SALT LAKE CITY — Mental health courts provide a rehabilitative alternative to jail or prison for individuals who've committed crimes because of a mental illness, but what the court is and how it works remains enigmatic to many.
“A disproportionate number of individuals with mental illnesses are incarcerated for minor offenses, contributing to the overcrowding of county jails,” according to Utah County’s website, which has approximated that some 88 inmates at the Utah County Jail have mental illnesses at any given time. “Based on available data, the outcomes of these incarcerations and associated costs have been the opposite of what was intended; rather than leading to remediation, the data shows that incarceration of mentally ill individuals increases recidivism and criminal acting out.”
Mental health court seeks to address this problem. Jackie Rendo, a spokeswoman for the National Alliance on Mental Illness, held an event Wednesday evening to educate the public on how mental health courts work in Utah and how best to support family members in that system.
Rendo provided a detailed analysis of the criminal mental health courts and what participants and their families can expect from the process:
What’s the difference between mental health courts and civil commitment courts?
The biggest differences between mental health courts and civil commitment courts, according to Rendo, is that the former is a criminal proceeding while the latter is civil and geared toward committing family members for mental health care. Criminal mental health court involves family members having been arrested and charged with crimes.
“It’s not uncommon for families/loved ones to view the court as a treatment provider,” Rendo said. “Whereas the court requires people to stay in treatment.”
The main function of the court is to ensure that justice has been served for crimes committed, but it handles that process differently because the individual who committed the crime suffers from a mental illness like schizophrenia, bipolar disorder, schizoaffective disorder, or other severe disorders, according to Rendo.
Most of the time people in criminal courts are there because they didn’t know they had a mental illness or they went off their medication. The mental health courts seek to either ensure that an individual receives treatment or ensure that they are following their treatment plan. Some of the goals of criminal mental health courts include getting the individual to:
- Stay on prescribed medications.
- Attend all treatment sessions including appointments with a psychiatrist, APRN, therapist and group sessions.
- Refrain from using alcohol, illegal drugs or medications that haven’t been prescribed to them.
The courts achieve these goals through a number of means, ranging from medication and treatment to rewards and sanctions.
What qualifies an individual for mental health courts?
There are both psychiatric and legal requirements for an individual convicted of a crime to qualify for mental health courts, according to the National Alliance on Mental Health in Utah. The psychiatric requirements include:
- A diagnosis of schizophrenia, bipolar disorder, or schizoaffective disorder. Some courts may include some individuals with severe mental disorders like depression or PTSD as well.
- If a primary diagnosis is not one of the above disorders, known as “Axis 1” mental health problems, they may be excluded from mental health court. They may also exclude individuals with certain personality disorders if it is the driving force of their behavior.
- They may also exclude those with traumatic brain injuries or coexisting developmental disorders because they don’t have the resources to treat them.
The legal requirements include:
- The individual must live in the same county as the court.
- Some crimes might be excluded from mental health court including driving under the influence, sexual offenses (aside from mental illness-related lewdness, occasionally), and extreme bodily violence.
- Most mental health courts require that treatment be delivered at a local mental health authority (Valley Behavioral Health in Salt Lake County, Weber Human Services in Weber County, etc…). Note that Salt Lake County is one of the few courts that allows some individuals to work with a private provider if it has been approved by the court.
- Some clinics require the participants be on Medicaid.
- Veterans may be able to continue receiving care from the Veteran’s Association.
How can an individual get into mental health court?
The individual must tell either their attorney or their judge that they would like to be tried in a mental health court, according to the National Alliance on Mental Health. They will then need to show valid medical records proving diagnosis or treatment, get assessed by a therapist (only if they are still being held in jail on their charges) and potentially attend a screening appointment with a provider.
They will then plead guilty in a plea deal from the prosecutor as conveyed by their attorney, according to Rendo. That plea deal might include a shortened sentence or other terms.
If the individual is admitted into mental health court they are allowed to serve their sentence outside of jail or prison as long as they are supervised and meet the requirements set by the mental health court.
What is the mental health court’s process?
The mental health court process is fairly intensive; partially because it’s intended to force participants into mental health care and partially because it is not a get out of jail free card— it is a punishment, Rendo said. The process, according to NAMI, includes:
- A weekly court visit to report to the judge. The visit may decrease to every other week or even once a month based on stability or good behavior.
- Taking all medication.
- Attending all treatment events, including therapy, counseling and group sessions.
- Refraining from alcohol or any drugs that haven’t been prescribed by a doctor.
- Following standard probation requirements.
- Undergoing random drug testing.
Prior to the court proceedings each week there is a staffing meeting where the mental health court team gathers before the court discussion to review each participant scheduled to come that day, according to Rendo. There the therapist summarizes the individual’s progress and the parole agent will report any issues or concerns from their end. The judge will then draw conclusions based on that information, Rendo said.
“Participants who haven’t met all their requirements will be discussed further to see what action is needed to help them become compliant or if a sanction is indicated,” Rendo explained. “Participants who have done everything they were supposed to do since their last court appearance will receive recognition for it.”
- Rocket docket/honor roll (the individual can go first at the court session and leave when their meeting with the judge is done).
- Candy bars, water bottles, wrist bands, gift cards.
- Drawing from a gift bag of small items.
- Less frequent drug testing.
- Less frequent court attendance.
- Early graduation.
- No rocket docket/honor roll.
- Community service.
- Jail sanctions with varying lengths of time.
If a patient, for example, misses a therapy session they might be sanctioned with the loss of rocket docket participation or community service, according to Rendo. If they miss multiple therapy sessions they might receive jail sanctions.
Other questions that may come up during mental health court
Is housing included for mental health court treatment? “There isn’t any money to provide access to all the things participants need most,” Rendo said. They will have to pay for their own housing, psychiatric and medical care, transportation, drug testing, food, clothes and so on.
What if the individual has work that overlaps with a therapy or drug testing appointment? “Treatment comes before jobs, family commitments, class schedules and court-ordered community service,” Rendo said. “Missing treatment may result in sanctions.”
What if the individual doesn’t want to take their medication because of the side effects? “Psychiatric medications have side effects,” Rendo said. “A common side effect is weight gain. Some of them can also be very sedating. If the participant is having a lot of problems with the medication they can talk to the provider, but ultimately if that’s the only thing that works they have to take it.”
Rendo added that not complying with medication may result in sanctions. The ultimate goal is to get the individual stable and to do that, medications may be necessary.
What if the individual uses drugs or alcohol? People are not to use drugs or drink alcohol, and they must tell the court if they’ve used, according to Rendo. They will be sanctioned for any use through community service or jail time.
What are the random drug testing requirements? Participants must get a urine drug test randomly, though often several times per week, according to Rendo. A missed urine drug test is considered a positive drug test and will be sanctioned accordingly. If the test shows a false positive the individual is able to contest it with the judge and have the results sent for further testing.
Can there be drugs, alcohol or weapons at the place of residence if they don’t belong to the individual in mental health court? No weapons, drugs or alcohol are allowed in the home of an individual in mental health court, even if they belong to family members, according to Rendo. Even guns kept in a safe may not be allowed under certain circumstances.
How can a friend or family member support their loved one? Rendo offered the following options as ways to support a loved one participating in mental health court:
- Attend court with them.
- Provide transportation.
- Give encouraging messages.
- Provide reminders and organizational tools.
- Attend the NAMI family to family class.
- Learn as much as possible about mental illness.
Ultimately, the goal of mental health court is to prevent the individual from breaking the law again and help them get to a functional level of mental stability. Learn more about preparing and managing mental health court at NAMI Utah’s website.