MHC Press Releases & Media

Mental Health and the Criminal Justice System: The Need for a Better Response

Chris Gaal
Monroe County Prosecuting Attorney

(Written in 2007)

Responding effectively to the needs of defendants with mental illness is one of the most difficult challenges we face in the criminal justice system. Over the years, as more and more funding has been cut from our nation’s public mental health infrastructure, the criminal justice system has become the default service provider for low-income mentally ill. This is a bad idea for a number of reasons.

Channeling mental health problems into the criminal justice system may first appear as a prudent way to save public dollars. But law enforcement is a poor substitute for medical care. Once a mentally ill person becomes unstable enough to commit a criminal offense, the public may be put at risk and law enforcement can only react to the crisis after the fact. If the offense involves a victim or an act of violence, it is more difficult to divert the defendant from the criminal justice system to mental health treatment, even when treatment rather than jail may more effectively address the root of the problem behavior. Punishing someone with a serious mental illness through incarceration often just makes the problem worse. For those rare unfortunates whose behavior spirals enough out of control to engage in a violent offense, such an inhumane fate may become inevitable.

A more effective approach would be to avoid the meltdown in the first place through preventive mental health services. Though resourceful, people in the criminal justice system simply do not have the expertise to adequately deal with mental health issues on their own. Success requires a community-wide commitment and the effective coordination of resources. Such collaboration is not easy to create – especially when additional financial and personnel resources are required. Still, an ounce of prevention is usually worth a pound of cure. Following that logic, jurisdictions around the country, and indeed even in Indiana, have developed Mental Health Courts and other programs to creatively address the problem.

As the newly-elected prosecutor, I convened a meeting of stakeholders in 2007 to promote a broad discussion of how we could improve our community’s response to mental health issues in the criminal justice system. On the table for debate were both problems and solutions.

One thing that came to light was that the Monroe County Community Corrections Advisory Board had already quietly approved a “Forensic Diversion Plan” detailing the specifics for addressing mental illness within the criminal justice system. The State legislature had in fact passed a statute requiring that every county with a community corrections program adopt such a plan. The plan had never been implemented, nor indeed even brought to the public’s attention, largely because Monroe County did not receive any funding from the state to pay for implementation.

Another problem that quickly arose was lack of funding for the jail diversion coordinator, Don Weller, PhD, who is affiliated with Mental Health America. Dr. Weller is a clinical psychologist who was going into the jail and interviewing inmates with potential mental illness issues. Dr. Weller’s original grant funding for this work had come to an end, and no one was willing to step forward and pick up the slack. After an impromptu lobbying effort, Sheriff Jim Kennedy agreed to include Don Weller in the jail budget, a special appropriation was approved by the county council, and this invaluable community resource was restored.

In the meantime, the Prosecutor’s Office had already been coordinating an informal Mental Health Review Team. Defendants from the jail were referred for evaluation by Dr. Weller, who obtained a signed release form allowing medical information to be shared. After conducting his initial evaluation, Dr. Weller would report his impression, and the team would discuss the cases with the benefit of background medical and criminal history. The team also included clinical counselors and psychiatrists from the Center for Behavioral Health (now Centerstone), and representatives from the prosecutor, the public defender or private defense attorney, and probation. Over the course of the year, the process picked up greater momentum – and more cases were being creatively resolved in a way that addressed both the mental health needs of the defendant and the need for public accountability.

In essence, the program offers eligible defendants the possibility of diversion from criminal prosecution in exchange for compliance with a mental health treatment plan. The requirements remain flexible enough so that the Review Team can tailor a plan to the specific case – taking into account factors such as the nature of the charged offense, the mental health condition of the defendant, the probable effectiveness of treatment, and the public safety good of the community. Depending on the specific case, the terms of diversion can be either informal or involve a term of supervised probation. Frequently the team takes on difficult issues such as obtaining Medicaid, veterans’ or other insurance benefits to pay for mental health treatment, and even coordinates transitional services related to housing or employment.

Cases involving violent offenses, drug dealing, and drunk driving are typically not eligible for diversion as a matter of public policy because of the risk to the community. But for many non-violent offenses, where mental health services can make a difference in addressing an untreated mental illness at the root of the behavioral problem, the program offers real benefits for both the defendant and the community.

The Mental Health Review Team has now moved beyond jail inmates, to reviewing cases of criminal defendants out on bond. There have been ongoing discussions involving judges and probation about how to expand and formalize the program. There is a clear need for a more effective mechanism to monitor compliance with the mental health treatment plan. This may involve a probation officer dedicated to working with mental health cases, or even a program based on the successful Drug Court model. As Monroe County Prosecuting Attorney, I am encouraging all the elements of the criminal justice system to work together with others in the community to improve our response to the issue of mentally ill criminal defendants – which I believe will lead to a safer community.

CRIMINAL JUSTICE AND COMMUNITY PARTNERS ANNOUNCE NEW MENTAL HEALTH COURT

Bloomington, IN — On October 10, 2014, a press conference was held by local criminal justice and community partner agencies to announce enhanced services for offenders with mental health disorders.

Indiana’s updated criminal code went into effect this past July.  Changes in the new law with respect to sentencing are expected to put increased pressure on local communities to provide treatment and rehabilitation programming to low-level felony offenders through county probation and community corrections programs.

The legislature intended the changes to improve public safety by encouraging greater use of evidence-based correctional programs to reduce recidivism.  Another goal was to control state spending on prisons.  Throughout the process, legislators have recognized the need to provide additional funding to help counties deal with the additional burden of expanding local services.  However, counties must compete aggressively for the limited pilot project funding currently available.

Thanks to an assertive partnership between the Circuit Court, Probation, the Prosecutor’s Office, community mental health provider Centerstone, and addictions recovery program Amethyst House, Monroe County has successfully obtained funding that will help meet the challenge imposed under the new criminal code by enabling the creation of a new Mental Health Pilot Project and Mental Health Court.

Monroe County Prosecutor Chris Gaal’s office has long coordinated a Mental Health Review Team that meets monthly to discuss criminal cases where the underlying behavioral problem is due to a serious untreated mental illness.  “It is not unusual for someone suffering from a serious untreated mental illness to engage in disruptive behaviors and eventually wind up in the criminal justice system,” explained Monroe County Prosecutor Chris Gaal.  “Where mental health treatment can effectively address an underlying behavioral problem, and we can effectively monitor compliance with such treatment, there are real benefits for both the individual and the long-term safety of the community.”

Since November 1999, the Monroe Circuit Court has operated a drug court that is a state-certified Problem Solving Court Program.  The Mental Health Pilot Project will expand both the Mental Health Review Team and the Problem Solving Court Program to add a Mental Health Court.  Judge Ken Todd will oversee the new Mental Health Court.

Judge Ken Todd stated, “The Mental Health Court is an expansion of our problem-solving approach to criminal justice issues.  For years, people in the community have worked to find more effective and humane responses to the intersection of the criminal justice system and the mentally ill.  The welcome increase in funding in July and August has allowed us to take a big step forward in addressing that issue.  The Monroe Circuit Court is pleased to be a part of the collaborative stakeholder process and this resulting partnership.”

NEW GRANT FUNDING

Criminal justice and community partners collaborated to pursue new state funding opportunities made possible since the 2014 criminal code update.  In July, the Monroe Circuit Court Probation received an increase of $64,747 in its Community Corrections program grant to pay for a full-time probation officer/case manager position to support the expanded services offered under the new problem-solving court.  Probation will help screen defendants for eligibility, expedite referrals to needed treatment services, and monitor participants for compliance with court requirements.

In August, Centerstone and Amethyst House each received funding through a Forensic Diversion Grant from the Indiana Judicial Center for a one-year pilot project.  Centerstone received $83,201, and Amethyst House received $25,000.  An additional $11,799 was provided for customized computer software licenses to support the new services and assist in measuring project outcomes.

Additional resources made possible by these new funds will allow the Mental Health Court to better monitor and supervise follow-through on treatment plans by participants.  Since learning of their success in obtaining funding, Mental Health Review Team members have held several meetings to plan details of the expansion to a Mental Health Court.  The team includes clinicians from Centerstone, the Jail Diversion Coordinator Dr. Don Weller, a probation officer, and a public defender.  In appropriate cases, the team can recommend a mental health treatment plan to address the underlying behavioral issues.

“The existing Mental Health Review Team often takes on difficult issues such as obtaining benefits to pay for the ongoing costs of treatment and medication, and coordinating transitional services related to housing or employment,” said Linda Grove-Paul of Centerstone.  “These grants and the new problem-solving courts will now provide additional resources to encourage follow-through on a treatment plans and a greater chance of successful outcomes.”

“Amethyst House is really pleased to be part of this grant project and to provide brain-injury informed treatment to people who have both a substance abuse issue and a co-occurring brain injury,” said Mark DeLong, Executive Director of Amethyst House.  “This is a severely underserved population, and for treatment to be effective, providers must understand both challenges for a person – addiction and the effects of brain injury.  Because of this grant funding, Amethyst is now in a position to offer this specialized treatment.”

“The Indiana University Speech and Hearing Clinic is proud to partner with the Mental Health Pilot Project and be part of the continuum of services for offenders who have experienced a traumatic brain injury (TBI),” said Laura Karcher, Clinical Associate Professor.  “TBI affects the whole community and providing services to help individuals return to productive lives will further enhance the quality of life for citizens of Monroe County.”

The Mental Health Court is scheduled to begin accepting referrals next week.

SUMMARY OF NEW PROGRAMS AND SERVICES

Monroe County Prosecuting Attorney:
*  Expansion of existing Mental Health Review Team to serve a new Mental Health Court.
* Expanded options for processing and prosecuting felony cases involving offenders with mental health disorders.

Monroe Circuit Court:
*  Addition of new Mental Health Court.  Judge MaryEllen Diekhoff will oversee this court.
*  Targeted services will be provided to offenders who are identified as having a mental health disorder through the Mental Health Court component.  Such services will include treatment for mental health disorders, substance use disorders, traumatic brain injury (TBI), and post traumatic stress disorder (PTSD).

Monroe Circuit Court Probation Department:
*  Expansion of state-certified Problem Solving Court Program to add Mental Health Court program.
*  Probation officer with extensive mental health treatment experience and training to supervise moderate and high risk felony offenders who have mental health disorders.
*  Probation officers will screen defendants for eligibility, expedite referrals to needed treatment services, and monitor participants for compliance with court requirements.
Centerstone:
*  New full-time Recovery Coach who will work closely with program participants to connect to Centerstone services and to leverage existing community resources.  The Recovery Coach is knowledgeable about mental health, addictions, housing, and benefits such as Medicaid and Social Security.
*  Part-time Clinician (.25 time) who will serve as a counselor and will be Program Coordinator overseeing all operations by Centerstone as it relates to this project.
*  Psychological assessments, clinical evaluations, therapist appointment leading up to meeting with a psychiatrist, psychiatric evaluation, coordination of medication management, funding for crisis admissions into Transitional Crisis Facility.

Amethyst House:
*  Expand transitional residential programs by two (2) beds for moderate-to-high risk felony offenders with co-occurring mental health and addictions diagnoses which will provide an additional 730 bed-days capacity per year.
*  Increase supportive housing and treatment services to the community and reduce the wait times for beds.
*  Creation of a program to assess and address the needs of persons with traumatic brain injuries and coordinate referrals to the Indiana University Department of Speech and Hearing Sciences Department for Traumatic Brain Injury services.
Indiana University Speech and Hearing Clinic:
*  To provide clinical services to program participants identified as having a traumatic brain injury in coordination with Amethyst House.