Cover Story

When people with mental illnesses are arrested for trespassing, drug possession and other nonviolent offenses in Oklahoma City, they are no longer automatically sentenced to jail or probation--where their illness would probably go untreated.

Instead, they can opt for a court specifically designed to give them the treatment and supervision they need. The judge, attorneys and community health organizations collaborate to coordinate treatment and ensure offenders stay on track.

The program is the first mental health court in the Southwest United States and part of a growing trend in America to divert nonviolent offenders with substance abuse and mental health problems from jail into treatment.

"It's wrong for people's undiagnosed and untreated mental illness to result in being incarcerated," says Rep. Ted Strickland (D-Ohio), a former maximum-security prison psychologist. "[Providing treatment] is more humane, it's more cost-effective and just simply the right thing to do."

In general, the courts hear the cases of nonviolent offenders who commit low-level felonies and misdemeanors and have mental health problems. Similarly, drug courts seek to address substance abuse problems in offenders commonly charged with possession and other drug-related offenses. In exchange for a guilty plea, the offenders enter treatment instead of prison. If they successfully complete treatment, authorities may remove the offense from their record, depending on the plea agreement.

The model has proven so successful that, since the nation's first drug court was established in 1989 in Miami, 946 drug courts have been implemented, and another 441 are in the planning stages, according to the National Association of Drug Court Professionals.

In 1997, Broward County, Fla., translated the drug court model to cases involving people with mental illnesses and created the nation's first mental health court. While mental health courts don't equal drug courts in numbers, recent funding from the Substance Abuse and Mental Health Services Administration and the Department of Justice may jump-start their spread.

A solution that works

The growth in alternative courts has been spurred by research that has proved such courts' effectiveness. In fact, a 2000 California law that requires judges to offer nonviolent offenders substance abuse or mental health treatment instead of prison time is saving the state up to $18 million a year, according to a report by the Judicial Council of California's Advisory Committee on Collaborative Justice.

Moreover, California's program reduced recidivism: Arrest rates for participants who completed the program declined by 85 percent, conviction rates by 77 percent and incarceration rates by 83 percent.

And considering that 15-20 percent of prisoners have a mental illness and more than 40 percent have participated in substance abuse programs or treatment, mental health and drug courts can reduce burgeoning prison rolls not only by initially diverting offenders, but also by reducing the likelihood they'll return to the justice system. That makes them an attractive option for states with strapped budgets looking to reduce prison costs.

"It's cheaper to provide outpatient services than to pay for their confinement in a prison," explains Strickland. "But more importantly, these are human beings who are worthy of receiving appropriate interventions and treatment."

Indeed, the courts' impact on the lives of those who are treated is just as important, say many psychologists. For example, 70 percent of California's drug court participants were employed upon completion of the program, a striking change from the fewer than 40 percent employed at program entry.

"Nationwide, the jails have become the No. 1 holding stop for the mentally ill," says clinical forensic psychologist Edith King, PhD, who works in the Oklahoma City mental health court. With fewer and fewer inpatient and outpatient services available for the mentally ill, she says, many people with mental health problems end up in jail for offenses, such as shoplifting, that stem from their illnesses.

But since many prisons aren't equipped to provide treatment or design release plans for people with mental health and substance abuse problems, the offenders are released only to be picked up again for another violation. Indeed, 75 percent of mentally ill inmates have been sentenced to time in prison or jail or to probation before their current sentences, according to the Bureau of Justice Statistics.

Chasing funding

Facts like those, coupled with the courts' documented successes, have prompted growing federal support for drug and mental health courts.

"We need to begin to change the way we deal with this problem," says Strickland. "And the way to do that is to empower communities by giving them the financial resources that will enable them to establish these specialty courts."

Strickland and his colleagues in Congress have been doing just that. In a push for more treatment, he teamed with then Rep. Mike Dewine (R-Ohio), who is now a senator, Sen. Pete Domenici (R-N.M.) and the late Sen. Paul Wellstone to pass a law authorizing federal funding for the creation of mental health courts in 2001. They garnered an additional $3 million in 2002. And Strickland and DeWine are continuing the legislative push for prison alternatives (see box, previous page).

This spring, the Department of Justice's Bureau of Justice Assistance began doling out that money to 23 city, county and state organizations to establish or bolster mental health courts. Among the grant recipients is the Oklahoma Department of Mental Health and Substance Abuse Services, headed up by psychologist Terry L. Cline, PhD. The department funneled the money to the Oklahoma County mental health court in which King works.

The court was established when its judge, Nancy Coats, donated $20,000 of her own campaign money after the state legislature authorized its creation, but no funding, last July.

Since its start on Nov. 1, the group has taken on a handful of cases, and hopes to reach a maximum caseload of 25 by the end of the year. The court only accepts offenders with serious mental illness, such as bipolar disorder or schizophrenia, who have committed a misdemeanor or nonviolent felony. Psychologists also screen out applicants whose illness makes them unlikely to complete the treatment.

After the district attorney determines their records are free of violence, King determines whether candidates are competent to stand trial and then psychologist Gail Poyner, PhD, screens them with personality inventories, an hour interview and a review of police reports and prior treatment information.

"People were afraid of letting them out into the community," King explains. "So we're bending over backwards to the extent that we have to leave out lots of people that we would like to work with."

Participants meet weekly with the court team, which monitors the offenders' progression through the program and also attends to co-occurring drug problems. The treatment usually lasts 12-24 months.

King and most of the court team donate their time or are on loan from their employers, such as the district attorney and public defender's office, Department of Corrections and Oklahoma Mental Health Consumer Council.

The new funding, $150,000 over two years, will pay for temporary respite beds if needed for program participants, weekly group therapy and will cover the salary of an additional case manager.

The group therapy, designed by Poyner and King, will address the offenders' involvement with the legal system and the thinking errors that led to committing a crime to better prepare them when they leave the program.

"Everyone involved is impacted in a positive way, from court participants and family members to taxpayers and law enforcement," says Cline of the program. "If these individuals can receive treatment, they are more likely to avoid jail time in the future and they are more likely to maintain recovery in their communities."