Mental health courts may struggle to fulfill a decades-old promise

In early December, Donald Brown stood nervously in the Hall County Courthouse, worried he would be sent back to prison.

The 55-year-old has struggled with depression, addiction and suicidal thoughts. He worried that a judge would terminate him from a special diversion program meant to prevent people with mental illness from being incarcerated. He failed to keep up with the program’s demanding work and community service requirements.

“I’m kind of scared. I feel kind of defeated,” Brown said.

Last year, Brown threatened to take his life at gunpoint, and his family called 911 for help, she said. Police arrived and Brown was arrested and charged with felon in possession of a weapon.

After months in jail, Brown was offered access to the Health Empowerment Linkage and Possibilities, or HELP, Court. If he pleaded guilty, he would bond with the services and avoid jail time. But if he didn’t complete the program, he would likely face jail time.

“It’s almost like a compulsion,” Brown said. “Here, sign these papers and get out of jail.” I feel like I could be treated a lot better.”

Lawyers, attorneys, clinicians and researchers said courts like the one Brown is navigating may struggle to keep their promise. Diversion programs, they said, are often expensive and resource-intensive and serve less than 1 percent of the more than 2 million people who have serious mental illness and are held in U.S. prisons each year.

People may feel pressured to take plea deals and go to court, seeing the programs as the only way to get treatment or avoid jail time. Courts are selective, in part because of political pressures on elected judges and prosecutors. Participants often must meet strict requirements that critics say are not treatment-focused, such as regular hearings and drug checks.

And there is a lack of conclusive evidence on whether courts help participants in the long run. Some legal experts, such as Lea Johnston, a law professor at the University of Florida, worry that the programs distract from more meaningful investments in mental health resources.

Jails and prisons are not the place for people with mental disorders, he said. “But I’m also not sure mental health court is the answer.”

The nation’s first mental health court was established in Broward County, Florida in 1997, “as a way to promote mental health recovery and wellness and avoid criminalization of mental health problems.” The model has been replicated with millions in funding from federal agencies such as the Substance Abuse and Mental Health Services Administration and the Department of Justice.

More than 650 adult and juvenile mental health courts were in operation as of 2022, according to the National Treatment Court Resource Center. There is no set way to perform them. Generally, participants receive treatment plans and are connected to services. Judges and mental health clinicians oversee their progress.

Researchers from the center found little evidence that the courts improve participants’ mental health or keep them out of the criminal justice system. “Few studies … assess the long-term effects” of the programs “beyond one year after exiting the program,” a 2022 policy brief on mental health courts said.

Courts work best when combined with investments in services such as clinical treatment, rehabilitation programs and housing and employment opportunities, said Kristen DeVall, the center’s co-director.

“If all these other props aren’t invested, then it’s kind of a wash,” he said.

The courts should be seen as “an intervention in that larger system,” DeVall said, not “the only resource to serve people with mental health needs” caught up in the criminal justice system.

Resource constraints can also increase the pressure to apply for mental health court programs, said Lisa M. Wayne, executive director of the National Association of Criminal Defense Lawyers. People seeking help may not feel they have alternatives.

“It’s not going to be people who can afford mental health intervention. It’s poor people, marginalized people,” he said.

Other court skeptics wonder about the programs’ higher costs.

In a study of a mental health court in Pennsylvania, Johnston and a University of Florida colleague found that participants were sentenced to more time under government supervision than if they had gone through the regular criminal justice system.

“The biggest problem is that they take attention away from more important solutions that we should be investing in, like community mental health care,” Johnston said.

When Melissa Vergara’s oldest son, Mychael Difrancisco, was arrested on a felony gun charge in Queens in May 2021, she thought he would be an ideal candidate for New York City’s mental health court because of his diagnosis of autism spectrum disorder and other behavioral health. conditions.

He estimated that he spent tens of thousands of dollars preparing Difrancisco’s case for trial. Meanwhile, her son sat in jail at Rikers Island, where she said he was assaulted multiple times and had to have half a finger amputated after being caught in a cell door.

In the end, his case was denied diversion to mental health court. Difrancisco, 22, faces up to four years and six months in prison.

“There’s not really an urgency to help people with mental health issues,” Vergara said.

Critics worry that such high entry thresholds may lead programs to exclude people who could benefit the most. Some courts do not allow those accused of violent or sexual crimes to participate. Prosecutors and judges may face pressure from constituents that may lead them to block people accused of high-profile crimes.

And judges often aren’t trained to make decisions about care for participants, said Raji Edayathumangalam, senior policy social worker at New York’s Defender County Agency.

“It’s inappropriate,” he said. “We’re all licensed to practice our different professions for a reason. I can’t show up to have a hernia operation just because I read about it or sat next to a hernia surgeon.”

Mental health courts can focus too much on requirements like drug testing, medication compliance and completing workbook assignments, rather than moving toward rehabilitation and clinical improvement, Edayathumangalam said.

Completing the programs can leave some participants with clean criminal records. But failure to meet a program’s requirements can trigger penalties — including jail time.

During a recent hearing in Clayton County Behavioral Health Court in suburban Atlanta, a woman left the courtroom in tears after Judge Shana Rooks Malone ordered her to report to jail for seven days for “being dishonest” about whether she accepted court-required medication;

It was her sixth violation of the program — previous consequences have included written assignments and “bench duties,” where participants must sit and think about their participation in the program.

“I don’t like going to jail,” Malone said. “This particular participant had some challenges. I’m rooting for her. But all the lesser sentences don’t work.”

However, other participants praised Malone and her program. And, in general, some say such diversion programs provide a much-needed lifeline.

Michael Hobby, 32, of Gainesville was addicted to heroin and fentanyl when he was arrested for drug possession in August 2021. After entering the HELP Court program, he became sober, began taking medication for anxiety and depression, and built a stable life.

“I didn’t know where to turn for help,” she said. “They put me in handcuffs and it saved my life.”

Even as Donald Brown awaited his fate, he said he had started taking medication to manage his depression and stayed sober because of HELP Court.

“I learned a new way of life. Instead of getting high, I’m learning to feel things now,” he said.

Brown avoided jail that day in early December. A hearing to decide his fate could happen in the coming weeks. But even if he’s allowed to stay in the program, Brown said, he worries it’s only a matter of time before he falls out of compliance.

“To try to better myself and get locked up for it is just a kick in the gut,” he said. “I tried really hard.”

KFF Health News Senior Correspondent Fred Clasen-Kelly contributed to this report.