'Mental Health Courts' Strive To Provide Treatment Instead Of Jail Time

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Because an estimated 70 percent of those involved in the criminal justice system are mentally ill, several Massachusetts agencies are working on new ways to help these defendants and protect public safety at the same time.

One of those ways is the mental health court. There are about 250 such courts around the country that hold special mental health sessions to provide treatment instead of jail. There are three Massachusetts courts that hold mental health sessions: in Springfield, Plymouth and Boston.

Keo Collins talks about the Springfield mental health court. (Deborah Becker/WBUR)
Keo Collins talks about the Springfield mental health court. (Deborah Becker/WBUR)

At a recent graduation ceremony at Springfield District Court, Kio Collins formally left the court’s Recovery with Justice program, in which he’s been participating for about a year.

"I feel like I've been given another chance to reach my potential,” Collins said. “The only thing in my way is my mental illness, which is under control now with medications, with therapists."

Collins first suspected he was schizophrenic when he started hearing voices as a teenager. He's now 37 and says it was always difficult to get proper mental health treatment.

"I got diagnosed with schizophrenia when I was about 23, after about five hospitalizations,” Collins said. “At first you don't know what's going on and you get on meds that don't help, so it’s a long process to get stable."

His mental health problems, he says, led him to self-medicate and then to crime.

"I would be doing good for maybe a year, two years, trying to go to church, but then voices come and the next thing I know I'm smoking cigarettes, drinking ,and doing drugs again,” Collins said.

Jack Morganstern, chief probation officer in Springfield District Court, knew Collins before he was in the program.

“He was well-known on the streets of Springfield, very involved with gangs and criminal activity,” Morganstern said. He didn't think Collins would ever be able to stay out of jail.

"If you had asked me from the get-go whether this individual would have made it and doing what he's doing today, I would have bet against it,” Morganstern said. “If he wasn't in the program, he would have been on regular probation, he may have missed appointments, violated and been incarcerated. But as a result of the program he's now taking college courses.”

That's the thrust of the program — to provide an alternative to cycling in and out of jail. One reason it works, Morganstern says, is because it limits participants. There are 21 people overseen by one case manager in Springfield, compared with the average probation officer's caseload of 150 defendants. It's also not a program for everyone and only about half of those referred are admitted. And there are strict criteria, including a verifiable history of mental illness, and a defendant must agree to participate in a rigorous treatment plan. That plan involves not only counseling, but weekly appearances before a judge, who almost acts like a therapist.

Here's Judge Michael Mulcahey talking with one defendant:

You've got a lot of pressure on you. We all want you to do well. If you slip up, you're going to face a violation, which carries with it a potential of being found guilty or being sentenced. You want to avoid that. None of us want to see you go through that.

Springfield's mental health court session started two-and-a-half a years ago when judges, the sheriff, prosecutors, defense attorneys and health care providers met to discuss the high number of mentally ill defendants and inmates. They ultimately designed the program and received a grant to pay for it. When that grant expired last year, the state took over the $70,000 annual cost.

Dr. Deborah Pinals, with the Department of Mental Health, says such courts are effective.

"In looking at the outcomes it seemed to make sense for the Department of Mental Health to have a leading role in funding and developing mental health courts in partnership with other stakeholders, including the courts,” Pinals said.

But what are the outcomes from mental health courts? Andrew Bourke, program director for Behavioral Health Networks Adult Court Clinics, who was among those who started the Springfield program, says it's still too early to tell. While most studies suggest a recidivism rate of between 17 and 20 percent — which is less than half of traditional court — for Bourke, there's a different measurement.

"We take the perspective that if somebody's getting help in a clinical sense, whether it's substance abuse treatment or psychiatric help and they're not re-offending, that's success,” Bourke said. “They've established other ways of getting help and they're getting help before they take the step of re-offending."

The Washington, D.C.-based Bazelon Center for Mental Health Law says many times courts like these are band-aids on a bigger problem. The center says society is still not addressing the need to get people mental health treatment before they end up in court.

But participants like Collins say the program works — at least for him.

“To be honest, a person has to come to a self-realization first," he said. "I don't know how spiritual you are; I think it happens in God's time. After I graduate today, I've still got supports in the mental health field, so I"m good."

Collins is now at community college studying human services and he hopes to one day work with troubled young people.

This program aired on April 23, 2012.

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Deborah Becker Host/Reporter
Deborah Becker is a senior correspondent and host at WBUR. Her reporting focuses on mental health, criminal justice and education.



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