports and treatments you can get better outcomes,” said Osher, whose organization focuses on creating safer communities by providing policy guidance to elected state officials.

“But we would be remiss if we said a mental health court… is going to solve the scale of the problem of the underrepresentation of people with mental illness.”

According to the National Alliance on Mental Illness, more than two million people are arrested and booked into jails each year. As recently reported in The Crime Report, on any given day, there are approximately 360,000 people with serious mental illnesses in jails and prisons, and another 760,000 under correctional supervision.

Housing is the ‘Biggest Problem’

“The biggest problem is housing,” said Colleen King of Brooklyn Defender Services and a veteran defense attorney at Judge D’Emic’s court.

King noted that the Brooklyn Mental Health Court does not like to release clients to shelters, where it is very difficult for them to navigate treatment and medications, and there is always a long wait to get housing. According to a recent The New York Times article, housing for the mentally ill in New York City is in chaos, with nearly 4,000 needy individuals without access to supportive housing.

“There aren’t that many modified therapeutic communities or supportive housing beds,” she added.

In New York, the Harbor House & Harbor House II, located in The Bronx, are two such facilities. They serve as rehabilitation centers for the mentally ill and addicts by providing housing, treatment, and counseling for those granted entry.

However, both houses combined only offer 109 beds, and the community is not a cookie-cutter. They are the only such facilities in the city. Thus, because beds are scarce and every mentally ill client needs something different, many don’t get in.

Housing for the mentally ill is a nationwide issue, with other states, such as California, Maryland, and Oregon, reporting an inability to provide supportive housing. Though King praised the Brooklyn Mental Health Court’s flexibility and willingness to expend all options when the first one fails, they, and courts like them, can only utilize the resources available in the communities they serve.

“A lot of my clients are homeless,” said King. “Having a safe place for them to go to that is outside the shelter system [is a challenge].”

In fact, according to MentalHealthPolicy.org, a nonpartisan think tank providing information about the care and treatment of people with serious mental illness, of the estimated 564,708 homeless individuals in the United States in 2015, 140,000 were believed to be suffering from a serious mental illness, while another 250,000 had symptoms of general mental illness.

Without the necessary housing for those they divert, mental health courts are left treading water as their mentally ill clients simply rotate through the system.

“If you don’t have someone housed when they’re coming out of jail, the success rate [of mental health courts] is going to go way down,” said Judge Steven Leifman, a Miami-Dade County judge and pioneer of the Eleventh Judicial Circuit Criminal Mental Health Project.

While Leifman admitted that Miami is one of the only U.S. communities with a dedicated tax for homelessness—allowing them to provide better housing than most—he maintained that resources are still a problem.

Mental health courts, he told The Crime Report in an interview, must focus on getting the people best served by the system into treatment programs first.

“In some situations, because people don’t understand these cases as well as they should, they tend to want to take cases that are at lower risk,” said Leifman.

“The chances of them reoffending are really low, the acuity of their illness isn’t that high, and they’re easier cases.”

While this can create more supposed success stories for the court, Leifman said, in the long run, focusing on those who represent less risk and lower needs wastes valuable resources on people who, arguably, would be fine without them.

Instead, he continued, mental health courts should focus on their highest risk/highest needs population, those who are most likely to get into trouble again and, thus, cost the most.

“We looked at thousands of people arrested in Miami-Dade who we knew had a mental health issue,” said Leifman.

“Ninety-seven people over a five-year period were arrested 2,200 times, spent 27,000 days in jail, and 13,000 days at a crisis unit/emergency room, costing $13.7 million. That’s who you want a mental health court to focus on.”

To tighten their net, Leifman suggested mental health courts should become part of a bigger process, where they work with the community, prosecutors and the defense bar to identify those best suited for their programs.

Crisis Intervention Teams

Police officers working in Crisis Intervention Teams are trained to identify the symptoms of mental illness and how to deescalate situations so that arrest is only a last resort. Such strategies, along with good diversion programs, make mental health courts more effective, he said.

Similar collaborations in the Miami-Dade program, Leifman argued, reduced the number of arrests in the county by half since 2008, and contributed to a decline in recidivism rates of mentally ill offenders from 70 percent to 20 percent in the same period.

Leifman is also creating a new facility that brings together law enforcement, criminal justice, and medical professionals under one roof, specializing in rehabilitation over punishment. In this way, he hopes to further weed out those who don’t need to be in custody and divert them to treatment immediately, instead of clogging the system with unnecessary cases and, as a result, further criminalizing the sick through arrest and jail time.

“Mental health courts should be used as part of that bigger diversion process,” said Leifman.”If you do it that way, they are excellent tools and they can have a very valuable role.”

However, according to Carol Fisler, the Director of Mental Health Court Programs at the Center for Court Innovation, while mental health courts are effective in diverting people who need it into treatment, a common mistake among those involved in the operations of those courts is to solely focus on bringing symptoms under control and considering the job done.

“They continue to be focused on thinking that mental illness is a much more direct contributor to crime than is the case,” said Fisler, adding that this is generally now accepted as an incomplete logic model.

In fact, according to a 2014 study by the American Psychological Association, which examined the relationship between the symptoms of mental illness and crimes committed by mentally ill subjects, mental illness has a much smaller role in crimes committed than people believe.

Of the 429 crimes coded for the study, only one-fifth were found to be directly related to the symptoms of mental illness.

Fisler believes that these numbers point to a need for more than just a court-monitored system of incentives and sanctions that are concerned solely with a person taking their medication and attending counseling—if mental health courts are to truly reduce recidivism.

Looking Past the Finish Line

They require looking ahead, past the finish line of a relatively short court program, and towards engaging people in civic society and the legal process, as much as in treatment.

“The research shows that treating symptoms does not necessarily reduce recidivism,” said Fisler.

“In the court process itself we should really be encouraging courts to put in practice principles of procedural justice.”

Emphasizing a more respectful and helpful court process, one where the individual can participate and understand his or her rights, the language used in court, and the decisions made, Fisler said that procedural justice garners a greater sense of trust in the neutrality of the court and the caring intent of all those involved in its management.

In a recent study examining and comparing mental health court methods in Washington D.C., courts that utilized this procedural model achieved much lower recidivism rates than courts adhering to more punitive modalities.

“What you’re really trying to do is change people’s behavior,” said Fisler.”The way you interact with people is a very powerful way of changing that behavior.”

At the BMHC, these tenets of procedural justice are common practice. Officials there establish a therapeutic relationship that focuses on respect, patience and understanding. In court, defendants often communicate with the judge directly regarding their progress, discuss and arrange their own treatment plans with social workers and caseworkers, and have an active role in their own rehabilitation.

Above all, they are afforded the understanding that rehabilitation takes time.

“People are going to struggle; it’s very rarely a straight road,” said Ruth O’Sullivan, the Project and Clinical Director of the BMHC.

Though some may sail through their program, O’Sullivan says most don’t, and the court as a whole tries to do whatever it can to help in a variety of ways. For participants who won’t join their program, Judge D’Emic has been known to make them come to court every week and sit there until they eventually decide they’d rather be in treatment.

Other times, O’Sullivan and her team of caseworkers, therapists and medical practitioners will go to the programs themselves, do case conferences, and find out why the client is struggling. If it’s a medication issue, they will interact with providers and see if changes should or can be made.

“We’ll try any different way that we think we can to help people through,” said O’Sullivan.

Dealing with Substance Abuse

In addition to these issues, the court must also account for substance abuse in their clients.

According to a 2014 survey by the Substance Abuse and Mental Health Services administration, of the estimated 43.6 million American adults experiencing some form of mental illness approximately 7.9 million had a co-occurring substance disorder.

In a mental health court, this represents a challenge because the client’s mental health can only be dealt with once he or she has been confirmed sober and stable.

Therefore, the key is to make sure that the treatment services and modality of the treatment are all co-occurring, meaning that they’re addressing both the person’s mental illness and their addiction at the same time, while also maintaining a fair understanding of the realities of addiction.

“We believe we’re the court of a million chances,” said O’Sullivan.

“If someone relapses, and they know that they need help and they’re willing to do what they need to do, we’ll try to get them into detox and rehab, get sobriety under their belt, and then get them back into treatment.”

However, while this alternative court model has been implemented in states across the country, some still adhere to a traditionally punitive system.

A 2016 Spotlight series on the mentally ill in Massachusetts found that a majority of the state’s mentally ill offenders struggle through a system with few options, and that many judges still look at punishment as the best solution, frequently recommending jail time for minor probationary infractions and drug relapses.

According to David Kelly, a Kings County assistant district attorney and founding member of the BMHC, the solution to outdated practices and stigma like these is training and in-service education.

“It’s a question of getting the word out and tamping it down when you see it,” said Kelly, who admits that, when the court first opened, he would encounter fellow ADA’s who imagined themselves psychiatrists.

“They would say, ‘he doesn’t look sick to me, I’ve seen him in the car park, he knows what he’s doing.’ That’s not how you diagnose somebody.”

It is Kelly’s responsibility to educate these people, on each and every case, if necessary, warning them to never prejudge, and to leave diagnosis to the professionals. In addition, along with the District Attorney’s office, the BMHC conducts anti-stigma and procedural training at least twice a year, inviting judges to participate, and holding talks with former defendants to learn exactly how to conduct their court in the way that they felt yielded the best result.

At the Council of State Governments Justice Center, a multimedia curriculum has been developed for fledgling mental health courts, one that emphasizes seeking out methods that have a proven effect on behavior, working out how best to implement these methods, and constantly seeking out new means of improvement.

The end goal is a court like the BMHC.

“One of the secrets of D’Emic’s courtroom is the fact that his court officers are highly well trained, and his officers know how to treat people with respect and kindness,” said Kelly.

“That’s how you do it.”

In the face of a fractured mental health system, the burden of the seriously mentally ill continues to fall on the criminal justice system.

Mental health courts, rather than a broad solution to the general problem, are best used when considering the diversion of a small percentage of that target population. However, even that small percentage can fall through the cracks without accessible housing, quality training, and a layered diversion process.

Therefore, a change in narrative must occur, one that involves more than treating the behavioral problems that brought someone to court in the first place.

“It’s not just a question of managing symptoms,” said Fisler.

“Maybe if rehabilitation is the goal, we should be looking at the drivers of criminal activity.”

Isidoro Rodriguez is a New York-based writer and a regular contributor to The Crime Report. He welcomes comments from readers.

from https://thecrimereport.org

Drug Courts Produce Modest Results Per Federal Report

Observations Do drug and other specialty courts reduce recidivism? President Trump Wants Drug Courts-Do They Work? Like evaluations of programs for serious offenders, outcomes for drug, mental health, and veteran’s courts are limited to small decreases in recidivism. For many, the focus is on low-level, low-risk offenders who may not need intensive treatment. Author Leonard […]

Observations Do drug and other specialty courts reduce recidivism? President Trump Wants Drug Courts-Do They Work? Like evaluations of programs for serious offenders, outcomes for drug, mental health, and veteran’s courts are limited to small decreases in recidivism. For many, the focus is on low-level, low-risk offenders who may not need intensive treatment. Author Leonard […]

from https://www.crimeinamerica.net

Imprisoning the Mentally Ill: America’s ‘Shameful Tragedy’

Efforts to close facilities like the Rikers Island jail complex in New York won’t work unless authorities find alternative ways to deal with seriously mentally ill individuals who run afoul of the justice system, New York’s former chief judge told conference-goers last week.

Efforts to close down Rikers Island, America’s largest jail complex, need to begin with finding effective alternative treatment for mentally ill individuals who are confined behind bars because there are no other places for them to go, according to New York’s former chief judge.

“These people are not in Rikers because they’re hardened criminals,” said Jonathan Lippman. “They’re there because they have a problem, (and) they don’t need to be brutalized by a penal colony that is a relic of the past.

“Instead of tough or soft on crime, let’s be smart.”

Lippman, who served as Chief Judge of the New York State Court of Appeals between 2009 and 2015, spoke at an October 4 forum on the future of the Rikers Island facility, which authorities have promised to close within 10 years.

He was chair of the Independent Commission that produced the April 2017 report recommending the closure of Rikers.

The Hon. Jonathan F. Lippman. Photo by Models for Change via Flickr

The forum, entitled “Closing in on Closing Rikers,” was held at Baruch College of the City University of New York, and examined viable alternatives to prison for the mentally ill that have enjoyed success in other states.

At Rikers, 19% of the inmates have been diagnosed with a serious mental illness.

“We’re not getting at that population yet, but if we’re going to close Rikers we have to do so,” said Cheryl Roberts, Executive Director of The Greenburger Center for Social and Criminal Justice, a nonprofit organization advocating for justice reform that co-sponsored this event.

Working with the New York Daily News and the Metro Area Industrial Foundation, The Greenburger Center invited behavioral health care expert Leon Evans, President and CEO of the Center for Health Care Services in San Antonio, Texas; and Miami-Dade County Mental Health Court Judge Steven Leifman—both of whom have pioneered strategies aimed at finding alternatives to incarceration (ATI) for the seriously mentally ill.

Leifman told the group he is still horrified by the memory of his visit years ago to a mental health hospital in Miami-Dade County while he was an intern for a prominent Miami legislator.

“I walked into a hellhole,” he said, recalling the sight of one teenager strapped to a bed and given thorazine which made him overweight. The teenager, it turned out, was not there for psychiatric treatment; he was autistic.

In another part of the hospital, he witnessed six naked men being hosed off by a guard as if they were animals.

But today, he pointed out, the mental health system’s failure to provide adequate care for troubled individuals has only shifted the burden to jails and prisons.

“(Some) 40% of all people with mental illnesses in this country at some point in their life will come into contact with the criminal justice system,” said Leifman, who has been one of the country’s most influential advocates of ATI.

Other participants in the forum included New York City Council Speaker Melissa Mark-Viverito, an outspoken advocate for local and national criminal justice reform.

“Looking at the way we look at incarceration, and having the punishment fit the crime, is critically important,” said Speaker Mark-Viverito.

In support of this idea, to date, Speaker Viverito and the New York City Council have contributed over $6 million to ATI initiatives, and recently passed the Criminal Justice Reform Act which decriminalized non-violent, low-level offences and replaced them with a summons.

The Act is a boon for the homeless and mentally ill that frequent New York City streets and subways.

“When you think about incarcerating someone for public urination, it’s unpleasant, but does that really make sense?” asked Speaker Viverito, who believes that authorities have to re-envision their approach to non-violent offenders who are apprehended for minor crimes—if they are ever to reach their goal of permanently closing Rikers.

According to the National Alliance on Mental Illness, more than two million people are arrested and booked into jails each year. A 2010 survey by the Treatment Advocacy Center found that people with mental illness are nine times more likely to be incarcerated than hospitalized, and 18 times more likely to find a bed in the criminal justice system than at any state and civil hospital.

These statistics are reflected in Rikers where, according to a 2015 New York Times article, a total of 4,000 men and women with diagnosed mental illnesses are incarcerated at any given time.

This number represents more than all the adult patients in New York State psychiatric hospitals combined.

But the problem is nationwide, according to Judge Liefman.

“On any given day, there are approximately 360,000 people with serious mental illnesses in jails and prisons and another 760,000 under correctional supervision,” he said.

“This is a shameful American tragedy and it must and can be reversed.”

To demonstrate what can be done to achieve this goal, Leifman discussed the Eleventh Judicial Circuit Criminal Mental Health Project, which he implemented in Florida in 2000. The project seeks to steer people with mental illness that have committed low-level offences away from incarceration and towards community-based care.

“Anybody that gets arrested on a misdemeanor in dade county, within three days they are evaluated and transferred from jail to one of our public or private crisis stabilization units,” said Leifman.

“Because they are on a criminal hold, we can reset the case to a few weeks, give them an opportunity to stabilize, have a team go see them, and offer them an opportunity to come into the program.”

If the person is accepted into the program, they can be in from three months to a year, depending on their illness and charges. While there, they are helped to find housing, clothes, benefits, and are assigned a peer counselor and case management assistance to lower their chances of reoffending.

Leifman said that, as a result of this program, recidivism rates in arrests of the mentally ill have, to date, fallen from 70% to 20%.

This focus on treatment and diversion over arrest and incarceration is believed by the criminal justice community to be the best option for improving what is considered a broken and costly system.

Miami-Dade County Judge Steven Liefman. Photo by Isidoro Rodriguez

According to a 2014 report from The Hamilton Project at the Brookings Institution, the U.S. spends $80 billion on incarceration costs every year. By relying on the criminal justice system to provide services, taxpayers are losing money by putting away people who come out worse than when they went in, Liefman observed.

“It’s gotten so bad that our communities are now having to choose between building a new jail and a new school or hospital,” he said.

“There’s something wrong with a society that is more willing to incarcerate its (population) than it is to treat it.”

For Judge Lippman, Rikers Island is a symbol of the misguided idea that mass incarceration has any rehabilitative function.

“Whether you’re there for three days, three weeks, or three years, you wind up in a much worse place than when you came in,” said Lippman, who agrees that diversion and treatment are the best course of action.

“It’s not just about punishing people, but it’s what the outcomes are for people coming into the criminal justice system and the impact on society.”

In addition, through research for his report recommending the closure of Rikers, Lippman found that by closing the prison, and focusing on smaller, more up-to-date facilities, New York would save over $1 billion annually.

The first step, in his mind, is lowering the prison population from 10,000 to 5,000, and the mentally ill are a key population.

“We need programs to focus on mental health in particular,” he said. “Programs that identify people with mental health problems before they get into the system.”

He cited programs such as Crisis Intervention Training (CIT), which police departments around the country, including New York, Texas, and Florida, have begun implementing with some success.

Focusing on de escalation, conflict resolution, and training to identify the symptoms of mental illness, CIT enables officers to decide if diversion is a necessary response to any situation.

“From 2008, when we started CIT, we had 117,000 arrests in Dade County,” noted  Leifman. “This year , it was 56,000. Our jail audit went in half,”

According to Evans of San Antonio’s Center for Health Care Services, CIT-trained officers working with his program’s “one-stop shop” for treating the mentally ill and others in crisis were able to decrease the county jail population by 22%.

“Treatment does work,” said Evans, whose center offers psychiatric care, substance use services, and general healthcare. However, he stresses that the success of these kinds of programs depends on collaboration.

While first serving as the Director of Community Services for the Texas Department of Mental Health and Mental Retardation, Evans became aware of all the people in the prison system of Texas who shouldn’t be there.

He immediately began working on an idea for a diversion program that would break the pattern of criminalizing the mentally ill in his county. However, in trying to get various departments and elected officials together, Evans experienced a lot of push back.

“Almost everybody said, ‘that’s a great plan, but not with my money,’” said Evans. “So, I went to the county judge.”

Working alongside the then newly appointed County Judge Nelson Wolff, Evans utilized this political muscle to help convene a health summit. Gathering together hospital executives, lawmakers, law enforcement officials, and business representatives, he built support for a more pragmatic and beneficial mental health system; one that meant less money spent on criminal justice, less-crowded hospitals, and homeless-free streets.

As a result, since the program’s implementation in 2002, Evans reported that recidivism rates for the mentally ill in his county currently stand at 6.6%, versus the national average for felons after release of 43% as reported by the Pew Research Center, and that taxpayers in San Antonio and Bexar County have saved more than $50 million over the last five years.

It is an example of cooperation and cohesion that he insists is necessary to emptying out jails and prisons like Rikers around the country.

“Be brave enough to talk about what doesn’t work, collect the data,” said Evans. “It’s not about who’s doing good or who’s doing better, it’s about improvement.”

According to Leifman, thanks to benefits like the passing of Kendra’s Law and access to extended Medicaid, New York is, in some ways, ahead of the game.

“We just got the law changed to be able to expand our AOT, which is an amazing pool for (the mentally ill) population,” said Leifman. “That’s one of the things you already have with Kendra’s Law.”

Effective since November of 1999, Kendra’s law grants judges the authority to issue orders that require people who meet certain criteria to regularly undergo psychiatric treatment. Coupled with mental health courts, which offer early screening in the court system, the law is a powerful tool in identifying and diverting the mentally ill out of the criminal justice system and into developing ATI programs such as the Greenberger Center’s own Hope House.

Scheduled to open in the Bronx in 2018, Hope House will be an assisted outpatient treatment center offering care and services comparable to the programs developed by Leifman and Evans.

The access to extended Medicaid allows prisoners to apply for insurance coverage while incarcerated and access said coverage upon release, the often impoverished mentally ill will have access to the funds needed to maintain medications and care.

Participants in the forum agreed that though many steps have been taken in the right direction, there is no one solution to the problem of Rikers, and no quick fixes in a system that still suffers from a “tough on crime” policy that stubbornly fails to acknowledge the data and science fueling the effort for change.

Joking that his program is an “overnight 17-year success,” Evans pointed out that achieving change and cooperation required the aid of a County Judge willing to bring together the community and make everyone work towards a solution.

He warned that what worked in one county in one state may not succeed elsewhere.

New York City Council Speaker Melissa Mark-Viverito. Photo courtesy Wikipedia.

“Change is hard,” said Evans. “There’s so much politics involved, there’s so much money involved, and nobody wants the spotlight on them.”

Speaker Viverito agreed.

“Yes, we’re starting to see some sort of conversation and change of view and perspective on a national level,” she said. “But it’s still very challenging to get people to think that incarceration is not the only solution to the problem.”

Though the Criminal Justice Reform Act passed, and seemed a simple solution to ebbing the tide of New York’s incarcerated, it, nonetheless, met with controversy and resistance.

“People thought that we were having the city run amuck,” said Viverito.

“Bringing the mental health challenges to the forefront and making sure it’s not a conversation that is held behind closed doors will take us a long way to dealing with the issue,” said Viverito.

Isidoro Rodriguez is a New York-based contributor to The Crime Report. He welcomes readers’ comments.

from https://thecrimereport.org

Will Federal Alternative-to-Prison Programs Survive the New Administration?

The future of Obama-era initiatives to offer reduced time for federal offenders if they complete programs of counseling is uncertain, says the U.S. Sentencing Commission. But it called for more studies of their effectiveness.

Emerging efforts to develop alternatives to incarceration for federal offenders have an uncertain future since drug sentencing guidelines were toughened by the Department of Justice this year, says the U.S. Sentencing Commission (USSC).

The charging and sentencing policies outlined by Attorney General Jeff Sessions in a May 10 memo “may have the effect of limiting the number of participants in the federal alternative-to-incarceration programs,” the USSC said in a report released this week.

“Without the support of the government, some of these… court programs may cease to exist, at least in their current forms.”

Alternatives-to-Incarceration (ATI) programs, in the form of drug courts, mental health courts and so-called “therapeutic” or “problem-solving” courts have been a fixture on the state judicial landscape for more than two decades.

Since the first drug court was launched in Miami in 1989, over 4,000 such alternative state courts now exist around the U.S.. Today, an estimated 55,000 adult state offenders participate annually in drug courts alone.

The state programs have been supported by national organizations such as the National Center for State Courts and the Conference of Chief Justices. However, they have also raised questions about their effectiveness in treating addiction or reducing recidivism.

At the same time, the USSC noted the “cost savings” realized from reduced prison beds and other factors is one reason they have been supported and promoted as a viable alternative to lengthy terms behind bars.

Nevertheless, such courts have been slow to emerge at the federal level, partly as a result of perceived conflicts with the 1984 Sentencing Reform Act and Supreme Court decisions. Today, federal ATI programs operate in 17 districts around the U.S.

Unlike “diversion courts,” which divert individuals to alternative channels such as treatment that will avoid a criminal record, the federal ATI courts offer convicted offenders an opportunity for reduced time if they successfully complete a program of counseling.

The USSC studied five federal ATI programs in an effort to assess their record in reducing recidivism, but concluded that there was still insufficient data to determine their overall success. It observed that the criteria used in evaluating the success of state programs did not automatically translate into evaluations that could be applied at the federal level.

“Proponents of (these) programs have pointed to limited data showing low recidivism rates of graduates of certain programs,” the study said.

“Although important, such data needs to be supplemented with data showing both the long-term recidivism rate of participants who did not successfully complete the programs, and the long-term recidivism rate of a meaningful comparison group of similarly situated offenders who received traditional dispositions of their cases.”

The five programs examined were:

  • South Carolina’s “Bridge Program” for drug abusers, launched in 2010;
  • The Conviction and Sentence Alternatives (CASA) program in the Central District of California;
  • The Pretrial Alternatives to Detention Initiative (PADI) in the Central District of Illinois;
  • The Repair, Invest, Succeed, Emerge (RISE) program of the District of Massachusetts;
  • The Sentencing Alternatives Improving Lives (SAIL) program of the Eastern District of Missouri.

Most of the programs involved only small numbers of federal offenders, relative to those charged and sentenced in traditional ways, but USSC staff interviewed judges, attorneys and other stakeholders in an effort to identify the areas that needed further study by social scientists.

The programs were “collegial” in stark contrast to the adversarial nature of federal courts, the USSC said.

“The presiding judge often does not wear a robe and sits at a table with the other team members rather than on the bench, (and the programs) involve weekly or semi-monthly meetings with multiple participating defendants,” the study reported.

Similar to state programs, the federal court teams typically address specific mental health and substance-abuse issues afflicting a defendant, and they work as well to improve defendants’ lives through counseling on family relationships, physical health, education and employment.

Nevertheless, the USSC observed that the handful of evaluations of federal “reentry” court programs so far showed results that were “mixed at best” in terms of their effectiveness and their rehabilitative potential compared to traditional supervisory programs.

The study said the programs needed more examination, for example, of the role of judges in such courts, and an analysis of whether they resulted in genuine cost-savings to taxpayers.

“Not only are the programs relatively new in the federal system and only have graduated a small number of participants to date, they have also developed in a decentralized manner and differ from each other in significant respects,” the USSC said. “Thus they cannot yet be evaluated empirically to determine whether the programs meet their articulated goals.”

The USSC acknowledged that the new Justice Department’s hardline approach to drug sentencing might make such questions academic.

The nascent federal ATI programs are an outgrowth of Obama-era reforms, encouraged by then-Attorney General Eric Holder as a way of prioritizing alternatives to lengthy drug sentences.

But the May 2017 Sessions memo effectively reversed the trend, calling on federal prosecutors to charge and pursue “the most serious, readily provable offense(s)…those that carry the most substantial guidelines sentence, including mandatory minimum sentences.”

At the same time, the USCC also noted that any expansion of federal ATI programs could also be hampered by the long-standing opposition in Congress to changing federal sentencing guidelines to encompass alternatives to punishment.

Nevertheless, the USCC made clear that it believed further empirical studies were necessary in order to effectively evaluate whether the programs were worth pursuing on a larger scale—and in particular whether they reduced racial disparities in sentencing.

“The recent emergence of federal alternative-to-incarceration court programs has raised several legal and social-science issues that must be carefully considered and informed by meaningful data before they can be answered by courts and policymakers,” study said.

For the complete version of the USSC report, please click here.

from https://thecrimereport.org

Can Mental Health Courts Stop the ‘Revolving Door’ of Justice?

A three-year study of participants in a Florida mental health court—the longest of its kind—found “significantly” lower re-arrest rates among individuals who completed the program of community-based treatment and counseling.

A three-year study of participants in one Florida mental health court program found that the rate of recidivism dropped “significantly” after they successfully completed the course of treatment mandated by the court as an alternative to jail time.

According to the authors of the Florida Institute of Technology (FIT) study, their findings, which represent the longest period of examination of mental health court outcomes of any previously published study, demonstrates that alternative courts can end the “revolving door” which cycles many mentally troubled individuals between jail and the streets.

“The ‘revolving door’ has been exhaustive of institutional resources, resulting in such a poor system of treatment that many argue that the system …treats offenders with mental health challenges to the extent that recidivism is inevitable,” wrote the study authors, Julie Costopoulos of FIT’s School of Psychology; and Bethany Wellman, a doctoral student at the school.

Their study of 118 participants in a Florida mental health court, which was not named, found that three months after release, 90% were not rearrested. After six months, 81% remained free of any charges; and three years after release, 54% had not recidivated.

Just as significantly, the authors found that those participants who were re-arrested were picked up usually for much lesser offenses than those which originally landed them in trouble with the law.

The authors claimed the study provided additional evidence that the targeted community-based treatment mandated by the mental health court helped participating individuals develop the skills and confidence to overcome their illness to the extent they could avoid repeated involvement with the justice system.

A Bureau of Justice Statistics study cited by the authors found that 55% percent of male inmates and 73 % of female inmates in the U.S. were mentally ill, with 23% of those mentally troubled individuals experiencing incarceration three or more times.

With the phase-out of many mandated mental health commitments to state hospitals and similar facilities for the justice-involved over the last decades,  criminal justice experts say jails and prisons are now effectively the largest treatment facilities for mental health in the U.S.

Mental health courts are among several court-based innovations aimed at providing alternatives to imprisonment for first-time or nonviolent offenders. The first mental health court was established in Broward County,Florida in 1997. But their numbers still remain comparatively low; as of 2016, there were some 300 such courts around the country, many of them funded under the 2002 federal Law Enforcement and Mental Health Project.

The FIT authors say their study should add more weight to arguments that alternative treatment for mentally ill offenders is cost-effective, and benefits both individuals and public safety.

“Jail doesn’t stop crimes by the mentally ill,” Costopoulos said in an interview published soon after the study.

“Treatment does.”

The complete study, “The Effectiveness of One Mental Health Court: Overcoming Criminal History,” was published June 21 online in the Psychological Injury and Law journal. It is available for purchase here, but journalists who would like a copy should contact TCR Deputy Editor Victoria Mckenzie at Victoria@thecrimereport.org

Readers’ comments are welcome.

from https://thecrimereport.org

Saving Troubled Minds

Mental health courts can offer alternatives to prison for individuals caught in the criminal justice system. The story of one Texas young man shows what happens when they’re not available.

Alfred Crain Ramirez II . Photo by Ana Ramirez/Victoria Advocate

The fate of a 27-year-old man came down to 12 jurors sitting elbow to elbow.

Although they had no expertise, the jurors had been given this weighty task because the system had repeatedly failed Alfred Crain Ramirez II, of Victoria, Tx.

The jurors weren’t supposed to think about whether Ramirez’s untreated schizoaffective disorder caused him to aim a loaded, .22-caliber rifle at his parents during an argument and threaten to pull the trigger. But it was all they could think about.

Guilty or not guilty. Those were their only choices.

On Day Four, they chose the latter after their screaming carried into the courtroom.

Eventually, the two holdouts were worn down.

Photo courtesy Victoria Advocate/Victoria County District Court.

“Judge,” Jury Foreman Dr. John P. Soule wrote in angular, all-capitalized handwriting. “We are now unanimous on both counts, but want in the record he needs mental help.”

Soule underlined “mental help.”

Two million people with mental illness are booked into jails every year, according to the National Alliance on Mental Illness.

Experts say communities like Victoria should start mental health courts, which address a defendant’s underlying illness rather than punish them for a crime that may be a symptom of their illness going untreated.

They say people who complete them are less likely to be caught in the criminal justice system again because the court partners with the treatment provider, two entities that don’t always work together seamlessly.

No One There

When the verdict of “not guilty” came back, Ramirez’s attorney, Arnold Hayden, remembered looking around the courtroom, wondering who would step up to help his client next.

But there was no one there.

“I did my job,” Hayden said. “The DA’s office should have thought about that before trying this case.”

Ramirez was charged with two counts of aggravated assault with a deadly weapon, which each carried a punishment of up to 20 years in prison. A conviction also would have made it harder for Ramirez to get certain benefits, such as low-income housing. When the prosecution didn’t offer Ramirez probation, Hayden said he thought it best to go to trial.

Hayden thinks his client would have been well-served by a mental health court, but to District Attorney Stephen Tyler, they are “gimmicks.”

The probation department already supervises defendants with mental illnesses well and tells the DA’s office when problems arise so a judge can address them in court, Tyler said.

In Victoria, three probation officers are assigned to that task, and they meet with the defendant and a case manager from the local mental health authority, the Gulf Bend Center, every month, said Stacy Murray, a supervisor.

After Ramirez was acquitted, he was released from the jail without medication. He walked about three miles home, not knowing that his arrival would prompt his parents to dial 911.

The DA’s office had helped his parents, Alfredo, 78, and Evelyn, 61, get an order from the judge requiring Ramirez not to go within 200 feet of them for two years. The police served him with the order that day, and suddenly, Ramirez was homeless.

“It would’ve been better if they had said, ‘You’re guilty, but we’re going to order you to go to a hospital,’” Ramirez said a few weeks after the verdict was reached.

He was at the Victoria Public Library reconnecting with friends he’d met over the Internet before he was jailed.

He also was trying to look for jobs and a place to live. Both were difficult because his ID had expired while he was in jail.

Ramirez had $20 to his name then, and he’d never had a job before.

He spent some of that $20 buying reflective tape at Wal-Mart to tape to his clothing, so he wouldn’t be hit by oncoming cars at night after the library closed.

His mother, meanwhile, was at home, caught between worrying for his safety and her own.

Although they disagree about what happened that day with the rifle two years ago, they both know few good things have happened since.

Evelyn Ramirez. Photo by Ana Ramirez/Victoria Advocate

“He let the police keep the rifle, and they are going to destroy it. That’s the only good thing to come out of this,” she said while going through her son’s messy bedroom.

Then she found swords, machetes and knives in his closet.

“Some of these, I don’t know where he got them,” she said.

The Challenge of Starting a Mental Health Court

In Midland County, which is in West Texas with a population of about 151,000 people, commissioners committed $166,700 from the general fund to keep their mental health court going. This came after it reduced participants’ arrests from 180 to five, and days in the jail from 3,135 to 180. Experts say that’s typical.

The cost to operate mental health courts goes up while a defendant is engaged in programming, but eventually they break even.

[Victoria advocates for the mentally ill have asked] Texas legislators to fund an $11.6 million, four-year plan to divert people with mental illness from the jails. Their plan calls for mental health case workers and deputies to build a rapport with people with mental illness that could prevent them from going into crisis and being arrested.

“It may be that we redirect enough of these that you wouldn’t need a mental health court,” said County Court-at-Law 2 Judge Daniel Gilliam, who also presides over Victoria’s DWI court.

But Carol Fisler, of the Center for Court Innovation in New York, said it doesn’t have to be an either-or scenario. People with mental illness should be assessed at each point in the criminal justice system so they can be diverted to treatment in the community.

Mental health courts can be limited to how many defendants they can serve at one time, said Dr. Fred Osher, of the Council on State Governments Justice Center. Midland’s will be capped at serving 25 people at one time so the probation officer doesn’t get overwhelmed, for example.

But judges have loud voices, and people will pay attention when they say they know firsthand more mental health treatment in the community is needed, he said.

A Cluttered Mind

Ramirez’s room, which sat untouched as his case made its way to the courtroom, is perhaps the best picture of where his mind was when he was arrested in 2015.

He slept all day on a faded orange couch and stayed up all night.

When he was awake, he heard voices and saw things that weren’t there. The only time he left his room was to grab something from the refrigerator. Food wrappers were strewn on the floor.

Ramirez thinks of himself as a survivalist, so when his mom gave him part of her winnings from a scratch-off lottery ticket, he bought the rifle from Academy Sports+Outdoors.

He says his mom knew about the purchase beforehand; she says she didn’t.

Evelyn Ramirez said the argument in 2015 started over a 2-liter bottle of soda.

She was working on the front yard when he asked her to help him look for it, she said.

“I’ve had both knees replaced and a plate in my back, so I can only do so much before I have to sit down. I guess I just wasn’t fast enough for him that day,” she said.

She said after her son struck her in the front-yard and at the doorway of their one story home, he came back with the rifle from his room and pointed it at her and husband.

“He said, ‘I’m going to blow your face off, both of you,” she said.

Ramirez doesn’t remember that. He said his mom gave him pills earlier in the day so he could sleep and he was later woken up by police and handcuffed.

Ramirez’s attorney, Arnold Hayden, said what probably pushed the jury to acquit his client were letters he admitted into evidence.

One, dated about a month before Ramirez turned 18, from Social Security asked Gulf Bend to share his records with it because he was applying for disability. Attached was a form signed by Ramirez giving Gulf Bend permission to do so. Another was a letter to Ramirez from Gulf Bend after he turned 18 informing him he was discharged from their care because he had aged out of services and indicated he didn’t wish to apply for more.

Hayden said he wasn’t sure whether there was a mix-up in paperwork, but he wanted “to show he (Ramirez) had tried and that he fell through the cracks.”

Tyler, meanwhile, said Hayden deliberately misled the jury by making an improper closing statement, and that’s why Ramirez is worse off than before.

Evelyn Ramirez said there’s enough blame to go around, though.

“I put my trust in the law, the DA and the 12 jurors, and nothing happened. I have no help,” she said.

The last she knew, police were looking for her son because he had threatened to kill himself when he couldn’t find a place to live.

“I can’t do nothing but wonder how, why and when,” she said.

Ramirez is recovering from a cold, but otherwise alive. He is staying at the Salvation Army. He temporarily had a part-time job as a knife salesman.

Two months after he was acquitted, Ramirez still hadn’t received any mental health treatment. He said he couldn’t get treatment without an ID or benefits, and he needed his Social Security card for that. The card was at his parents’ house, which was off limits.

None of it makes sense to the jury foreman, Dr. John P. Soule, who held Ramirez’s fate in his hands.

Soule has resumed seeing patients at his internal medicine practice in Victoria, but he still thinks about his first and only experience as a juror. He hopes to never be called again.

“There were a couple of nights where I could not sleep,” Soule said.

When he learned Ramirez was made no better off by the jury’s decision to acquit him, Soule was saddened.

“I’m not surprised at all, but I think that’s wrong,” he said. “This is clearly a case where someone needs to help this young man who cannot help himself.”

To learn about Midland’s Mental Health Court, click here.

Jessica Priest is a 2016 John Jay/Langeloth Health and Justice Reporting Fellow. This is a slightly abridged version of the final installment of a series called “Minds That Matter,” prepared as her Fellowship project. The full version along with videos is available here; and earlier installments can be read here. Jessica welcomes readers’ comments.

 

 

from https://thecrimereport.org

Bronx (NY) Mental Health Court Doesn’t Work

Bronx (NY) Mental Health Court Doesn’t Work Our notes: Specialty courts are popping up throughout the country and that’s good; the criminal justice system is trying to find ways of dealing with people who need to be diverted. Just note that there are some who claim too much success from specialty courts. Over promising is […]

Bronx (NY) Mental Health Court Doesn’t Work Our notes: Specialty courts are popping up throughout the country and that’s good; the criminal justice system is trying to find ways of dealing with people who need to be diverted. Just note that there are some who claim too much success from specialty courts. Over promising is […]

from http://www.crimeinamerica.net