States Try Out Courts Tailored for Mentally Ill In an effort to stop the repeated cycling of mentally ill people through courts and prisons, some states are setting up special courts for the mentally ill. The goal of judges, prosecutors and attorneys is to get treatment, housing and other kinds of support for defendants. Proponents say it's more effective -- and cheaper -- than jail.
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States Try Out Courts Tailored for Mentally Ill

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States Try Out Courts Tailored for Mentally Ill

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States Try Out Courts Tailored for Mentally Ill

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ROBERT SIEGEL, host

From NPR News, this is ALL THINGS CONSIDERED. I'm Robert Siegel.

MELISSA BLOCK, host

And I'm Melissa Block.

In many states around the country, judges have set up special courts to deal with defendants who have severe mental illnesses. The goal is to stop people from repeatedly cycling through the courts and jails and transform them into productive members of society.

NPR's Ari Shapiro reports.

ARI SHAPIRO reporting:

Todd Lee is 39 years old. He never expected to be around to say that.

Mr. TODD LEE: I've tried to commit suicide a couple times. I drank some Clorox and I threw myself down two flights of steps.

SHAPIRO: He struggled with bipolar disorder his whole life. He was in and out of mental hospitals and jails in the Cincinnati area. For about eight years he engaged in what mental health professionals call self-medication.

Mr. LEE: My drug of choice is alcohol and the crack cocaine and the other drugs, the pills and the marijuana, all that was due to my alcoholism. It was a thing about I couldn't control my drug use. I let people in and out my apartment all times of the night, all day. Let prostitutes run their tricks in there. It was just real, real chaotic.

SHAPIRO: Today Lee has a full time job. He's clean with his own house and car. He still has a hard time believing this, but his turning point was an arrest. Police caught him with a gram of cocaine and instead of sending him back to prison again, Judge Michael Sage sent him to a new kind of court.

Judge MICHAEL SAGE: It's been my experience if you can treat the mental illness, the criminal issues, the substance abuse issues, all those tend to take care of themselves.

SHAPIRO: The court Todd Lee went to has a psychiatrist, a case manager and people to help find housing and employment. Instead of punishment, it focuses on rehabilitation. When people come before the judge they aren't defendants or patients. The staff refers to them as clients.

On this day, a woman with stringy, brown hair is standing before Judge Sage's bench for the first time. The court's confidentiality rules prohibit us from using her name. She seems like she's at the bottom of a deep hole.

Judge SAGE: You don't like yourself, right? You don't feel like you're a very good person right now.

Unidentified Woman: No

Judge SAGE: You're a good person, okay? And you wouldn't be in this program unless you can make it and be successful. We're not gonna put you in here so you can fail.

SHAPIRO: This is the first step of the process. Another woman who comes before the bench for a check-in today is nearly at the end of her program. Her two kids sit in the back of the room. She's expecting to regain custody of them soon.

Judge SAGE: I'm proud of you. You know that. Take care of your kids back there okay?

Unidentified Woman #2: I will.

Judge SAGE: Congratulations.

Unidentified Woman #2: I want to say thanks, Your Honor, because I just want to say thanks for you giving me so many chances and letting me be here today like this.

SHAPIRO: There are more than 120 mental health courts across the country. They aren't distributed evenly. Ohio has thirty, for example, while other states have none. And although they've become widespread, researchers have only completed local studies of their effectiveness. Dr. Henry Steadman is president of Policy Research Associates in Delmar, New York, and he recently began a national study of whether mental health courts work and for whom.

Dr. HENRY STEADMAN (Policy Research Associates): I think at this point it looks like it's something that can be very beneficial for all parties involved.

SHAPIRO: But he says there's still a lot more research to be done.

Dr. STEADMAN: I believe that for many of the people coming through the mental health courts, these are a wonderful intervention that will save the community money, will, in fact, provide a better quality of life and will, in fact, benefit the people enrolled in the mental health courts. And the key is just to refine that a little bit so that it isn't used for people with whom it will not be as effective.

SHAPIRO: The money argument can be counterintuitive. How can a program that incorporates housing, counseling, medication and employment assistance be cheaper than just locking someone up?

Ohio Supreme Court Justice Evelyn Stratton, who led the drive for mental health courts in her state, says the statistics are actually very dramatic. In Ohio, keeping someone in the mental health program costs taxpayers $30 a day, all-inclusive.

Ms. EVELYN STRATTON (Ohio Supreme Court Justice): If you put them in prison, it's $60 a day. If you put them in a mental hospital, it's $451 day. And if you put them in a general hospital, it's $1500 a day.

SHAPIRO: She says those numbers have convinced many a local politician to fund this program. But some mental health advocates aren't sure it's a good idea. Ira Burnham is legal director of the Bazelon Center for Mental Health Law in Washington, D.C. He says yes, mentally ill people need help. But do they really have to be arrested to get it?

Mr. IRA BURNHAM (Bazelon Center for Mental Health Law): If that's the way you access services for an individual, we think, that you're going to encourage arrests.

SHAPIRO: And getting arrested can have unintended consequences.

Mr. BURNHAM: There are some mental health courts that require a guilty plea as a condition of proceeding through the court. And so having an arrest or a conviction can disqualify one from employment, can disqualify one from certain kinds of publicly supported housing and can also potentially disqualify one from certain kinds of other public benefits. So that's a problem in and of itself.

Ms. DENISE TOMASINI JOSHEY(ph) (Council of State Governments): The sad truth is that the criminal justice system doesn't have control over whether people receive mental health treatment before they actually reach the courts.

Denise Tomasini Joshey is a policy analyst at the Council of State Governments, which gives technical assistance to the mental health courts.

Ms. JOSHEY: So they're trying to do something about that issue once the person arrives at the court, but there's nothing that they can really do about that before. I think that there is a consensus among criminal justice personnel that these people should have been taken care of before they ever got to the point where they were arrested.

SHAPIRO: There are no national standards for mental health court policies. But there is an emerging consensus in favor of them. At a conference of state chief justices last January, representatives from all fifty states adopted a resolution endorsing the concept of mental health courts and the Justice Department has allocated money to create more of them.

Supporters of mental health courts don't fit any one political or ideological profile. Judge Michael Sage in Cincinnati is a former prosecutor. He calls himself a bedrock conservative and says nobody's ever argued that he's soft on crime.

Judge SAGE: I make the argument when I have opposition, is what is the right thing to do? And the right thing to do is to put them in this program and to treat them. And hopefully then make sure that they don't end up back in the streets, repeating crime and doing the same things that they did before.

SHAPIRO: One of the men being treated in Sage's program keeps a list of things he's grateful for each day as part of his therapy. When he showed up in court for his check-in, his case manager asked what was on his list that day? The client replied having a judge who understands mental illness.

Ari Shapiro, NPR News.

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