Progressive Changes to a Mental Health Court Program

Submitted by Judge Stephen S. Goss, Superior Court, Dougherty Judicial Circuit
 
         The Dougherty Superior Court Mental Health/Substance Abuse (MH/SA) Treatment program was launched in 2002. The program initially addressed mentally ill offenders but almost immediately added a drug court track. altFor the last ten years, the core felony treatment court has acted as a co-occurring disorders program, since many mentally ill offenders self-medicate their unresolved mental health issues with street drugs and alcohol. The program has been successful in reducing recidivism, widening the gaps of time between mental status decompensation episodes, and lessening the severity of such episodes, thereby reducing jail days and inpatient state hospital admissions. Since 2006, the program has served as one of the national mental health courts Learning Sites.[1]

         This article reviews four points where the program has adapted to address needs and changing conditions in this jurisdiction.

         Case management services are essential: The addition of dedicated case managers, teamed with two crisis intervention trained (CIT) state probation officers, was a dramatic leap forward in the early years of the program. Case management is a key piece for the success for these mentally ill offenders. With this population, little things can become big things quickly.

alt         A schizophrenic who hears voices in his head is unlikely to be able to navigate medical appointments and court appearances by himself. Some of these necessary services, like confirming appointments, arranging transportation with a relative, assisting with filling out forms at the Social Security or housing office, and making sure there are enough tablets left in the prescription bottle cannot be billed to insurance or Medicaid. These simplistic life details can literally make the difference in the probationer staying stable and at home versus off medicine, arrested, and either in the jail, state prison, or state hospital at high taxpayer expense.

         Data is essential for program evaluation and sustainability: As an early mental health court, we started without a well-defined template.[2] We focused on starting the program and handling the participants’ cases. The need to develop data on a national level became apparent years later.

         All mental health courts have powerful human stories. However, these defendants utilize expensive services in varied governmental budgets, including state and local courts, county jails, community mental health clinics and emergency rooms, state hospitals, and state prisons. Because none of these entities have integrated budgets and computer systems, it is extremely difficult to track cost avoidance information, which can quantify the true amounts these mentally ill offenders cost taxpayers.

         In a multiple year project funded by the Bureau of Justice Assistance (and now available in the public domain to other courts), Dr. Kevin Baldwin of Applied Research Services and Dr. Aaron Johnson of Mercer University helped us develop an internet-based encrypted system to track costs of these offenders. This allows state hospital staff, jail staff, case managers, and probation officers to enter basic data on a participant from their various locations in order to build a data set on recidivism, drug testing, treatment, and compliance issues. Court staff also loaded the information from the paper files of every person that had been in the program. Our ten-year data set confirms what we believed anecdotally. The program has the greatest impact on recidivism and cost reduction when we are able to stabilize and sustain the high maintenance, high need offenders in the program.

         Reentry track: After several years of operating the core program, it was apparent we had a subset of mentally ill felons that were not in the program but needed the supervision and case management. Like every other community, Albany has a group of chronic seriously mentally ill offenders that criminal justice, court, and treatment personnel know on sight. Some of these offenders, when off medicines, have incurred a prior aggravated assault charge that acts as a criminal justice disqualifier to enroll in the core mental health court.

         The person returns from jail or prison to serve the probation portion of a split sentence. Putting that schizophrenic probationer on a regular supervision caseload without sufficiently addressing the mental health and substance abuse issues is simply waiting for the next bad outcome. After a conference with the District Attorney, Sheriff, probation staff, and treatment personnel, we added an Intensive Mental Health Probation supervision track specifically for prison/jail reentry offenders with these same techniques. This high maintenance population is where we have seen significant cost savings; we also reduce their episodes and recidivism.

         Competency Docket[3]:The Dougherty County Courts are the largest customer for the forensics staff at Southwestern State Hospital. A competency docket was created in an effort to move competency evaluation cases in a more systematic fashion, open up forensic beds at the hospital, and reduce deputy sheriff transports. When a motion is filed to have a mental competency to stand trial evaluation performed, the case is placed on the competency docket regardless of which judge in the circuit is assigned to the case. Until the competency issue is resolved, I preside over the case.

         The administrative assistant for the MH/SA program is the routing point. She keeps all the cases in a spreadsheet provided to the court, counsel, jail staff, and state hospital personnel. Attached to a session of MH/SA court, the competency docket is called once a month. The forensic psychologists attend, and we review the status of every case. If transport orders are needed, they are signed. If police reports are needed by forensic staff, they are delivered. If a person is found competent, the case is returned to the originating judge for handling on the merits. If there is a clinical finding of incompetence, a bench or special jury trial is conducted. I hear any needed commitment hearings.

         This effort has reduced by half the number of pending competency cases and has increased the clearance rate by state hospital forensic staff. By handling the cases in a more coordinated fashion, the psychologists make fewer trips to Albany but handle more cases per trip. It has reduced the number of transports by the Sheriff’s deputies.

         These are examples of how a mental health court program can adapt. Better coordination among stakeholders allows for improved docket management. It also creates better outcomes in many cases and leverages scarce resources. Often the offenders we see have multiples issues that intersect with their crimes. Creating dynamic systems that focus on those issues make for safer communities and more efficient use of taxpayer dollars.




Judge Stephen S. Goss has served as a Superior Court judge in the Dougherty Judicial Circuit since 1999. He serves on the teaching faculty of the National Judicial College and the National Drug Court Institute presenting on the subjects of mental health and co-occurring disorders programs. He serves as a senior consultant for the SAMHSA GAINS Center on co-occurring disorders in the criminal justice system and is a member of the board of the Judges Leadership Initiative and the mental health courts committee of the National Association of Drug Court Professionals.



[1] Information on the Bureau of Justice Assistance and Council of State Governments Learning Sites can be found at the Consensus Project website at www.consensusproject.org/learningsites
[2] The first mental health court program in Broward County, Florida started in 1997.
[3] Goss and Bailey. Establishing and Managing a Competency Docket in a Rural or Resource Challenged Jurisdiction (2011) can be accessed at www.mentalcompetency.org/resources/articles/files/Goss -- Establishing and Managing a Competency Docket.pdf?collection=journals&handle=hein.journals/jusj30&div=24&id=&page.

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