Mental Health Courts: Promise and Problems
Speech to Illinois Academy of Criminology
May 19, 2004

1. Lots of mentally ill persons in the criminal justice system
   • DOJ study found 12 to 18% of prisoners were mentally ill
   • Illinois DOC has 6,000 mi's v.5500 in all public and private mental hospitals
   • Cook County Jail : 1,000 to 1,500 persons with mental illnesses
   • Getting exact number depends on definition--what is mental illness?
      
2. Problems caused by mi's in criminal justice system
   • Costs:
   • Processing: lawyers, judges, bailiffs, court reporters, clerks
   • Jail (pre-trial detention) costs (with or without treatment)
   • Convicted prisioners: $20,000/person/year Dixon (with or without treatment)
   • Lack of treatment–conflict between world view of criminal justice system and the mental health system
   • Recidivism–criminal justice/mental health
   • Costs to victims
      
3. History of Mental Health Courts
   • Patterned after drug courts
   • Broward County , FL (Indianapolis/King County,WA/Alaska)
   • Federal demonstration grants
   • Local initiatives: Cook, DuPage, Kane, Winnebago
      
4. Goals of Mental Health Courts
   • Main goal–reduce jail costs
   • Reduce other criminal justice costs
   • Reduce recidivism
   • Increase medication/treatment compliance
   • Increase community mental health funding (They've stolen all our clients; let's steal all of their money)
      
5. Model(s) of Mental Health Court(s)
   • Send mentally ill criminal defendants to one or more dedicated courtrooms
   • Which crimes (usually limited to non-violent misdemeanors)
   • Which diagnoses–do we include dual diagnosis (MISAs)
   • Usually not Axis II
   • Plea bargaining model
   • Probation/supervision
   • Judicial involvement (hard/soft)
   • Who provides treatment/who pays for treatment
   • Liaison to court/TASC model/probation officer
      
6. Do they work? What does that mean? Reference to goals
   • Anecdotal support–counties who start mh courts do not terminate them
   • UVA/MacArthur Foundation study
   • Reduce recidivism–compared to what?
   • Reduce criminal justice costs (jail costs)
   • Increase treatment compliance
      
7. Problems/Concerns
   • (Improper?) Coercion
   • Only way to get mental health services is to commit a crime/compare to substance abuse services in criminal justice system
   • May confuse role of criminal defense counsel
   • Other interventions may be better
   • Provide discharge planning services (jails and prisons)
   • See Thresholds/DHS/Cook County Jail award winning model which reduced recidivism by more than 60%
   • Police training
   • Just more mental health services–why target criminals