Well-intentioned mental health courts can struggle to achieve their goals

Mental health courts connect people to treatment and keep them out of jail. But they also often come at the price of admitting guilt, which participants say feels like coercion.

MARTNEZ, host:

More than 2 million people incarcerated in US prisons each year have been diagnosed with a serious mental illness. In recent decades, programs have sprung up across the country to get people out of trouble and connect them with help that could keep them out of prison. They are called mental health courts. Sam Whitehead and our partner KFF Health News report that well-intentioned courts can struggle to achieve these goals.

SAM WHITEHEAD, BYLINE: It’s an early December afternoon and Donald Brown(ph) is nervously awaiting the start of a mental health court hearing in Gainesville, Ga. In just a few minutes, the 55-year-old will find out if he’s been kicked out of the diversion program for failing to meet work and community service obligations, and potentially back in prison.

DONALD BROWN: I’m kind of at a loss for words. I’m scared to death. I mean, I don’t like prison. So I got a taste of being outside. Coming back is just – it’s really hard.

WHITEHEAD: Brown has struggled with depression. Last year he threatened to take his own life with a gun. His family called 911 for help, the police arrived and Brown was arrested and charged with aggravated possession of a firearm. After months in jail, Brown was offered access to court. If he pleaded guilty, he would be connected to services and avoid prison if he completes the program.

BROWN: You know, you’re there for 10 1/2 months. You have no idea how you’re going to get out. It’s almost like forcing, you know? Here, sign these papers, you can get out of jail.

WHITEHEAD: Brown says the diversion program has helped him stay sober and get medication for his depression, but it’s also been stressful keeping up with the program’s demands. If kicked out, Brown fears he could face years in prison.

BROWN: I have learned a new way of life. You know, instead of getting high, I’m getting to know things now, and I’m making an effort to try and improve myself. That’s why being locked out is like a kick in the gut.

WHITEHEAD: You can find mental health courts in over 650 communities. They are not prescribed, but usually participants receive treatment plans and access to counseling and medication. Judges and mental health doctors monitor their progress. Lea Johnston is a professor of law at the University of Florida. Jails and prisons, he says, are no place for people with mental health issues.

LEA JOHNSTON: But I’m also not sure mental health court is the solution.

WHITEHEAD: Johnston says the programs can distract policymakers from more meaningful investments.

JOHNSTON: The bigger problem is that they’re distracting from more important solutions that we should be investing in, like community mental health care.

WHITEHEAD: Nearly 60% of participants completed programs in 2019, according to the National Treatment Court Resource Center. Researchers there say there is little evidence that diversion programs improve mental health outcomes or affect relapse in the long term. Kristen DeVall leads the organization. He says the courts can’t work as well when the social safety net is full of holes. In many communities, it can be difficult to find stable housing, counseling, and recovery services.

KRISTEN DEVALL: If all these other necessary supports are not invested in, it’s kind of a wash.

WHITEHEAD: Critics of mental health courts say participation shouldn’t come at the cost of pleading guilty. Raji Edayathumangalam, a licensed clinical social worker with New York County Defender Services, says judges often aren’t trained to make informed decisions about participants’ treatment.

RAJI EDAYATHUMANGALAM: It is inappropriate. We all have the right to practice our various professions for a reason, right? I can’t come in for hernia surgery just because I read about it or sat next to a hernia surgeon for 10 days.

WHITEHEAD: Some mental health court participants praised the programs for helping them get their lives back on track. At a recent hearing in Atlanta’s Mental Health Court, many of the attendees thanked Judge Shana Rooks Malone in person. But one woman left the courtroom in tears. He had just been sentenced to seven days in jail for being dishonest about whether he was taking court-mandated medication. Malone, a lawyer by training, says he doesn’t like being incarcerated.

SHANA ROOKS MALONE: But that particular participant has had some challenges. I support him, but lesser punishments haven’t worked.

WHITEHEAD: The final straw, Malone said, would be to remove him from the program entirely and send him to prison. Meanwhile, Donald Brown worries that it will eventually be his fate as well. He escaped from prison that early December day. A hearing on whether he can remain in mental health court is expected in the coming weeks.

MARTNEZ: That was Sam Whitehead with our partner KFF Health News.

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