Two years ago, "Mary," a woman diagnosed with a paranoid schizophrenia and accused of loitering, would have waited in jail for 21 days to have her case heard. Then, upon her conviction, she would have served up to six months in a Broward County, Fla., jail.

But thanks to the county's mental health court, instead of serving jail time, she's under court order to receive the mental health care she needs, which in her case includes medication for her schizophrenia and counseling for substance abuse.

Mary is one of 1,345 cases helped so far by the mental health court, the first U.S. court to provide treatment to mentally ill defendants who are arrested for nonviolent misdemeanors, such as loitering or creating a public nuisance. The voluntary program offers a service that is often missing in the judicial system: diagnosis of mental illness and follow-up treatment so that mentally ill defendants stop bouncing from homeless shelters to jail to hospitals and back again.

And the program is noteworthy for another aspect. Those who conduct the screenings and determine which cases should be referred to mental health court are doctoral students from the Center for Psychological Studies at Nova Southeastern University. Currently the only graduate psychology program to offer a court-based practicum, Nova requires students to spend 10 to 20 hours at the courthouse each week in addition to their other program requirements, such as coursework in forensic psychology and family and criminal law.

Before Nova became involved with the mental health court, no one screened defendants for mental illnesses.

"The students are really an essential operational component of the court," says County Court Judge Ginger Lerner-Wren, who presides over Broward County's mental health court.

The court's success has led a handful of other jurisdictions to establish mental health courts, including King County, Wash., Cook County, Ill., and San Bernardino County, Calif. (see related article, page 59).

Meanwhile, Congress is considering legislation that would provide funding to establish additional mental health courts.

Filling a void

Experts say mental health courts are becoming increasingly important as a growing number of mentally ill individuals are incarcerated in jails and prisons instead of being given mental health treatment. Recent statistics show that:

  • Three out of four mentally ill inmates have been sentenced to time in prison, jail or probation at least once prior to their sentence, according to a July 1999 report by the U.S. Bureau of Justice Statistics.

  • The same report finds that 16 percent of all inmates in state prisons and local jails suffer from mental illness.

  • From 25 percent to 40 percent of America's mentally ill will have contact with the criminal justice system, estimates the National Alliance for the Mentally Ill.

Psychology and law enforcement experts blame this mounting social problem on the drop in mental health services available to people with mental illness after states shuttered their mental health hospitals in the late 1960s and early 1970s. At that time, community treatment centers were expected to fill in the gaps but many couldn't because they lacked the resources to provide services. In recent years, funding for outpatient services has gotten even tighter and people with chronic mental illnesses are more apt to fall through the cracks and end up in jail for petty crimes.

The need to address this problem is why programs like Nova's are seen as essential.

"Forensic psychology has become one of the hottest areas of the field," says clinical and forensic psychologist Lenore Walker, EdD, professor, coordinator of the forensic concentration and practicum supervisor at Nova. "We're teaching psychology students how to apply their clinical skills to a legal setting."

Walker has worked with the Broward County Public Defender's Office for seven years and helped to bring Nova and the Broward County courts together.

Nova's outreach

Since it began two years ago, 44 students have participated in the forensic program. This year, eight students are participating in the year-long practicum.

Practicum students begin their day early, arriving at the jail at 8 a.m. to screen people who were arrested overnight. The experience gives them an up-close and personal view of the court system and defendants.

"We look at the reasons they're arrested," says Allyson Ruha, a third-year Nova student who is currently in the practicum. "Repeated arrests for disorderly conduct, trespassing and prostitution are often linked to mental health problems."

The atmosphere at the jail is initially unsettling, says Ruha, as the defendants haven't showered and those who have been arrested on battery charges are often bruised and bloody.

Before their arraignments, Ruha and other students ask the defendants about prior mental health treatment, whether they've abused drugs or alcohol and if they've had any head injuries. If they identify a defendant with a mental health problem, they alert the public defender and recommend that the defendant be referred to mental health court. If defendants agree to participate in mental health court, students conduct more extensive assessments, performing psychosocial evaluations and sometimes testifying before the judge as to why defendants should receive treatment rather than jail time.

In such cases, the judge usually orders defendants to participate in a treatment program for at least six months. They may be referred to the local mental health center, an outpatient program for substance abuse or a residential treatment program, depending on their needs.

One place defendants may be referred to is OPTIONS, an outpatient program staffed by Nova students. Since January, students have provided individual and group therapy for the 20 women at a treatment center next to the courthouse. OPTIONS can treat up to 40 women with serious mental illness and substance-abuse-related disorders, particularly those who suffer from severe emotional or physical abuse, major depression or post-traumatic stress disorder.

OPTIONS began this year and is funded by a $226,000 grant from the Bureau of Justice Assistance of the U.S. Department of Justice. The program focuses on empowering participants through cognitive-behavioral therapy, individual and group psychotherapy, medication, skills training and self-care activities. For instance, they're encouraged to practice yoga and meditation, learn computer skills and participate in art and group therapy.

Creating more mental health courts

Several members of Congress are hoping to replicate Broward County's mental health court across the country.

Rep. Ted Strickland, PhD (D­Ohio), and Sen. Mike DeWine (R­Ohio), introduced legislation to create additional mental health courts. Strickland's bill would provide $2 million annually over the next five years to create 25 mental health courts across the nation while DeWine's bill would provide $50 million over the next five years to create 105 mental health courts. Hearings on the proposals are expected to begin this summer.

Both Strickland, a psychologist, and DeWine, a former prosecutor who managed Ohio's prison system when he was the state's lieutenant governor, know firsthand the problems people with mental illness face in jail.

"No one benefits from our current practice of incarcerating nonviolent petty offenders who are in serious need of mental health treatment," says Strickland. "The courts, jail and prisons have become stifled with cases of individuals who are likely to recidivate unless they receive treatment.

Correctional officers are expected to fill the role of mental health professionals when the mentally ill are sent to jail because many of these inmates don't understand why they are there."