In the 1950s, Ohio began the process required by state law to close many of its mental institutions. For most people with a mental illness, de-institutionalization has been successful. New medicines and extensive community outreach have allowed even the seriously mentally ill to live rich and fulfilling lives.
However, a relatively small number of mentally ill persons have difficulty adjusting to lives outside of an institution. They may not take their prescribed medication, and may become dangerous to themselves or others. Some may medicate their psychiatric symptoms with illegal drugs and alcohol. Some support themselves by stealing or prostitution. Many commit other more minor crimes while trying to survive, such as panhandling and trespassing to sleep in buildings or public places.
As a result, jails and prisons have become crowded with mentally ill people. The Los Angeles county jail houses more mentally ill people than any hospital in the country. In almost every jail or prison, a disproportionate number of inmates have a diagnosis of a mental illness.
Q: Why have a special court for the mentally ill? If a person commits a crime, why should he or she get different treatment?
A: Recently, the criminal justice system has recognized that incarceration alone does not always produce the desired results of reducing crime and promoting public safety. Traditional jail settings generally are not adequately equipped to handle the special needs of mentally ill persons, such as monitoring necessary medication. Some courts have established special dockets (schedules within a court) specifically for mentally ill offenders.
The specialty docket's first goal is to get the offender back on the required medication. The mental health court judge offers the offender a chance to voluntarily comply with a psychiatrist's orders. If the offender will not take the medicine, then he or she is hospitalized to ensure medical compliance. Because one judge oversees the process, the offender is likely to get appropriate treatment much more quickly than through the more traditional approach.
Moving the person from jail to a setting that will allow treatment frees up needed and expensive jail beds and lets the person begin to progress towards a healthy re-entry to the community. Also, the more quickly treatment is available, the faster the person can be stabilized.
Q: What happens after these offenders are stabilized medically? Shouldn't they have to answer for their crimes?
A: Once the offender has been medically stabilized, that person comes back to court with a lawyer. The offender may plead guilty to the charges and enter the Mental Health Court program. Akron's program, the first of many in Ohio, is a two-year, intensive, treatment-based probation. Offenders work with case managers to address their issues with a goal toward preventing recidivism - the commission of new crimes. The first issue is always compliance with medication requirements. Many people do not like to take the medicine because of side effects or changes they experience. Others will take the medicine for a while but stop once they feel better. The case manager and the court work together to ensure that the person stays on the medicine prescribed by the psychiatrist.
In addition, the case manager helps the defendant to take responsibility for and control over his or her life and for managing the mental illness. For many, this requires treatment for alcohol or drug addiction. Offenders must prove sobriety through frequent urine tests. Many also need help finding housing and employment when appropriate.
Participants must appear regularly in court to discuss their progress. They may receive rewards for accomplishing goals or sanctions such as community service, house arrest or jail for failing to meet program requirements. For example, a sanction can be imposed if the offender stops taking the recommended medicine or uses illegal drugs.
Q: What advantages do mental health courts offer over traditional approaches?
A: Mentally ill offenders have cycled in and out of the traditional system, getting arrested when they stop taking their medication. When they stay on the medicine, they generally do not get arrested, so the program works to ensure that offenders continue to take appropriate medication.
A recent study estimates that mentally ill offenders will use $40,000 of services annually as they cycle in and out of institutions. A specialty court uses existing services and adds intensive case management at an additional cost of only several thousand dollars a year. In order to successfully complete the program, the offender must meet the goals of stabilization at every level: medication compliance, housing, employment and sobriety.
At the end of the two-year program, the successful "graduate" should have learned the skills necessary to remain a healthy, law-abiding member of the community.
Kent State University has studied the Akron Municipal Court since its inception. Its analysis shows that drug court participants use fewer jail bed and mental health bed days, and that graduates are committing significantly fewer crimes.
Ohio has been recognized nationally for its leadership in establishing mental health courts. Akron is a teaching site for a federal program that helps other courts begin a specialty program for the mentally ill.
Law You Can Use is a weekly consumer legal information column provided by the Ohio State Bar Association. This article was prepared by Hon. Elinore Marsh Stormer, formerly the mental health court judge in Akron's Municipal Court.