Wednesday, February 06, 2013
Here is a open letter I would like to send to Gov.
Pence.
R.C.
Dear Governor Pence:
In my many years of working with the seriously mentally ill
[SMI], there have many periods of public outrage because of the actions of a
psychotic individual. John Lennon was shot. President Reagan was shot.
There were random and nonsensical murders all across the country. And of course
there is the recent massacre of children at the Sandy Hook school. All
committed by the mentally ill. With each tragedy there is a public outcry
to supervise the mentally ill better. To provide better treatment. To provide
better supervision. To do a better job of protecting the public. I
would like to help with this.
Most of my 35 plus years of working in social services has
been working with the dangerous and serious mentally ill. I have been
responsible for monitoring 600 [of a possible 1000 or so] mental patients who
live in the community [in Marion County] and who were under court orders and
civil commitment to comply with treatment. I worked with the mental health
court to try to bring recalcitrant patients in compliance with their court
orders.
At any given time, while supervising these patients,
approximately 50% were non-compliant either by not taking their medications,
missing appointments, or by substance abuse. The court had very few tools to
force compliance.
It was very frequent that we would see the arrest of one of
our patients for a notorious crime and then it made headlines all over the
media. It was sad that we could not have prevented this. It was sad that
we could not share with the criminal court information about the patients civil
commitment nor his mental history. There is no sharing of this vital info with
any agency.
There are many problems with the supervision of dangerously
mentally ill. I believe with my experience from working with the Marion County
Prosecutor’s Office, the Public Defenders’ Agency, the Marion County Court
System, the Marion County Jail, and the Marion County Community Corrections
that I have knowledge and experience which would be helpful. In the past
I have help develop the PAIR Mental Health Diversion Program. I served on Mayor
Goldsmith’s Task Force on the Dangerous Mentally Ill. I served on Prosecutor
Newman advisory panel on the Incarcerated Mentally Ill. And I served on
the advisory committee for DOC under Commissioner Cohen.
I believe with rational planning and action, we can prevent
many tragic crimes committed by the dangerous and serious mentally ill.
I would like to again work on this problem. I am
willing to be part of a advisory committee to explore these issues. I am also
willing to serve on the Governor’s Commission on Mental Health.
Please advise me if I can be of service. I can be reached at
ph. 317-354-6668.
Sincerely,
Robert Cardwell, LSW
January 31, 2013
Thursday, January 31, 2013
Reasons for the Governor
to form a Interagency DOC/DMH Advisory Board
Up to 20% of the inmates
at DOC [Dept of Corrections] have serious mental illness [SMI]. 95% of these
inmates will be eventually released into society. They frequentfully drop out of treatment,
violate their parole, commit a psychotic crime, or are arrested on nuisance
charges.
Up to 80% of the
in-patients in the DMH [Division of Mental Health] have court issues. This can
be relatively minor charges to very serious charges like murder and
cannibalism. A high percentage of this SMI patients are released to the
community for follow up in group homes. If the SMI patient refuses to
cooperate, he is either re-admitted to the hospital or is re-arrested on
another charge and is sent to jail, prison, or released to the streets.
Most civil commitments
for psychiatric treatment eventually end up treated in the community on an
out-patient commitment. Fifty percent to Two thirds of psych patients on
outpatient commitment are non-compliant. There is no regular supervision with
realistic consequences of patients on an out- patient commitment.
SMI patients on
commitments are frequently arrested and the criminal court or police have no
knowledge of the person’s civil commitment of psychiatric treatment.
There are no resources
to hospitalize all of these non-compliant persons on outpatient commitments. At
any given time there are about one thousand dangerous and SMI court committed
patients living in the community who are non-compliant with treatment and
supervision. Many of these SMI patients are arrested for a wide range of crimes
and the criminal court does not know that the civil court has placed this
individual on a civil commitment.
SMI inmates at DOC tend
to stay longer and are much more expensive to manage. It is very common for SMI
inmates to go to jail or prison on minor charges and then get much more serious
charges while in custody and stretch out a sentence of a few months to
sometimes ten years.
The Incompetent to Stand
Trial [ICST] laws are out of date and cause many problems and expense. For
example, a SMI is arrested. He is held in jail many months till a court date.
He is then found incompetent. He is sent
to Logansport State Hospital to be treated. Most of the time with treatment,
the SMI patient becomes competent and is returned to jail. He has to wait at jail several months for a
court date. He quits taking his
medications and by the time he goes to court he is psychotic and incompetent
again. He may be in this revolving door
for years.
The “Guilty But Mentally
Ill” laws are out of date and inefficient.
Sex Offenders my benefit
from life long civil commitments.
There are more injuries
from SMI patients. SMI inmates get injured more frequently. Staff are injured
more frequently by SMI.
There is no routine
monitoring or reporting of the dangerous and serious mentally ill. A SMI with a court commitment could buy a gun
legally and get a gun permit.
We have to do something.
We need change now.
Sunday, July 01, 2012
Presentation of New Ideas for the PAIR Program 2012
Greetings!
I am Bob Cardwell. I am one of the
founders of the PAIR Mental Health Diversion Program. Back in the beginning of
The Pair Program, I helped facilitate its start by doing the mental health
screenings in lock up and leading the group presentations to the PAIR
Roundtable.
I
am here today to talk today about this program. It is a program dear to my
heart. I have worked in the mental health field since 1975. My involvement though goes back to my visits
to my mother who was a nurse at Central State Hospital. In the sixties it was
common for employees to bring their kids in to the picnics and festivities. It
is becoming rarer as I grow older, but it still , once in a while, I run into a
old resident, or hear something about an old Central State Hospital resident I
met as a child.
So
for good or bad, being involved in the mental health field is a big part of my
life. In spite of all the work I have done and goals I have accomplished, there
is only one thing I might be remembered for doing, and that is why I am here
today. The PAIR Mental Health Diversion Program is my legacy. It is perhaps my
sole chance at being recognized or to have my work remembered. I want to see
the PAIR Mental Health Program grow and continue to do good work.
Here
are my goals for this presentation:
1.
I want to talk about some ideas to grow the program.
2. I want to talk about ideas to make the
program safer and to increase the quality of care and
3. I wish to talk about
ideas to fund the PAIR Program.
***
I
met with a young lady recently. She was a MSW student making a mid-career
switch to social work and was writing a research paper on the PAIR Program. She
had already interviewed several past and present members of the PAIR
Program. She updated me on the current state of the PAIR mental health
diversion program. The round table meeting still happens every Thursday. It is
unclear if any of the players are the same as they were when I and my
associates started the PAIR Program. It seems that some of the representatives
of the original stakeholders still attend. The representative for the largest
mental health service provide is there. An assistant prosecutor is there. A
public defender is there as are some support clerical staff from the PD's
office. And finally, she said that someone from the MHA--The Marion County
Mental Health America association still advocates for the mentally ill as a
court monitor.
Sadly,
there seems to be missing the attendance of anyone who actively goes out and
searches for persons who could actually benefit from the program. In the
beginning of PAIR, there were several persons actively advocating for the
mentally ill as they entered custody and help coordinate any emergency or long
term treatment.
Roughly
60, 000 people are processed through the Arrestee Processing Center. Only 10%
or 6000 are held for more than a few days. A conservative estimate would be
that 10% of these longer term detainees are the seriously mentally ill, or
about 600 are held who need serious psychiatric treatment. That conservative
number would easily make the Marion Co. Jail the largest mental health
inpatient [or custody] treatment facility in the state. And who is actually
treating the largest group of mentally ill persons in custody? A private
contractor. A contractor whose main
goal is to make a profit. There is no concern for the long term welfare of the
patient or the county. There is no accountability to the patient, the court, or
the community. To my knowledge, there is no one at the PAIR round-table to
represent this private contractor nor to represent the welfare of the serious
mentally ill offender.
I
believe this lack of over-site and accountability for the treatment of the SMIO
is wrong and should be corrected. It is possible that I don't have all the
facts, but several reports from the PAIR program suggests that there is
something wrong. The biggest indicator seems to be the lack of utilization of
the PAIR Program by those SMIO [serious mentally ill offender] in jail. I am
told that in spite of the program being in existence for 17 years, it is
roughly handling the same number of clients, about four dozen, as it did in the
beginning of the program. Why is there no growth? What happened to all the
in-kind services provided to the PAIR program? What happened to all the
significant investments of personnel time and expense? Has the PAIR program
evolved into a show boat of good intentions and good will publicity without
doing any real work?
In
the beginning, I believed that we in the PAIR program thought we could really
make a difference. It was the naiveté and the belief that caring people could
change the world, or at least our county. When I first started working on the
PAIR project I tired to pull in people who were not only knowledgeable and
powerful, but truly seemed to care about the work and for the ideal of doing
something good for the welfare of the community. This group ended up including
professors, judges, attorneys, doctors, social workers, nurses, prosecutors,
advocates, and the public defenders. Interestingly, many of the early PAIR
workers had family members or love ones with mentally illness and had first
hand experience with the deficits in the current social network or so called
safety net for those with psychiatric problems. All of the early participants
in PAIR seemed to understand that the criminal/justice system's treatment of
the SMIO is/was a microcosm of how the mentally ill are treated in the real
world. Early on we tried to promote the notion that a rationale and humane
manner of treating the mentally ill in the criminal/justice system could
actually save money. We didn't want money. We wanted to save money and the
dignity of the ill. We wanted to save all of us money and be more caring to the
mentally ill too.
We
benefited from Prosecutor Scott Newman's crusade to cut costs and his posting
of the "top ten frequent arrestees". He asserted that these few
persons accounted for over a million dollars in processing costs, which
included: man hours, court costs, and the cost of incarceration. Often times
when the subject was released by the court to the community, he would then be
re-arrested before his release papers were even finished being processed. All
of the persons on this list were frequently treated at the local mental health
centers. And the final comment on the list was that all of the arrests were for
trivial charges like public intoxication, trespass, disturbing the peace, etc;
or what are generally known as misdemeanor nuisance charges. Most of the
people on this list would be dead before the end of the decade.
Who
advocates for a sane system now? Who actually enters into the pit and tries to
rescue people? I would like to see the PAIR Program grow and do some good. I
would like to shake the program out of it complacency and see it actually do
something more than just being happy with the status quo. It seems at present,
the program is little more than window dressing, or a dog and pony show. This
PAIR program gives elected officials some plausible deniability of the state of
the care of the mentally ill in the county facilities. They can say, "We
are working on it". "Look what the PAIR Program does." ETC.
Meanwhile, sick people are suffering in jail cells and nothing is being done
about nudging them toward treatment nor helping them improve their lives.
The
PAIR Program is in reality advocating for the same number of people we did 20
years ago and there is no supervision of care on the front lines in the
jail.
***
I
would like to offer the following suggestions on re-invigorating the PAIR
program and improving it:
I
would like to see a build up the esprit de corp and an increase of knowledge of
the PAIR Roundtable participants. In the beginning of the PAIR program, we went
on frequent field trips to treatment facilities and service providers. We went
to Carter State Hospital, a Day Reporting program, Richmond State Hospital,
Madison State Hospital, and Logansport State Hospital. I did not get the time
to do more on the criminal/justice side. I would advocate the PAIR Roundtable start
taking tours of the courts, the jail, the arrestee processing center, and
community corrections center. The group needs to understand what truly happens
on the front lines. These field trips, educate and informs all who are involved in the work with the
mentally ill.
I
believe there needs to be more advocacy in the PAIR program. The Protection and
Advocacy service needs to be more involved in the needs of the mentally ill in
custody. They have federal and state mandated powers to this. Also, the ACLU
needs to get involved and advocate for a rational consent decree to insure that
the rights of the SMIO [serious mentally ill offender] are being protected in
jail. Finally, the MHA [Mental Health America] needs to arrange for its
staff or volunteers either to respond to the requests of the incarcerated SMIO
or to periodically visit to insure the quality of supervision is being
maintained. In my day, the local federal court has several supervision
projects.
I
believe there needs to be a designated staff person from the PAIR program, to screen
for the mentally ill in the group of daily new arrestees. That is what I use to
do. I would screen the records of
perhaps a hundred new arrestees and interview ten, everyday. Now, this could be
a two part screening with the first part being done by trained medical staff
and the bail commissioners. If the inmate is grossly psychotic and dangerous,
or at risk; he should be sent for
immediate emergency care. The second part of the screening should be done by a
representative of PAIR who has acecss
to the county or public mental health records. At any given time, there are
dangerous persons entering the jail whom are already under care for mental
illness or addiction and under the
supervision of a court order, be it a civil commitment, probation, parole, bail
conditions, community corrections, or some other pending criminal case. All of
these public and private records need to be available in one database for the
use of the PAIR screener. The PAIR screener refers the appropriate case to the
respective appropriate entity, while determining those who meet the guidelines
for an intervention by the PAIR program. The PAIR Screener will bring
those cases who meet the guidelines to the PAIR roundtable meeting on
Thursdays.
I
believe that the Prosecutor's screening committee either needs to have a
representative of PAIR in attendance or a member of the screening committee
needs to attend the weekly PAIR Roundtable. The screening determines the
severity and whether charges should even be officially brought against an
individual. This process may present the opportunity for the prosecutor to make
a informal offer of diversion rather than simply dropping a charge which may be
of benefit to the arrestee and the community. The PAIR program could follow up
and report whether the agreement was followed or not and if so, the charges
could be dismissed. I believe many new cases for the PAIR Mental Health
Diversion could be found during this screening process.
I
believe here should be periodic public workshops to train and inform the public
about the PAIR program. I believe one of the best things we use to do as a
group was to participate in public and professional workshops. I traveled all
over the state and also gave presentations in Chicago to the National NAMI
meeting and to Washington DC, to give a workshop at the National Public Health
Convention. The PAIR Program needs to participate more in this process and
contribute to the body of knowledge about the incarcerated mentally ill.
I
believe that the providers of psychiatric treatment in the Marion Co. Jail
System and Community Corrections need to send a representative to the PAIR
Roundtable and provide a record of those receiving treatment in custody. This
would insure some continuity of care and provide some reasonable
oversight. Some of these same inmates may cycle through our different
systems many times and the more we know about their history and treatment, the
more effective and humane we can be.
The
CIT officer's program seems to be working well. I believe there should be a CIT officer in attendance at the
weekly PAIR roundtable to discuss problems and issues of mutual interest. This
could aid in the enforcement of the diversion agreements and increase the
effective use of the Immediate Detention law. This cooperation could aid
the ideal of community policing and increase the likelihood that the CIT
officer and SMIO have an opportunity to have an informal diversion agreement.
There
are multiple types of diversion programs and agreements. There is a domestic
violence court, a drug court, a protective order court, and perhaps others who
have a diversion agreement. I believe there should be some coordination and
database of those on diversion and what the conditions of the agreement are.
This sharing of knowledge will cut down on duplication of resources. There
should be a public record of a diversion agreement.
I
believe there should be a representative of the Marion Co. Probation Department
in attendance at the PAIR Roundtable. Many of the mentally ill offenders won't
qualify for diversion, but will have their treatment supervised by probation.
Another benefit to the probation department is that many of their clients are
mentally ill and will need services long after the probation is over. There is
a strong possibility that many of them will be re-arrested for nuisance crimes.
This cooperation would benefit the community.
I
believe the courts, and specifically the Circuit Court and the Probate Court
should be more involved in the PAIR program. Many of those arrested are already
on a civil commitment out of the Probate Court which is suppose to supervise
the person's mental health treatment. At present, it is possible for a mentally
ill person to be on a civil commitment, on several types of diversion, and to
be on probation: ALL AT THE SAME TIME!
The Circuit Court needs to determine a way to coordinate this better. It would
be especially beneficial for the Probate Court to send someone with knowledge
of the civil commitments to the PAIR Roundtable as it is the responsibility of
this court to supervise committees' treatment. A more long term goal could be
that there would be designated court for civil commitments and for minor
criminal charges. This court could follow persons on commitment and diversion. This
new court could issue new commitments and diversion. It could offer
supervision. This new mental health court could also screen and coordinate the
petitions for ICST and its mandated provisions. A court with specialized
knowledge in ICST would save the system much in time and expense.
I
believe that the PAIR Roundtable needs to be more formalized. There should be
formalized roles. There should be an up or down vote on accepting someone for
the PAIR program. This would necessitate that there be some formal bylaws and a
formal administrative body or advisory board. The advisory board should be
appointed by the mayor, the City-County Council, and/or the governor. The PAIR
Roundtable would work under the supervision of the PAIR Mental Health Diversion
program. The PAIR Advisory board would need a similar body as the community
corrections board. There should be a representative of the Mayor, the
City-County Council, the IDOC, the Marion Co. Courts, The Marion Co. Sheriff,
The Marion Co. Prosecutor, The Community Corrections Director, Mental Health
Advocates, Members of the Public, and Mental Health Service Providers. The PAIR
Roundtable and interested parties should nominate official members of the
roundtable and they shall be affirmed by the advisory board.
The
purpose of the PAIR Roundtable is to hear case presentations and to vote on
whether that individual is appropriate for the diversion program and may
possibly benefit from its supervision. The cases will be presented by the PAIR
screener or other interested parties after being placed on the agenda by the
PAIR coordinator. The number of participants to the roundtable should be
reasonable to facilitate discussion and to keep information as confidential as
possible. Members should include the screener, the coordinator, a public
defense attorney, assistant prosecutor, advocate, patient program monitor, and
formalized representatives of major public mental health providers. Other
interested parties could attend the PAIR roundtable meeting but should have the
power to vote.
The
court supervision and monitor portion of the diversion program should continue
to be in the Mental Health Diversion Court. As usual, there will be a hearing
where the court monitor reports on the progress report under supervision of the
assistant prosecutor. The client will give testimony under the supervision of
the public defender. The judge will ask questions of comments at will. The
diversion agreement is either extended, terminated as failure, terminated as a
success. If the agreement is a failure, the prosecutor will decide on whether
to send this matter back to criminal court for prosecution.
I
recommend that the PAIR Program find new ways to fund the program. I suggest to follow the money. Do a cost
benefit analysis. Many of the agencies and government entities which benefit
from the PAIR Program have their own revenue streams. Some of these streams are
taxes, grants, and fees. Some of these fees are collected from individuals and
some from other agencies. Often times this cache of money is not supervised by
any oversight and are used at the discretion of a department head or an elected
official. Sometimes these individual funds are a repository of millions of
dollars collected per year and are sometimes used for the most trivial of
projects and to promote the PR of the agency. Two examples are the diversion
fund of the prosecutor's office and the sheriff's commissary fund. Most of what
the public knows about these funds come from the shadows. There needs to be
known more about these funds and how they can be utilized for the public good
like funding the PAIR program. If the prosecutor or sheriff has millions of
dollars floating around for their discretionary use, the PAIR Program should be
advocating for some funding as their services save money for the respective
agencies.
Finally,
another initiative I have thought about is the Make, Sake, Bake, Take, or Shake Program. PAIR can make money by collecting fees from
either the individuals or from the participating agencies. The sake part of the initiative is getting
donations because this a good program and people should fund it for goodness'
sakes. The bake part is where the
members of the PAIR program do different fund raisers to get enough money to
fund part of the PAIR program. The take
portion is to take funds from agencies which benefit but who may not want to
give it to you like the sheriff or prosecutor. The shake idea is to seek funding through taxes or funding through the
City-County Council. The PAIR program logically saves money and the time of many
agencies. These agencies should contribute funds to help PAIR help them reach
their performance goals more efficiently.
These
are just a few of my thoughts, here at the beginning of the Summer in 2012.
Are
there any questions or comments?
DISCUSSION
Respectfully
Submitted,
Robert
Cardwell, LSW, QMHP
Original
PAIR Program Founding Member.
Saturday, July 25, 2009
What a Mental Health Court should be.
Mental Health America
Position Statement 53: Mental Health Courts
Policy
Mental health courts have been created in numerous jurisdictions across the United States, largely as a response to the increasing number of defendants with serious mental illnesses who are caught up in the criminal justice system. Mental Health America and other mental health advocacy organizations need to work to ensure that mental health courts do not lead to greater criminalization and stigma for persons living with mental illness and greater fragmentation of the mental health system.
The presence of defendants with mental illnesses in the criminal justice system imposes substantial costs on that system and substantial harm on defendants. It is difficult, if not impossible, to provide humane and just treatment to persons with mental illnesses in prisons and jails. Thus, Mental Health America strongly supports thoughtful efforts to reduce the number of defendants with mental illnesses in the criminal justice system and in prisons and jails. Mental Health America's diversion policy states that case.[1]
To the extent that mental health courts are an effective mechanism for reducing the number of persons with mental illnesses in prisons and jails and subject to the concerns expressed in this policy, Mental Health America supports the creation of mental health courts. Mental Health America enthusiastically supports efforts to use new or existing criminal justice funding-federal, state or local--to provide community mental health services to persons with mental illnesses being diverted from prisons and jails through well-designed mental health court programs.
However, mental health courts can also be used to criminalize persons with mental illness, for "lifestyle" offenses. Mental health courts are a highly inappropriate way to treat homeless people and people with mental illness whose offenses flow from their troubled life on the street, and Mental Health America strongly opposes the use of mental health courts for this purpose or with this effect.
There are many other successful and innovative ways to divert persons with mental illnesses from the criminal justice system, including the creation of law enforcement-mental health liaison programs, increased training of law enforcement personnel and a general improvement in the funding and effectiveness of community mental health services. In order to prevent the misuse of mental health courts, such courts should be but one part of a coordinated community effort to reduce the number of persons with mental illnesses in the criminal justice system. The filing of actual criminal charges against persons with mental illnesses which would result in their assignment to a mental health court should be the last resort after all reasonable efforts at diversion have been exhausted.
It is critical that Mental Health America, Mental Health Associations and other advocates work to promote diversion from the criminal justice system as the central mission of mental health courts, wherever they exist and by whatever name they are called. Advocates need to insist on mental health court standards that assure a non-coercive and de-stigmatizing approach and leave civil commitment as the central standard for the authorization of coercion, when it is needed and justified, not the criminal courts. A criminal record should not be a cost of getting mental health treatment.
Discussion
Where they exist, Mental Health America advocates that mental health courts play a role in convening criminal justice, mental health, substance abuse and other relevant social service agencies to facilitate diversion from the criminal justice system. Mental health courts should not act as mandators of treatment, using criminal sanctions to coerce compliance, imposing the stigma of criminalization as a condition of access to treatment resources. They should focus instead on diversion.
It must be conceded that when diversion is not possible, mental health courts may serve to assure treatment for persons with serious mental illness convicted of crimes and divert them from incarceration, if not from conviction. This too is a valuable role. Anything that keeps people with serious mental illness out of prisons and jails should be encouraged. With good will, mental health courts can broker diversion and protect the vulnerable from being crushed in the gears of the criminal justice system. However, the risk that remains is that mental health courts actually defeat diversion in favor of a kind of endless, boundary-less criminal probation, and that more and more people with mental illness will be swept into the criminal justice system, which would be an extremely unjust outcome.
Above all, mental health courts must avoid becoming a preferential point of entry for persons who have been unable to obtain community-based treatment, thus draining resources from an already underfunded community mental health treatment system. Treatment preference should not be given to persons accused of crimes over others who have not committed a crime, but who are still unable to access services. Mental health courts should never become a way to "jump the line" and get preferential access to existing resources.
The ultimate danger is that in the hope of improving access to treatment resources, and even providing some, mental health courts will, in the end, increase coercion and stigma. There is also the risk that they will fail to effectively triage available treatment resources to achieve the best overall public health outcomes. The basic problem is that the courts cannot run the mental health system from their limited vantage point and cannot provide the resources needed to fill the gaps.
Mental health courts risk inappropriate intervention of the criminal justice system, with no real improvement in treatment outcomes. At best, they may effectively determine individual needs and advocate for good individual treatment. At worst, they risk further criminalizing people with mental illness and fragmenting the mental health and criminal justice systems. Mental health courts are functioning all over the country now, and their implementation concerns all mental health advocates. It is a time for advocacy.
Mental Health America believes that advocates must remain skeptical of mental health courts and attentive to their evolution. Mental health courts inherently risk further criminalization of persons with mental illness and may compete with diversion programs unless they embrace diversion as their own focus. Mental Health America believes that eventually, all mental health courts should satisfy the guidelines established in this policy.
Background
Mental Health Courts - While there is no accepted definition, mental health courts have been created by local initiatives, often adapting the model of drug courts, and focusing initially on dually diagnosed substance abuse and mental illness, to obtain mental health treatment for persons with mental illness accused of crimes. Currently, some mental health courts involve using the authority of the court to impose treatment compliance as a condition of release from jail or bail. Failure to comply may result in sanctions being imposed, up to and including incarceration.
Diversion - There are two basic models of diversion. Under the predominate model, a person is assigned to a treatment program and criminal charges are suspended or dropped. Any program that provides for dismissal of charges or deferred prosecution, even after arraignment, is considered to be "meaningful diversion." Programs under which persons are assigned to probation after a plea of guilty are sometimes referred to as diversion. However, these programs are only a diversion from incarceration and not diversion from the criminal justice system.
The concept of mental health courts has been promoted in order to respond to the increasing number of people with mental illness caught up in the criminal justice system. The failure of American society to make good on the promise of community-based care is one of the reasons for this increase. America has never committed the resources necessary to provide adequate community mental health services for people who are at risk of commitment to or being discharged from institutions (including hospitals, prisons and jails). Additionally, lack of education contributes to the prejudice, stigma and discrimination against persons with psychiatric disabilities. Increased enforcement, especially of misdemeanor "lifestyle" offenses, has criminalized symptoms of mental illness and co-occurring substance abuse disorders.
One of the primary concerns which Mental Health America has about mental health courts is that they may be used inappropriately as tools to coerce treatment. Since mental health courts are relatively new, there is not a great deal of research about the level of coercion involved in such courts. The research which has been conducted, however, is encouraging. A recent study of the Broward County Mental Health Court found that "the mean score on a self-report perceived coercion measure (0.69) was low in an absolute sense and...lower than almost any score on a comparable measure of perceived coercion previously reported in the literature."[2] This study emphasized that a key element affecting the perceived lack of coercion was the fact that participants could opt out and be returned to the courts which heard cases involving defendants who were not identified as having a mental illness. Additionally, the study emphasized the importance of insuring that defendants were aware of this option.
Similarly, mental health courts were much less apt to use jails as a sanction for failure to comply with court-ordered treatment than were the drug courts after which they are modeled.[3]
Given the wide variation among the designs of mental health courts, these studies do not demonstrate that mental health courts are non-coercive. But they do demonstrate that it is possible to design a mental health court with minimal coercion. Mental Health America urges jurisdictions which chose to create a mental health court to follow those models which use minimal coercion.
In 2000, the United States Congress authorized a mental health court demonstration program (P.L. 106-515). In doing so, Congress identified mental health courts as having the potential to address the criminalization of people with mental illness. Mental health courts are here to stay. Mental Health America is concerned that communities may rush to implementation without considering all of the components of an effective system to respond to the needs of persons with mental illness involved in the criminal justice system. In the absence of a framework of values to guide the development of mental health courts, the needs and rights of people with mental illness may be ignored and threatened. This policy seeks to provide such a framework
Principles
Minimizing the use of coercion is fundamental to effective mental healthcare and treatment and recovery from mental illness, and the most coercive entry point for mental health treatment is the criminal justice system. The United States already incarcerates people at the highest rate in the western world, and we have effectively institutionalized many persons with mental illness in correctional facilities.
Criminal courts rarely address mental health issues in sentencing decisions. Corrections systems are assigned the classification/diagnosis as well as the treatment responsibility, once there has been a criminal conviction, with deferred sentences and probation after a plea as a gray area of court involvement. However, probation and other forms of post-conviction court involvement, including deferred sentences contingent on mental health treatment, are really only alternatives to incarceration, not alternatives to the use of criminal sanctions.
Communities must develop services that meet the comprehensive needs of mental health consumers. It is essential that any mental health court program bring additional treatment resources to the community, rather than depleting already limited existing resources. In addition to significant increases in public investment, services must be integrated across public and private agencies to address the full range of consumer needs. Individual treatment plans should be focused on consumer recovery and choice and should include: mental and physical healthcare, case management, housing, supportive education, substance abuse treatment, and psychosocial services in the least restrictive environment possible.
Mental health courts may act as a catalyst in developing this comprehensive, community-based mental health system because state and local corrections are often only minimally involved and unable to pay more attention. As a convener, mental health courts may be able to get the attention of other agencies that they do not control, to promote real and enduring systems change. In this capacity, the court convenes criminal justice, mental health, substance abuse and other social service agencies and community resources to respond to the needs of those persons before the court. However, that convening role requires real commitment from the judiciary and entails substantial risks.
Concerns
The greatest danger is that mental health courts will assume a coercive role, both in allocating scarce treatment resources and in further criminalizing and stigmatizing persons with mental illness who get caught up in the criminal justice system. Secondarily, there is a risk of fragmentation, both of the struggling community-based mental health treatment system, and of the already-fragmented criminal justice system.
At the extreme, mental health courts may become a preferred means of access, with mental health judges granting treatment preference to persons accused of crimes over others. In addition, unless citizens are vigilant in monitoring the development and implementation of mental health courts, court processes may lead to even greater criminalization, stigma and fragmentation. Already, people with mental illness stay in jail two to three times longer than others charged with the same offenses.
Guidelines
State and local Mental Health Associations are in a strategic position in their communities to influence and guide the development and implementation of mental health courts in ways that safeguard the needs and rights of consumers. In order to avoid potential risks in establishing mental health courts, Mental Health America advocates that state and local Mental Health Associations be involved in the development and implementation of mental health courts from very early on. To assist in this effort, the following guidelines have been developed to support mental health advocates and justice systems in shaping new mental health court initiatives and holding mental health courts accountable where they currently exist.
1. Comprehensive mental health outreach - Access to community-based mental health treatment services for all people needs to be improved, and should not depend on the existence of mental health courts. Equally effective services should be assured for the treatment needs of persons not accused of crimes. This requires an investment in outreach services to promote voluntary treatment as an essential complement to any mental health court program.
2. Maximum diversion - Pre-booking diversion should be assured for all persons accused of crimes for whom a voluntary mental health treatment plan is a reasonable alternative to the use of criminal sanctions. Timely and accurate mental health screening and evaluation is the single most critical element in a successful diversion program. Mental health courts may be helpful in assuring such diversion, but should never be the only way, or even the primary way, that it can occur.
3. Meaningful diversion - Meaningful diversion would require that when appropriate, no charges would be filed, and the individual is diverted directly to treatment without entering the criminal justice system. In the alternative, when charges must be filed, criminal proceedings should be deferred for a set period, usually not exceeding a year. Dismissal of criminal charges would then be guaranteed after a set period of successful treatment participation.
4. No requirement for a guilty plea - A guilty plea should not be required to enter a mental health court program. This requirement precludes diversion from the criminal justice system at the earliest possible point in time and further criminalizes a person because of his or her mental illness. As indicated above, the preferred method is to hold charges in abeyance until the successful completion of the treatment program.
5. Voluntary/Non-coercive - While the threat of criminal charges influences any decision, participation in any mental health diversion program should involve the same level of voluntary choice required of a criminal plea. No one should have to decide whether or not to accept diversion until the terms and the nature of the proposed treatment plan have been fully discussed and documented.
6. Least restrictive alternative. - All persons participating in diversion programs should be treated in the least restrictive alternative manner available, and all unnecessary institutionalization should be avoided. Jails are generally an inappropriate place for persons waiting for diversion as jail experiences tend to exacerbate underlying symptoms of mental illness. Long jail stays should be avoided in all diversion cases.
7. Right to refuse treatment - The qualified[4] right of a person with mental illness accused of a crime to refuse a particular treatment, including a particular medication, should be protected in a manner at least as protective of the consumer as the civil commitment process. A process should be established to review treatment refusals of persons diverted from the criminal justice system so that any decision to reinstate charges is made in an informed manner after all reasonable alternatives have been exhausted.
8. Advocate/Counselor - In addition to competent legal counsel in any criminal case, an experienced counselor, who may be a peer or other non-lawyer counselor, independent of any treatment facility, should be available to help the accused person to reach an informed decision. This person should also serve as an advocate to ensure that necessary services that have been mandated as part of a treatment plan are provided in a timely and appropriate manner. Mental Health Associations and other consumer advocacy groups may take on this important role.
9. Confidentiality - Networking to find an appropriate treatment setting, without safeguards, could compromise client confidentiality. Systems must be put in place to ensure confidentiality from the time that a person enters a mental health program.
10. Cultural competence - Cultural competence is essential to treatment success. Mental Health America believes that services must be tailored to the specific needs of communities and individuals in order to effectively address public health problems.
11. Community coalitions - The development of community coalitions, including partnerships between criminal justice, mental health and substance abuse treatment agencies, is essential to successful diversion programs. Such coalitions also should be involved in the creation and oversight of mental health courts. Consumers of mental health services and family members affected by mental illness need to be included in all such coalitions to assure that they address the real barriers to effective mental health treatment in that community.
12. Comprehensive outreach and training - Community coalitions need to reach out to all criminal justice system personnel and ensure that training is provided at all levels to deal with issues of mental illness, wherever and whenever they occur.
13. Co-occurring disorders - In addition, persons with co-occurring disorders, and especially substance abuse, must be treated in an integrated way, so that substance abuse is not an impediment to diversion.
14. Convening role - The focus of mental health courts should be on convening prosecution, probation, treatment and social services agencies to promote interagency collaboration in the interest of the individual. The focus should not be on the use of criminal sanctions to compel treatment.
15. Consolidation and coordination of cases - Cases should be consolidated to assure that the individual is the focus rather than the case. Centralized, coordinated case management and a single treatment plan are needed to avoid fragmentation, with or without a mental health court.
16. Handling relapses in the court setting - Relapses are inevitable during the recovery process. As such, an individual's time under jurisdiction of the mental health court should not be extended as a result of these relapses.
17. Evaluation - Timely monitoring of court processes, waiting lists, and consumer outcomes are essential to ensure that mental health courts are responding appropriately to persons with mental illness, that waiting lists are kept to a minimum, and that treatment providers are held accountable for consumer outcomes.
Effective Period
The Mental Health America Board of Directors on November 17, 2001 and revised by the Mental Health America Board of Directors on November 13, 2004, adopted this policy. It will remain in effect for a period of five years.
Expiration: November 13, 2009
[1]Mental Health America Policy Number 50 (Issued 2002), "In Support of Maximum Diversion of Persons with Serious Mental Illness from the Criminal Justice System."
[2] (The score was compared to the scores of both voluntary and involuntary inpatients and involuntary outpatients.) Poythress, N. et al, "Perceived Coercion and Procedural Justice in the Broward County Mental Health Court," 25 Int. J. of L. & Psych. 517 (2002)
[3] Griffin, et al, "The Use of Criminal Charges as Sanctions in Mental Health Courts," 53 Psych. Services 1285 (Oct. 2002)
[4] Washington v. Harper, 494 U.S. 210
HELP
In Crisis? 1-800-273-TALK If you, a friend or a loved is going through a tough time
Policy from:
Mental Health America
2000 N. Beauregard Street, 6th Floor Alexandria, VA 22311
Phone (703) 684-7722
Toll free (800) 969-6642
TTY 800/433-5959
Fax (703) 684-5968
Position Statement 53: Mental Health Courts
Policy
Mental health courts have been created in numerous jurisdictions across the United States, largely as a response to the increasing number of defendants with serious mental illnesses who are caught up in the criminal justice system. Mental Health America and other mental health advocacy organizations need to work to ensure that mental health courts do not lead to greater criminalization and stigma for persons living with mental illness and greater fragmentation of the mental health system.
The presence of defendants with mental illnesses in the criminal justice system imposes substantial costs on that system and substantial harm on defendants. It is difficult, if not impossible, to provide humane and just treatment to persons with mental illnesses in prisons and jails. Thus, Mental Health America strongly supports thoughtful efforts to reduce the number of defendants with mental illnesses in the criminal justice system and in prisons and jails. Mental Health America's diversion policy states that case.[1]
To the extent that mental health courts are an effective mechanism for reducing the number of persons with mental illnesses in prisons and jails and subject to the concerns expressed in this policy, Mental Health America supports the creation of mental health courts. Mental Health America enthusiastically supports efforts to use new or existing criminal justice funding-federal, state or local--to provide community mental health services to persons with mental illnesses being diverted from prisons and jails through well-designed mental health court programs.
However, mental health courts can also be used to criminalize persons with mental illness, for "lifestyle" offenses. Mental health courts are a highly inappropriate way to treat homeless people and people with mental illness whose offenses flow from their troubled life on the street, and Mental Health America strongly opposes the use of mental health courts for this purpose or with this effect.
There are many other successful and innovative ways to divert persons with mental illnesses from the criminal justice system, including the creation of law enforcement-mental health liaison programs, increased training of law enforcement personnel and a general improvement in the funding and effectiveness of community mental health services. In order to prevent the misuse of mental health courts, such courts should be but one part of a coordinated community effort to reduce the number of persons with mental illnesses in the criminal justice system. The filing of actual criminal charges against persons with mental illnesses which would result in their assignment to a mental health court should be the last resort after all reasonable efforts at diversion have been exhausted.
It is critical that Mental Health America, Mental Health Associations and other advocates work to promote diversion from the criminal justice system as the central mission of mental health courts, wherever they exist and by whatever name they are called. Advocates need to insist on mental health court standards that assure a non-coercive and de-stigmatizing approach and leave civil commitment as the central standard for the authorization of coercion, when it is needed and justified, not the criminal courts. A criminal record should not be a cost of getting mental health treatment.
Discussion
Where they exist, Mental Health America advocates that mental health courts play a role in convening criminal justice, mental health, substance abuse and other relevant social service agencies to facilitate diversion from the criminal justice system. Mental health courts should not act as mandators of treatment, using criminal sanctions to coerce compliance, imposing the stigma of criminalization as a condition of access to treatment resources. They should focus instead on diversion.
It must be conceded that when diversion is not possible, mental health courts may serve to assure treatment for persons with serious mental illness convicted of crimes and divert them from incarceration, if not from conviction. This too is a valuable role. Anything that keeps people with serious mental illness out of prisons and jails should be encouraged. With good will, mental health courts can broker diversion and protect the vulnerable from being crushed in the gears of the criminal justice system. However, the risk that remains is that mental health courts actually defeat diversion in favor of a kind of endless, boundary-less criminal probation, and that more and more people with mental illness will be swept into the criminal justice system, which would be an extremely unjust outcome.
Above all, mental health courts must avoid becoming a preferential point of entry for persons who have been unable to obtain community-based treatment, thus draining resources from an already underfunded community mental health treatment system. Treatment preference should not be given to persons accused of crimes over others who have not committed a crime, but who are still unable to access services. Mental health courts should never become a way to "jump the line" and get preferential access to existing resources.
The ultimate danger is that in the hope of improving access to treatment resources, and even providing some, mental health courts will, in the end, increase coercion and stigma. There is also the risk that they will fail to effectively triage available treatment resources to achieve the best overall public health outcomes. The basic problem is that the courts cannot run the mental health system from their limited vantage point and cannot provide the resources needed to fill the gaps.
Mental health courts risk inappropriate intervention of the criminal justice system, with no real improvement in treatment outcomes. At best, they may effectively determine individual needs and advocate for good individual treatment. At worst, they risk further criminalizing people with mental illness and fragmenting the mental health and criminal justice systems. Mental health courts are functioning all over the country now, and their implementation concerns all mental health advocates. It is a time for advocacy.
Mental Health America believes that advocates must remain skeptical of mental health courts and attentive to their evolution. Mental health courts inherently risk further criminalization of persons with mental illness and may compete with diversion programs unless they embrace diversion as their own focus. Mental Health America believes that eventually, all mental health courts should satisfy the guidelines established in this policy.
Background
Mental Health Courts - While there is no accepted definition, mental health courts have been created by local initiatives, often adapting the model of drug courts, and focusing initially on dually diagnosed substance abuse and mental illness, to obtain mental health treatment for persons with mental illness accused of crimes. Currently, some mental health courts involve using the authority of the court to impose treatment compliance as a condition of release from jail or bail. Failure to comply may result in sanctions being imposed, up to and including incarceration.
Diversion - There are two basic models of diversion. Under the predominate model, a person is assigned to a treatment program and criminal charges are suspended or dropped. Any program that provides for dismissal of charges or deferred prosecution, even after arraignment, is considered to be "meaningful diversion." Programs under which persons are assigned to probation after a plea of guilty are sometimes referred to as diversion. However, these programs are only a diversion from incarceration and not diversion from the criminal justice system.
The concept of mental health courts has been promoted in order to respond to the increasing number of people with mental illness caught up in the criminal justice system. The failure of American society to make good on the promise of community-based care is one of the reasons for this increase. America has never committed the resources necessary to provide adequate community mental health services for people who are at risk of commitment to or being discharged from institutions (including hospitals, prisons and jails). Additionally, lack of education contributes to the prejudice, stigma and discrimination against persons with psychiatric disabilities. Increased enforcement, especially of misdemeanor "lifestyle" offenses, has criminalized symptoms of mental illness and co-occurring substance abuse disorders.
One of the primary concerns which Mental Health America has about mental health courts is that they may be used inappropriately as tools to coerce treatment. Since mental health courts are relatively new, there is not a great deal of research about the level of coercion involved in such courts. The research which has been conducted, however, is encouraging. A recent study of the Broward County Mental Health Court found that "the mean score on a self-report perceived coercion measure (0.69) was low in an absolute sense and...lower than almost any score on a comparable measure of perceived coercion previously reported in the literature."[2] This study emphasized that a key element affecting the perceived lack of coercion was the fact that participants could opt out and be returned to the courts which heard cases involving defendants who were not identified as having a mental illness. Additionally, the study emphasized the importance of insuring that defendants were aware of this option.
Similarly, mental health courts were much less apt to use jails as a sanction for failure to comply with court-ordered treatment than were the drug courts after which they are modeled.[3]
Given the wide variation among the designs of mental health courts, these studies do not demonstrate that mental health courts are non-coercive. But they do demonstrate that it is possible to design a mental health court with minimal coercion. Mental Health America urges jurisdictions which chose to create a mental health court to follow those models which use minimal coercion.
In 2000, the United States Congress authorized a mental health court demonstration program (P.L. 106-515). In doing so, Congress identified mental health courts as having the potential to address the criminalization of people with mental illness. Mental health courts are here to stay. Mental Health America is concerned that communities may rush to implementation without considering all of the components of an effective system to respond to the needs of persons with mental illness involved in the criminal justice system. In the absence of a framework of values to guide the development of mental health courts, the needs and rights of people with mental illness may be ignored and threatened. This policy seeks to provide such a framework
Principles
Minimizing the use of coercion is fundamental to effective mental healthcare and treatment and recovery from mental illness, and the most coercive entry point for mental health treatment is the criminal justice system. The United States already incarcerates people at the highest rate in the western world, and we have effectively institutionalized many persons with mental illness in correctional facilities.
Criminal courts rarely address mental health issues in sentencing decisions. Corrections systems are assigned the classification/diagnosis as well as the treatment responsibility, once there has been a criminal conviction, with deferred sentences and probation after a plea as a gray area of court involvement. However, probation and other forms of post-conviction court involvement, including deferred sentences contingent on mental health treatment, are really only alternatives to incarceration, not alternatives to the use of criminal sanctions.
Communities must develop services that meet the comprehensive needs of mental health consumers. It is essential that any mental health court program bring additional treatment resources to the community, rather than depleting already limited existing resources. In addition to significant increases in public investment, services must be integrated across public and private agencies to address the full range of consumer needs. Individual treatment plans should be focused on consumer recovery and choice and should include: mental and physical healthcare, case management, housing, supportive education, substance abuse treatment, and psychosocial services in the least restrictive environment possible.
Mental health courts may act as a catalyst in developing this comprehensive, community-based mental health system because state and local corrections are often only minimally involved and unable to pay more attention. As a convener, mental health courts may be able to get the attention of other agencies that they do not control, to promote real and enduring systems change. In this capacity, the court convenes criminal justice, mental health, substance abuse and other social service agencies and community resources to respond to the needs of those persons before the court. However, that convening role requires real commitment from the judiciary and entails substantial risks.
Concerns
The greatest danger is that mental health courts will assume a coercive role, both in allocating scarce treatment resources and in further criminalizing and stigmatizing persons with mental illness who get caught up in the criminal justice system. Secondarily, there is a risk of fragmentation, both of the struggling community-based mental health treatment system, and of the already-fragmented criminal justice system.
At the extreme, mental health courts may become a preferred means of access, with mental health judges granting treatment preference to persons accused of crimes over others. In addition, unless citizens are vigilant in monitoring the development and implementation of mental health courts, court processes may lead to even greater criminalization, stigma and fragmentation. Already, people with mental illness stay in jail two to three times longer than others charged with the same offenses.
Guidelines
State and local Mental Health Associations are in a strategic position in their communities to influence and guide the development and implementation of mental health courts in ways that safeguard the needs and rights of consumers. In order to avoid potential risks in establishing mental health courts, Mental Health America advocates that state and local Mental Health Associations be involved in the development and implementation of mental health courts from very early on. To assist in this effort, the following guidelines have been developed to support mental health advocates and justice systems in shaping new mental health court initiatives and holding mental health courts accountable where they currently exist.
1. Comprehensive mental health outreach - Access to community-based mental health treatment services for all people needs to be improved, and should not depend on the existence of mental health courts. Equally effective services should be assured for the treatment needs of persons not accused of crimes. This requires an investment in outreach services to promote voluntary treatment as an essential complement to any mental health court program.
2. Maximum diversion - Pre-booking diversion should be assured for all persons accused of crimes for whom a voluntary mental health treatment plan is a reasonable alternative to the use of criminal sanctions. Timely and accurate mental health screening and evaluation is the single most critical element in a successful diversion program. Mental health courts may be helpful in assuring such diversion, but should never be the only way, or even the primary way, that it can occur.
3. Meaningful diversion - Meaningful diversion would require that when appropriate, no charges would be filed, and the individual is diverted directly to treatment without entering the criminal justice system. In the alternative, when charges must be filed, criminal proceedings should be deferred for a set period, usually not exceeding a year. Dismissal of criminal charges would then be guaranteed after a set period of successful treatment participation.
4. No requirement for a guilty plea - A guilty plea should not be required to enter a mental health court program. This requirement precludes diversion from the criminal justice system at the earliest possible point in time and further criminalizes a person because of his or her mental illness. As indicated above, the preferred method is to hold charges in abeyance until the successful completion of the treatment program.
5. Voluntary/Non-coercive - While the threat of criminal charges influences any decision, participation in any mental health diversion program should involve the same level of voluntary choice required of a criminal plea. No one should have to decide whether or not to accept diversion until the terms and the nature of the proposed treatment plan have been fully discussed and documented.
6. Least restrictive alternative. - All persons participating in diversion programs should be treated in the least restrictive alternative manner available, and all unnecessary institutionalization should be avoided. Jails are generally an inappropriate place for persons waiting for diversion as jail experiences tend to exacerbate underlying symptoms of mental illness. Long jail stays should be avoided in all diversion cases.
7. Right to refuse treatment - The qualified[4] right of a person with mental illness accused of a crime to refuse a particular treatment, including a particular medication, should be protected in a manner at least as protective of the consumer as the civil commitment process. A process should be established to review treatment refusals of persons diverted from the criminal justice system so that any decision to reinstate charges is made in an informed manner after all reasonable alternatives have been exhausted.
8. Advocate/Counselor - In addition to competent legal counsel in any criminal case, an experienced counselor, who may be a peer or other non-lawyer counselor, independent of any treatment facility, should be available to help the accused person to reach an informed decision. This person should also serve as an advocate to ensure that necessary services that have been mandated as part of a treatment plan are provided in a timely and appropriate manner. Mental Health Associations and other consumer advocacy groups may take on this important role.
9. Confidentiality - Networking to find an appropriate treatment setting, without safeguards, could compromise client confidentiality. Systems must be put in place to ensure confidentiality from the time that a person enters a mental health program.
10. Cultural competence - Cultural competence is essential to treatment success. Mental Health America believes that services must be tailored to the specific needs of communities and individuals in order to effectively address public health problems.
11. Community coalitions - The development of community coalitions, including partnerships between criminal justice, mental health and substance abuse treatment agencies, is essential to successful diversion programs. Such coalitions also should be involved in the creation and oversight of mental health courts. Consumers of mental health services and family members affected by mental illness need to be included in all such coalitions to assure that they address the real barriers to effective mental health treatment in that community.
12. Comprehensive outreach and training - Community coalitions need to reach out to all criminal justice system personnel and ensure that training is provided at all levels to deal with issues of mental illness, wherever and whenever they occur.
13. Co-occurring disorders - In addition, persons with co-occurring disorders, and especially substance abuse, must be treated in an integrated way, so that substance abuse is not an impediment to diversion.
14. Convening role - The focus of mental health courts should be on convening prosecution, probation, treatment and social services agencies to promote interagency collaboration in the interest of the individual. The focus should not be on the use of criminal sanctions to compel treatment.
15. Consolidation and coordination of cases - Cases should be consolidated to assure that the individual is the focus rather than the case. Centralized, coordinated case management and a single treatment plan are needed to avoid fragmentation, with or without a mental health court.
16. Handling relapses in the court setting - Relapses are inevitable during the recovery process. As such, an individual's time under jurisdiction of the mental health court should not be extended as a result of these relapses.
17. Evaluation - Timely monitoring of court processes, waiting lists, and consumer outcomes are essential to ensure that mental health courts are responding appropriately to persons with mental illness, that waiting lists are kept to a minimum, and that treatment providers are held accountable for consumer outcomes.
Effective Period
The Mental Health America Board of Directors on November 17, 2001 and revised by the Mental Health America Board of Directors on November 13, 2004, adopted this policy. It will remain in effect for a period of five years.
Expiration: November 13, 2009
[1]Mental Health America Policy Number 50 (Issued 2002), "In Support of Maximum Diversion of Persons with Serious Mental Illness from the Criminal Justice System."
[2] (The score was compared to the scores of both voluntary and involuntary inpatients and involuntary outpatients.) Poythress, N. et al, "Perceived Coercion and Procedural Justice in the Broward County Mental Health Court," 25 Int. J. of L. & Psych. 517 (2002)
[3] Griffin, et al, "The Use of Criminal Charges as Sanctions in Mental Health Courts," 53 Psych. Services 1285 (Oct. 2002)
[4] Washington v. Harper, 494 U.S. 210
HELP
In Crisis? 1-800-273-TALK If you, a friend or a loved is going through a tough time
Policy from:
Mental Health America
2000 N. Beauregard Street, 6th Floor Alexandria, VA 22311
Phone (703) 684-7722
Toll free (800) 969-6642
TTY 800/433-5959
Fax (703) 684-5968
Wednesday, August 20, 2008
Judge Barb Collins of PAIR to Lead Discussion
Judge Barb Collins will be a presenter at the NAMI State Conference in OCt.
http://www.nami.org/MSTemplate.cfm?Section=2008_NAMI_Indiana_State_Conference&Site=NAMI_Indiana&Template=/ContentManagement/HTMLDisplay.cfm&ContentID=65464
Read more here.
Image
2008 NAMI INDIANA STATE CONFERENCE
New Hope for Better Living: Treating the Whole Person
OCTOBER 18, 2008 Marten House/ Lilly Auditorium
CURRENT AGENDA
Click Here to Register Now
8:00 – 9:00am Registration and Gathering
9:00 – 9:15am Welcome
Marciniak Scholarship Award Recipient
9:15 – 10:15 Keynote Speaker: Fred Frese Click Here for Speaker Bio
10:15 – 10:30 Break
10:30 – 11:15 Workshops #1
Ask the Judge – Judge Barbara Collins
Peer Specialist – Bruce Van Dusen
Keeping SSDI while working part-time – Rebecca Deetz
Social Security Administration
Electronic Medical Records Panel Discussion - TBA
11:30 – 12:15 Workshops #2
Clubhouse Coalition – Paul Curry
Sunshine Clubhouse, South Bend Indiana
Spirit – Greg Denniston
Author, The Meaning of Faith and Mental Illness
Parents & Teachers as Allies – Teresa Hatten
NAMI Fort Wayne, President of NAMI Indiana Board
Breaking the Silence – Bill Lefurgy
President NAMI West Central
Electronic Medical Records Panel Discussion - TBA
12:15 – 1:30 Lunch and Exhibitors
1:30 – 1:45 Awards Presentation
1:45 – 2:15 Plenary Speaker - Ted Colburn Click Here for Speaker Bio
NAMI Fort Wayne
2:15 – 2:30 Break
2:30 – 3:30 Ask the Doctor
Schizophrenia - Dr. Andrew Chambers
Mood Disorders / Children’s Disorders - TBA
Borderline Personality Disorder – Dr. Joan Farrell
Larue Carter Hospital, Indianapolis
Treating the Whole Person – Dr. Thom Liffick, Evansville
Electro-Convulsive Therapy – Dr. Alan Schmetzer
Professor/Director, Indiana University Dept. of Psychiatry
Consumer Council Meeting
3:30 – 4:00 Wrap-up/Grand Prize Drawing
http://www.nami.org/MSTemplate.cfm?Section=2008_NAMI_Indiana_State_Conference&Site=NAMI_Indiana&Template=/ContentManagement/HTMLDisplay.cfm&ContentID=65464
Read more here.
Image
2008 NAMI INDIANA STATE CONFERENCE
New Hope for Better Living: Treating the Whole Person
OCTOBER 18, 2008 Marten House/ Lilly Auditorium
CURRENT AGENDA
Click Here to Register Now
8:00 – 9:00am Registration and Gathering
9:00 – 9:15am Welcome
Marciniak Scholarship Award Recipient
9:15 – 10:15 Keynote Speaker: Fred Frese Click Here for Speaker Bio
10:15 – 10:30 Break
10:30 – 11:15 Workshops #1
Ask the Judge – Judge Barbara Collins
Peer Specialist – Bruce Van Dusen
Keeping SSDI while working part-time – Rebecca Deetz
Social Security Administration
Electronic Medical Records Panel Discussion - TBA
11:30 – 12:15 Workshops #2
Clubhouse Coalition – Paul Curry
Sunshine Clubhouse, South Bend Indiana
Spirit – Greg Denniston
Author, The Meaning of Faith and Mental Illness
Parents & Teachers as Allies – Teresa Hatten
NAMI Fort Wayne, President of NAMI Indiana Board
Breaking the Silence – Bill Lefurgy
President NAMI West Central
Electronic Medical Records Panel Discussion - TBA
12:15 – 1:30 Lunch and Exhibitors
1:30 – 1:45 Awards Presentation
1:45 – 2:15 Plenary Speaker - Ted Colburn Click Here for Speaker Bio
NAMI Fort Wayne
2:15 – 2:30 Break
2:30 – 3:30 Ask the Doctor
Schizophrenia - Dr. Andrew Chambers
Mood Disorders / Children’s Disorders - TBA
Borderline Personality Disorder – Dr. Joan Farrell
Larue Carter Hospital, Indianapolis
Treating the Whole Person – Dr. Thom Liffick, Evansville
Electro-Convulsive Therapy – Dr. Alan Schmetzer
Professor/Director, Indiana University Dept. of Psychiatry
Consumer Council Meeting
3:30 – 4:00 Wrap-up/Grand Prize Drawing
Judy Spray has resigned from the PAIR Program
Judy Spray has resigned from the PAIR Program. She will be sorely missed. Judy has done a great job for the past 10 years. The PAIR Program could not have been started without her work and surely would not have stayed together all these years.
Good luck Judy!!!1
Good luck Judy!!!1
Friday, February 22, 2008
Getting Help for the Mentally Ill
Click here to read info on getting help for a loved one in Indianapolis, Indiana.
Thursday, February 21, 2008
Updated 2/21/08
Getting Help for Loved Ones Who are Mentally Ill
An Action Plan for Helping those with Mental Illness
An Opinionated Guide by Bob Cardwell
Sad, but true....
For most families, when they think about getting help for a mentally ill love ones, they think of the state hospitals. This is understandable. The state hospitals get a lot of attention. They get a lot of money. Historically, and in the community’s collective memory, the state hospitals are where loved ones went when they were mentally ill. Most families can recall family histories where a grandparent, a cousin, a sister, parent, or other loved one went to a state hospital for help. This is not true in today’s treatment scheme.
The state hospitals are the treatment choice of last resort. They are not truly for the families. The state hospitals are an option [albeit the last choice] of community treatment providers. The community treatment providers only put a sick person in a state hospital when they can find no other option available. An admission to a state hospital is not based on the seriousness of the illness. The admission is based on many other factors such as: legal issues, political issues, need of subjects for research, criminal charges, and public outcry. The new system has pretty much eliminated problems with patient abuse and clear neglect, but the state hospitals offer little treatment for mentally illness other than forcing medications.
A mentally ill individual is much more likely to receive involuntary “treatment” in the local jail than in a state hospital. Sadly, there are many more mentally ill persons in jail being treated than in the state hospitals.
This is a plan for family members helping those with mental illness in Marion County, Indiana, or the Greater Indianapolis area. Please go here to read about some suggestions from a general standpoint or to find some ideas for your area.
My basic belief is that whenever possible, those with mental illness should take the responsibility for their own care. However, mental illness often robs individuals of their judgment and it becomes necessary for family and the community to intercede for the safety of the individual and the community.
I would like to start off with two names of the most knowledgeable and caring persons I know on matters of mental health. These persons are: Mike Trent, of Midtown Mental Health Center [ph 317- 630-7791] and Judy Spray, of the PAIR Mental Health Diversion Program [317- 327-6869]. I would certainly start with these two for ideas and guidance on helping a loved one into treatment.
If he is dangerous to himself or others, the family can seek an Emergency Detention to a mental health center. After a period of 72hrs, the hospital has to determine if he is dangerous as a result of mental illness. If so, the hospital can have him court ordered for long-term inpatient or outpatient treatment. This procedure must be initiated in cooperation with a mental health center as the petition for an emergency detention must have a doctor's statement, as well as a factual witness, and the agreement of the mental health center that they will hospitalize the person for a period of observation. There may be a fee charged by the mental health center for this service. Some mental health centers serving Indianapolis are:
Midtown MHC
Gallahue MHC/Community Hospital
BehaviorCorp.
Adult and Child MHC
Assorted Mental Health Providers
If the mentally ill person presents an immediate danger, one can always call 911 and explain that there is a mentally ill person in need who may harm themselves or others. The mentally ill person can be picked up by the responsible law enforcement officer and taken to the nearest appropriate treatment facility under provisions of the Immediate Detention Law. Another strategy is to avoid calling 911, if time and circumstances permit, and call the shift commander of the appropriate law enforcement district. This may permit the commander the time to exercise more judgment and discretion on what officers to send out and at what time. Working with caring law enforcement officers may lessen the trauma to the mentally ill person and facilitate the person gaining appropriate access to the right services. A mission of the Indianapolis law enforcement agencies are to encourage the notion of "community policing" and the problem of the mentally ill falls under this plan. To find the appropriate officer in Indianapolis, go to IMPD here.
If he is gravely disabled, the family can go to Probate Court and seek Guardianship over him. The court or his guardian can then sign him in for treatment. You will need to start with an attorney first.
If he has any pending criminal charges [probation, parole, court case], the court, parole officer, or probation officer can order him into treatment. IF he is in custody, email or call [317-231-8263], the jail and request that he be evaluated for treatment while in custody. It would also be advisable to notify the PAIR Mental Health Diversion Program, at 317-327-6869, and request an evaluation. To check if your loved one is in jail, go to MCSD here.
If he is a nuisance, the family, or any responsible party, can go to court and ask for a protective order. The court can order him to quit being a nuisance to the petitioner and order him into treatment. To get a protective order one has to go through the Marion Co. Prosecutor's Office and be a resident of the county. This person also has to be the offended party. There may be a charge for filing the petition. A person may qualify for free assistance in getting a protective order.
If the family has the means, they can hire an attorney for help. Check with the local bar association or with the local chapter of NAMI to find attorneys versed in this area of the law.
The Indiana Civil Liberties Union [ICLU] often investigates systematic problems with the delivery of mental health services to jail and prison inmates.
Finally, if all of the above doesn't work out, get an advocate. All of the mental health centers and courts are political entities who depend on funding and the good will of the public. You would be surprised how much a phone call from an advocate will help with your cause. Just look up the phone numbers, web addresses, or location; then write or call, but follow up and expect a response. Here are some possible advocates in no particular order:
Protection and Advocacy Agency of Indiana
or specifically with mental health treatment issues, go here.
Marion Co. Mental Health Association
Adult Protective Services
NAMI- National Alliance of the Mentally Ill
TAC- Treatment Advocacy Center
State Representatives
Federal Representatives
Judge Barb Collins, Marion County Superior Court
[Mental Health Expert and Advocate]
Court 8
City-County Bldg Room E-643
6th Floor, East Wing
(317) 327-3202
Mayor Greg Ballard
Governor Mitch Daniels
Misc. Helpful Indiana Resources
Read about The PAIR Mental Health Diversion Program here.
Read about mental health laws across the country here.
Good Luck and God Bless!
Bob Cardwell [email bob@bobcardwell.com]
Updated 2/21/08
Getting Help for Loved Ones Who are Mentally Ill
An Action Plan for Helping those with Mental Illness
An Opinionated Guide by Bob Cardwell
Sad, but true....
For most families, when they think about getting help for a mentally ill love ones, they think of the state hospitals. This is understandable. The state hospitals get a lot of attention. They get a lot of money. Historically, and in the community’s collective memory, the state hospitals are where loved ones went when they were mentally ill. Most families can recall family histories where a grandparent, a cousin, a sister, parent, or other loved one went to a state hospital for help. This is not true in today’s treatment scheme.
The state hospitals are the treatment choice of last resort. They are not truly for the families. The state hospitals are an option [albeit the last choice] of community treatment providers. The community treatment providers only put a sick person in a state hospital when they can find no other option available. An admission to a state hospital is not based on the seriousness of the illness. The admission is based on many other factors such as: legal issues, political issues, need of subjects for research, criminal charges, and public outcry. The new system has pretty much eliminated problems with patient abuse and clear neglect, but the state hospitals offer little treatment for mentally illness other than forcing medications.
A mentally ill individual is much more likely to receive involuntary “treatment” in the local jail than in a state hospital. Sadly, there are many more mentally ill persons in jail being treated than in the state hospitals.
This is a plan for family members helping those with mental illness in Marion County, Indiana, or the Greater Indianapolis area. Please go here to read about some suggestions from a general standpoint or to find some ideas for your area.
My basic belief is that whenever possible, those with mental illness should take the responsibility for their own care. However, mental illness often robs individuals of their judgment and it becomes necessary for family and the community to intercede for the safety of the individual and the community.
I would like to start off with two names of the most knowledgeable and caring persons I know on matters of mental health. These persons are: Mike Trent, of Midtown Mental Health Center [ph 317- 630-7791] and Judy Spray, of the PAIR Mental Health Diversion Program [317- 327-6869]. I would certainly start with these two for ideas and guidance on helping a loved one into treatment.
If he is dangerous to himself or others, the family can seek an Emergency Detention to a mental health center. After a period of 72hrs, the hospital has to determine if he is dangerous as a result of mental illness. If so, the hospital can have him court ordered for long-term inpatient or outpatient treatment. This procedure must be initiated in cooperation with a mental health center as the petition for an emergency detention must have a doctor's statement, as well as a factual witness, and the agreement of the mental health center that they will hospitalize the person for a period of observation. There may be a fee charged by the mental health center for this service. Some mental health centers serving Indianapolis are:
Midtown MHC
Gallahue MHC/Community Hospital
BehaviorCorp.
Adult and Child MHC
Assorted Mental Health Providers
If the mentally ill person presents an immediate danger, one can always call 911 and explain that there is a mentally ill person in need who may harm themselves or others. The mentally ill person can be picked up by the responsible law enforcement officer and taken to the nearest appropriate treatment facility under provisions of the Immediate Detention Law. Another strategy is to avoid calling 911, if time and circumstances permit, and call the shift commander of the appropriate law enforcement district. This may permit the commander the time to exercise more judgment and discretion on what officers to send out and at what time. Working with caring law enforcement officers may lessen the trauma to the mentally ill person and facilitate the person gaining appropriate access to the right services. A mission of the Indianapolis law enforcement agencies are to encourage the notion of "community policing" and the problem of the mentally ill falls under this plan. To find the appropriate officer in Indianapolis, go to IMPD here.
If he is gravely disabled, the family can go to Probate Court and seek Guardianship over him. The court or his guardian can then sign him in for treatment. You will need to start with an attorney first.
If he has any pending criminal charges [probation, parole, court case], the court, parole officer, or probation officer can order him into treatment. IF he is in custody, email or call [317-231-8263], the jail and request that he be evaluated for treatment while in custody. It would also be advisable to notify the PAIR Mental Health Diversion Program, at 317-327-6869, and request an evaluation. To check if your loved one is in jail, go to MCSD here.
If he is a nuisance, the family, or any responsible party, can go to court and ask for a protective order. The court can order him to quit being a nuisance to the petitioner and order him into treatment. To get a protective order one has to go through the Marion Co. Prosecutor's Office and be a resident of the county. This person also has to be the offended party. There may be a charge for filing the petition. A person may qualify for free assistance in getting a protective order.
If the family has the means, they can hire an attorney for help. Check with the local bar association or with the local chapter of NAMI to find attorneys versed in this area of the law.
The Indiana Civil Liberties Union [ICLU] often investigates systematic problems with the delivery of mental health services to jail and prison inmates.
Finally, if all of the above doesn't work out, get an advocate. All of the mental health centers and courts are political entities who depend on funding and the good will of the public. You would be surprised how much a phone call from an advocate will help with your cause. Just look up the phone numbers, web addresses, or location; then write or call, but follow up and expect a response. Here are some possible advocates in no particular order:
Protection and Advocacy Agency of Indiana
or specifically with mental health treatment issues, go here.
Marion Co. Mental Health Association
Adult Protective Services
NAMI- National Alliance of the Mentally Ill
TAC- Treatment Advocacy Center
State Representatives
Federal Representatives
Judge Barb Collins, Marion County Superior Court
[Mental Health Expert and Advocate]
Court 8
City-County Bldg Room E-643
6th Floor, East Wing
(317) 327-3202
Mayor Greg Ballard
Governor Mitch Daniels
Misc. Helpful Indiana Resources
Read about The PAIR Mental Health Diversion Program here.
Read about mental health laws across the country here.
Good Luck and God Bless!
Bob Cardwell [email bob@bobcardwell.com]
Updated 2/21/08
