3. Improving Responses to
People with Mental Illnesses
The Essential Elements of a
Mental Health Court
A report prepared by the
Council of State Governments Justice Center
Criminal Justice/Mental Health Consensus Project
for the
Bureau of Justice Assistance
Office of Justice Programs
U.S. Department of Justice
Michael Thompson
Dr. Fred Osher
Denise Tomasini-Joshi
5. Contents
Acknowledgments v
Introduction vii
Ten Essential Elements
1 | Planning and Administration 1
2 | Target Population 2
3 | Timely Participant Identification and
Linkage to Services 3
4 | Terms of Participation 4
5 | Informed Choice 5
6 | Treatment Supports and Services 6
7 | Confidentiality 7
8 | Court Team 8
9 | Monitoring Adherence to Court
Requirements 9
10 | Sustainability 10
Conclusion 11
6. iv Improving Responses to People with Mental Illnesses
7. Acknowledgments
Many thanks are due to all those at the Bureau of Governments Justice Center thanks them, as well as
Justice Assistance (BJA), a component of the Office a group of leading mental health court experts who
of Justice Programs, U.S. Department of Justice, spent a full day at BJA’s conference Mental Health
who supported the development of this publication, Courts and Beyond in 2005 in Los Angeles to provide
particularly Domingo S. Herraiz, Director; A. Eliza- extensive comments on a subsequent draft of the
beth Griffith, Deputy Director for Planning; Robert document. In addition, representatives of BJA’s Men-
tal Health Court Learning Sites added important
Hendricks, former Acting Senior Policy Advisor for
information throughout the review process.
Mental Health; Michael Guerriere, former Senior
A number of current and former Justice
Policy Advisor for Substance Abuse and Mental Center staff members were key contributors to
Health; Ruby Qazilbash, Senior Policy Advisor for the document, including director of communica-
Substance Abuse and Mental Health; and Rebecca tions Martha Plotkin, research associate Lauren
Rose, Policy Advisor for Substance Abuse and Men- Almquist, and project coordinator Daniel
tal Health. Souweine. The project also benefited greatly from
Special thanks must also be given to the the advice of Justice Center consultants Barry Ma-
National Drug Court Institute (NDCI), particularly honey, President Emeritus of the Justice Manage-
Karen Freeman-Wilson, West Huddleston, and Car- ment Institute, D. Alan Henry, Director Emeritus of
son Fox, for their guidance on how this publication the Pretrial Justice Institute, and Timothy Murray,
could benefit from, and integrate, their experiences Executive Director of the Pretrial Justice Institute.
developing the seminal publication Defining Drug Finally, Justice Center staff express their grati-
Courts: The Key Components. tude to the hundreds of contributors who reviewed
Representatives of the sites awarded grants online drafts. Through a web forum, these respon-
under BJA’s Mental Health Court Grant Program dents provided valuable comments and offered
spent considerable time at a national conference insights and suggestions that made Essential Ele-
in Cincinnati in 2004 providing valuable feedback to ments a stronger, more practical resource.
a draft of Essential Elements. The Council of State
The Essential Elements of a Mental Health Cour t v
8. vi Improving Responses to People with Mental Illnesses
9. Introduction
Mental health courts are a recent and rapidly with mental illnesses charged with crimes, and
expanding phenomenon. In the late 1990s only a make more effective use of limited criminal justice
few such courts were accepting cases. Since then, and mental health resources.
more than 150 others have been established, and As the commonalities among mental health
dozens more are being planned. Although early courts begin to emerge, practitioners, policymakers,
commentary on these courts emphasized their dif- researchers, and others have become interested in
ferences—and their diversity is undeniable— developing consensus not only on what a mental
the similarities across mental health courts are health court is, but on what a mental health court
becoming increasingly apparent. In fact, the vast should be. The purpose of this document is to articulate
majority of mental health courts share the following such consensus in the form of 10 essential elements.
characteristics:
• A specialized court docket, which employs a
problem-solving approach to court processing in About the Elements
lieu of more traditional court procedures for cer- This publication identifies 10 essential elements of
tain defendants with mental illnesses mental health court design and implementation.1
• Judicially supervised, community-based treat- Each element contains a short statement describing
ment plans for each defendant participating in criteria mental health courts should meet, followed
the court, which a team of court staff and mental by several paragraphs explaining why the element is
health professionals design and implement important and how courts can adhere to it. Ulti-
mately, benchmarks will be added, enabling courts
• Regular status hearings at which treatment to better assess their fidelity to each element.
plans and other conditions are periodically Although both adult and juvenile mental
reviewed for appropriateness, incentives are health courts have emerged in recent years, this
offered to reward adherence to court conditions, publication pertains only to adult mental health
and sanctions are imposed on participants who courts. There are two primary reasons for this
do not adhere to the conditions of participation focus. First, as of this writing, there are only a hand-
• Criteria defining a participant’s completion of ful of mental health courts targeting juveniles. Sec-
(sometimes called graduation from) the program ond, the significant differences between the
provision of mental health and criminal justice
The reasons communities give for establishing services for juveniles and that for adults makes it
mental health courts are also remarkably consis- difficult to develop a document that encompasses
tent: to increase public safety, facilitate participation both populations.
in effective mental health and substance abuse Just as the success of local drug courts
treatment, improve the quality of life for people prompted the development of many mental health
1. Essential Elements was developed as part of a technical assistance development of mental health courts in 23 jurisdictions in FY 2002
program provided by the Council of State Governments (CSG) Jus- and 14 jurisdictions in FY 2003. The Justice Center currently pro-
tice Center through the Bureau of Justice Assistance (BJA) Mental vides technical assistance to the grantees of BJA’s Justice and Men-
Health Courts Program. The BJA Mental Health Courts Program, tal Health Collaboration Program, the successor to the Mental
which was authorized by America’s Law Enforcement and Mental Health Courts Program.
Health Project (Public Law 106-515), provided grants to support the
The Essential Elements of a Mental Health Cour t vii
10. courts, Defining Drug Courts: The Key Components, a the elements are present, they will manifest differ-
1997 publication of the U.S. Department of Justice, ently across jurisdictions. In addition, some mental
inspired this document. Although there are signifi- health court practitioners may disagree with some
cant differences between drug courts and mental of the statements below, identify elements that may
health courts, the Key Components document pro- be missing, or argue that some of these elements
vided the foundation in format and content for are unrealistic. This debate will drive stronger
Essential Elements. efforts in the field and maximize the effectiveness
Two key principles underlie the 10 essential of America’s mental health courts.
elements. First, at the heart of each element is col- Because mental health courts will continue to
laboration among the criminal justice, mental mature and new research will become available,
health, substance abuse treatment, and related sys- changes to this publication are inevitable. Essential
tems. True cross-system collaboration is necessary Elements will periodically be updated to reflect inno-
to realize any of these elements and, for that matter, vative thinking from the field and to include the
to successfully operate a mental health court. It is benchmarks that mental health court administra-
generally accepted that achieving this type of collab- tors can use to assess their progress in implement-
oration is difficult, particularly in regard to breaking ing the essential elements in their courts.
down institutional barriers and eschewing the
adversarial process. Second, the elements make
clear, both explicitly and implicitly, that mental Methodology
health courts are not a panacea. Reversing the over-
representation of people with mental illnesses in The essential elements are culled from a variety of
the criminal justice system requires a comprehen- sources, including interviews with former BJA Men-
sive strategy of which mental health courts should tal Health Courts Program (MHCP) grantees, on-site
be just one piece. visits to grantee and non-grantee mental health
Though these elements are drawn in large part courts, and a review of the scholarly literature.2 An
from the experience of existing courts, they are not original draft of the elements document was prepared
research-based. Only a few studies have been com- for the 2004 BJA MHCP conference. Comments
pleted, though more are underway, to better under- from the conference attendees were incorporated into
stand the operation and impact of mental health a second draft, which served as source material for the
courts. Proponents of mental health courts hope Guide to Mental Health Court Design and Implementa-
that these investigations will substantiate the rela- tion, a BJA-sponsored publication.
tive importance of different elements for court This latest version was informed by comments
functioning and client outcomes. In the meantime, from the field transmitted through a well-publicized
these elements should prove useful for communi- web-based discussion forum. A group of practition-
ties interested in developing a mental health court ers and experts reviewed and discussed these com-
or reviewing the organization and functions of an ments and suggested revisions to the draft. This
existing court program. version incorporates those suggestions.
The elements described in this document will
not be present in every mental health court. When
2. The first major investigation of mental health courts was “Emerg- to Mental Health Court Design and Implementation, July 2005, and
ing Judicial Strategies for the Mentally Ill in the Criminal Caseload: the Rand study Justice, Treatment, and Cost: An Evaluation of the
Mental Health Courts in Fort Lauderdale, Seattle, San Bernardino, Fiscal Impact of Allegheny County Mental Health Court, March 2007.
and Anchorage,” by John Goldkamp and Cheryl Irons-Guynn, April Readers interested in these and other resources related to mental
2000. Since then, several studies about mental health courts have health courts should visit www.consensusproject.org/mhcourts.
been published, including the BJA-sponsored report entitled Guide
viii Improving Responses to People with Mental Illnesses
11. Ten Essential Elements
1 planning and administration
A broad-based group of stakeholders representing the criminal justice, mental health,
substance abuse treatment, and related systems and the community guides the planning
and administration of the court.
Mental health courts are situated at the intersection The planning committee should identify agency
of the criminal justice, mental health, substance leaders and policymakers to serve on an “advisory
abuse treatment, and other social service systems. group” (in some jurisdictions members of the advi-
Their planning and administration should reflect sory group will also make up the planning commit-
extensive collaboration among practitioners and tee), responsible for monitoring the court’s
policymakers from those systems, as well as com- adherence to its mission and its coordination with
munity members. To that end, a multidisciplinary relevant activities across the criminal justice and
“planning committee” should be charged with mental health systems. The advisory group should
designing the mental health court. Along with suggest revisions to court policies and procedures
determining eligibility criteria, monitoring mecha- when appropriate, and should be the public face of
nisms, and other court processes, this committee the mental health court in advocating for its support.
should articulate clear, specific, and realizable goals The planning committee should address ongoing
that reflect agreement on the court’s purposes and issues of policy implementation and practice that
provide a foundation for measuring the court’s the court’s operation raises. Committee members
impact (see Element 10: Sustainability). should also keep high-level policymakers, including
Ideally, the development of a mental health those on the advisory group, informed of the court’s
court should take place in the context of broader successes and failures in promoting positive change
efforts to improve the response to people with men- and long-term sustainability (see Element 10). Addi-
tal illnesses involved with, or at risk of involvement tionally, by facilitating ongoing training and educa-
with, law enforcement, the courts, and corrections. tion opportunities, the planning committee should
Such discussions should include police and sher- complement and support the small team of profes-
iffs’ officials, judges, prosecutors, defense counsel, sionals who administer the court on a daily basis,
court administrators, pretrial services staff, and cor- the “court team” (see Element 8).
rections officials; mental health, substance abuse In many jurisdictions, the judiciary will ulti-
treatment, housing, and other service providers; mately drive the design and administration of the
and mental health advocates, crime victims, con- mental health court. Accordingly, it should be well
sumers, and family and community members. represented on and take a visible role in leading
both the planning committee and advisory group.
The Essential Elements of a Mental Health Cour t 1
12. 2 target population
Eligibility criteria address public safety and consider a community’s treatment capacity, in
addition to the availability of alternatives to pretrial detention for defendants with mental
illnesses. Eligibility criteria also take into account the relationship between mental illness and a
defendant’s offenses, while allowing the individual circumstances of each case to be considered.
Because mental health courts are, by definition, including drug courts and community courts, as tar-
specialized interventions that can serve only a por- get populations are likely to overlap.
tion of defendants with mental illness, careful Clinical eligibility criteria should be well
attention should be paid to determining their target defined and should be developed with an under-
populations. standing of treatment capacity in the community.
Mental health courts should be conceptualized Mental health court personnel should explore ways
as part of a comprehensive strategy to provide law to improve the accessibility of community-based
enforcement, court, and corrections systems with care when treatment capacity is limited and should
options, other than arrest and detention, for explore ways to improve quality of care when serv-
responding to people with mental illnesses. Such ices appear ineffective (see Element 6: Treatment
options include specialized police-based responses Supports and Services).
and pretrial services programs. For those individuals Mental health courts should also focus on
who are not diverted from arrest or pretrial deten- defendants whose mental illness is related to their
tion, mental health courts can provide appropriately current offenses. To that end, the planning commit-
identified defendants with court-ordered, commu- tee should develop a process or a mechanism,
nity-based supervision and services. Mental health informed by mental health professionals, to enable
courts should be closely coordinated with other spe- staff charged with identifying mental health court
cialty or problem-solving court-based interventions, participants to make this determination.
2 Improving Responses to People with Mental Illnesses
13. 3 timely participant identification
and linkage to services
Participants are identified, referred, and accepted into mental health courts, and then linked to
community-based service providers as quickly as possible.
Providing safe and effective treatment and supervi- necessary, it should be expedited, especially for
sion to eligible defendants in the community, as defendants charged with misdemeanors. The time
opposed to in jail or prison, is one of the principal required to accept someone into the program
purposes of mental health courts. Prompt identifi- should not exceed the length of the sentence that
cation of participants accelerates their return to the the defendant would have received had he or she
community and decreases the burden on the crimi- pursued the traditional court process. Final deter-
nal justice system for incarceration and treatment. mination of eligibility should be a team decision
Mental health courts should identify potential (see Element 8: Court Team).
participants early in the criminal justice process by The time needed to identify appropriate serv-
welcoming referrals from an array of sources such ices, the availability of which may be beyond the
as law enforcement officers, jail and pretrial serv- court’s control, may constrain efforts to identify par-
ices staff, defense counsel, judges, and family mem- ticipants rapidly (see Element 6: Treatment Sup-
bers. To ensure accurate referrals, mental health ports and Services). This is likely to be an issue
courts must advertise eligibility criteria and actively especially in felony cases, when the court may seek
educate these potential sources. In addition to creat- services of a particular intensity to maximize public
ing a broad network for identifying possible partici- safety. Accordingly, along with connecting mental
pants, mental health courts should select one or two health court participants to existing treatment, offi-
agencies to be primary referral sources that are cials in criminal justice, mental health, and sub-
especially well versed in the procedures and criteria. stance abuse treatment should work together to
The prosecutor, defense counsel, and a improve the quality and expand the quantity of
licensed clinician should quickly review referrals available services.
for eligibility. When competency determination is
The Essential Elements of a Mental Health Cour t 3
14. 4 terms of participation
Terms of participation are clear, promote public safety, facilitate the defendant’s engagement in
treatment, are individualized to correspond to the level of risk that the defendant presents to the
community, and provide for positive legal outcomes for those individuals who successfully
complete the program.
Mental health courts need general program param- process. In addition, program duration should vary
eters for plea agreements, program duration, super- depending on a defendant’s program progress. Pro-
vision conditions, and the impact of program gram completion should be tied to adherence to the
completion. Within these parameters, the terms of participant’s court-ordered conditions and the
participation should be individualized to each strength of his or her connection to community
defendant and should be put in writing prior to his treatment.
or her decision to enter the program. The terms of Least restrictive supervision conditions should
participation will likely require adherence to a treat- be considered for all participants, especially those
ment plan that will be developed after engagement charged with misdemeanors. Highly restrictive con-
with the mental health court program, and defen- ditions increase the likelihood that minor violations
dants should be made aware of the consequences of will occur, which can intensify the involvement of
noncompliance with this plan. participants in the criminal justice system.
Whenever plea agreements are offered to peo- When a mental health court participant com-
ple invited to participate in a mental health court, pletes the terms of his or her participation in the
the potential effects of a criminal conviction should program, there should be some positive legal out-
be explained. Collateral consequences of a criminal come. When the court operates on a pre-plea model,
conviction may include limited housing options, a significant reduction or dismissal of charges can
opportunities for employment, and accessibility to be considered. When the court operates in a post-
some treatment programs. It is especially important plea model, a number of outcomes are possible
that the defendant be made aware of these conse- such as early terminations of supervision, vacated
quences when the only charge he or she is facing is pleas, and lifted fines and fees. Mental health court
a misdemeanor, ordinance offense, or other non- participants, when in compliance with the terms of
violent crime. their participation, should have the option to with-
The length of mental health court participation draw from the program at any point without having
should not extend beyond the maximum period of their prior participation and subsequent withdrawal
incarceration or probation a defendant could have from the mental health court reflect negatively on
received if found guilty in a more traditional court their criminal case.
4 Improving Responses to People with Mental Illnesses
15. 5 informed choice
Defendants fully understand the program requirements before agreeing to participate in a mental
health court. They are provided legal counsel to inform this decision and subsequent decisions
about program involvement. Procedures exist in the mental health court to address, in a timely
fashion, concerns about a defendant’s competency whenever they arise.
Defendants’ participation in mental health courts is defendant should be spelled out in writing. Defen-
voluntary. But ensuring that participants’ choices dants should have the opportunity to review these
are informed, both before and during the program, terms, with the advice of counsel, before opting into
requires more than simply offering the mental the court.
health court as an option to certain defendants. Defense attorneys play an integral role in help-
Mental health court administrators should be ing to ensure that defendants’ choices are informed
confident that prospective participants are compe- throughout their involvement in the mental health
tent to participate. Typically, competency determina- court. Admittedly, the availability of defense counsel
tion procedures can be lengthy, which raises varies from one jurisdiction to another. In some com-
challenges for timely participant identification. This munities, defendants’ access to counsel depends on
is especially important for courts that focus on the crime with which they were charged or the pur-
defendants charged with misdemeanors (see Ele- pose of the hearing. Recognizing these constraints,
ment 3: Timely Participant Identification and Link- courts should strive to make defense counsel avail-
age to Services). For these reasons, as part of the able to advise defendants about their decision to
planning process, courts should develop guidelines enter the court and have counsel be present at status
for the identification and expeditious resolution of hearings. It is particularly important to ensure the
competency concerns. presence of counsel when there is a risk of sanctions
Even when competency is not an issue, mental or dismissal from the mental health court. Defense
health court staff must ensure that defendants fully counsel participating in mental health courts—like
understand the terms of participation, including all other criminal justice staff assigned to the court—
the legal repercussions of not adhering to program should receive special training in mental health
conditions. The specific terms that apply to each issues (see Element 8: Court Team).
The Essential Elements of a Mental Health Cour t 5
16. 6 treatment supports and services
Mental health courts connect participants to comprehensive and individualized treatment
supports and services in the community.They strive to use—and increase the availability of—
treatment and services that are evidence-based.
Mental health court participants require an array of Treatment providers should remain in regular
services and supports, which can include medications, communication with court staff concerning the
counseling, substance abuse treatment, benefits, appropriateness of the treatment plan and should
housing, crisis interventions services, peer supports, suggest adjustments to the plan when appropriate.
and case management. Mental health courts should At the same time, court staff should check with
anticipate the treatment needs of their target popula- community-based treatment providers periodically
tion and work with providers to ensure that services to determine the extent to which they are encoun-
will be made available to court participants. tering challenges stemming from the court’s super-
When a participant is identified and linked to a vision of the participant.
service provider, the mental health court team Case management is essential to connect par-
should design a treatment plan that takes into ticipants to services and monitor their compliance
account the results of a complete mental health and with court conditions.4 Case managers—whether
substance abuse assessment, individual consumer they are employees of the court, treatment
needs, and public safety concerns. Participants providers, or community corrections officers—
should also have input into their treatment plans. should have caseloads that are sufficiently manage-
A large proportion of mental health court par- able to perform core functions and monitor the
ticipants have co-occurring substance abuse disor- overall conditions of participation. They should
ders. The most effective programs provide serve as the conduits of information for the court
coordinated treatment for both mental illnesses and about the status of treatment and support services.
substance abuse problems. Thus, mental health Case managers also help participants prepare
courts should connect participants with co-occur- for their transition out of the court program by
ring disorders to integrated treatment whenever ensuring that needed treatment and services will
possible and advocate for the expanded availability of remain available and accessible after their court
integrated treatment and other evidence-based prac- supervision concludes. The mental health court
tices.3 Mental health court teams should also pay may also provide post-program assistance, such as
special attention to the needs of women and ethnic graduate support groups, to prevent participants’
minorities and make gender-sensitive and culturally relapses.
competent services available.
3. Evidence-based practices (EBPs) are mental health service interven- prior training of the individuals who are implementing it, whether
tions for which consistent scientific evidence demonstrates their abil- they are social workers, nurses, or case management specialists”
ity to improve consumer outcomes. R.E. Drake, et al., “Implementing (see SAMHSA’s Treatment Improvement Protocol [TIP] #27, “Case
Evidence-Based Practices in Routine Mental Health Service Settings,” Management for Substance Abuse Treatment”). The definition of a
Psychiatric Services 52 (2001): 179–182. Other EBPs include assertive particular case management approach can be derived from its func-
community treatment, psychotropic medications, supported employ- tions and objectives. Case management functions include assess-
ment, family psychoeducation, and illness self-management. ing, planning, linking, coordinating, monitoring, and advocating.
4. The term “case management” has multiple definitions. Moreover, For example, the Office of Juvenile Justice and Delinquency Preven-
specific interventions such as assertive community treatment tion (OJJDP) of the U.S. Department of Justice in its publication
(ACT) and intensive case management (ICM) are themselves case Drug Identification and Testing in the Juvenile Justice System, defines
management models. According to the Substance Abuse and Men- case management as “an individualized plan for securing, coordi-
tal Health Services Administration (SAMHSA) “any definition of nating, and monitoring the appropriate treatment interventions and
case management today is inevitably contextual, based on the needs ancillary services necessary to treat each offender successfully for
of a particular organizational structure, environmental reality, and optimal justice system outcomes.”
6 Improving Responses to People with Mental Illnesses
17. 7 confidentiality
Health and legal information should be shared in a way that protects potential participants’
confidentiality rights as mental health consumers and their constitutional rights as defendants.
Information gathered as part of the participants’ court-ordered treatment program or services
should be safeguarded in the event that participants are returned to traditional court processing.
To identify and supervise participants, mental discussions about that person’s mental illness,
health courts require information about their men- which can stigmatize the defendant. Even informa-
tal illnesses and treatment plans. When sharing this tion concerning a defendant’s referral to a mental
information, treatment providers and representa- health court should be closely guarded—particu-
tives of the mental health court should consider the larly because many of these individuals may later
wishes of defendants. They must also adhere to fed- choose not to participate in the mental health court.
eral and state laws that protect the confidentiality of To minimize the likelihood that information about
medical, mental health, and substance abuse treat- defendants’ mental illnesses or their referral to the
ment records. mental health court will negatively affect their crim-
A well-designed procedure governing the inal cases, courts whenever possible should main-
release and exchange of information is essential to tain clinical documents separately from the
facilitating appropriate communication among criminal files and take other precautions to prevent
members of the mental health court team and to medical information from becoming part of the
protect confidentiality. Release forms should be part public record.
of this procedure. They should be developed in con- Once a defendant is under the mental health
sultation with legal counsel, adhere to federal and court’s supervision, steps should be taken to main-
state laws, and specify what information will be tain the privacy of treatment information through-
released and to whom.5 Potential participants out his or her tenure in the program. Clinical
should be allowed to review the form with the information provided to mental health court staff
advice of defense counsel and treatment providers. members should be limited to whatever they need
Defendants should not be asked to sign release of to make decisions. Furthermore, such exchanges
information forms until competency issues have should be conducted in closed staff meetings; dis-
been resolved (see Element 5: Informed Choice). cussion of clinical information in open court should
When a defendant is being considered for the be avoided.
mental health court, there should not be any public
5. For information on complying with the Health Insurance Portabil-
ity and Accountability Act (HIPAA), please visit SAMHSA’s Web
site at www.hipaa.samhsa.gov/hipaa.html.
The Essential Elements of a Mental Health Cour t 7
18. 8 court team
A team of criminal justice and mental health staff and service and treatment providers receives
special, ongoing training and helps mental health court participants achieve treatment and
criminal justice goals by regularly reviewing and revising the court process.
The mental health court team works collaboratively Mental health court planners should carefully
to help participants achieve treatment goals by bring- select team members who are willing to adapt to a
ing together staff from the agencies with a direct role nontraditional setting and rethink core aspects of
in the participants’ entrance into, and progress their professional training. Planners should seek
through, the court program. The court team func- criminal justice personnel with expertise or interest
tions include conducting screenings, assessments, in mental health issues and mental health staff with
and enrollments of referred defendants; defining criminal justice experience. Planners should also
terms of participation; partnering with community work to ensure that the judge who will preside over
providers; monitoring participant adherence to the mental health court is comfortable with its goals
terms; preparing for all court appearances; and devel- and procedures.
oping transition plans following court supervision. Team members should take part in cross-train-
Team members should work together on each partic- ing before the court is launched and during its oper-
ipant’s case and contribute to the court’s administra- ation. Mental health professionals must familiarize
tion to ensure its smooth functioning. themselves with legal terminology and the work-
The composition of this court team differs ings of the criminal justice system, just as criminal
across jurisdictions. These variations notwithstand- justice personnel must learn about treatment prac-
ing, it typically should comprise the following: a tices and protocols. Team members should also be
judicial officer; a treatment provider or case man- offered the opportunity to attend regional or
ager; a prosecutor; a defense attorney; and, in some national training sessions and view the operations
cases, a court supervision agent such as a probation of other mental health courts. New team members
officer. Many courts also employ a court coordinator should go through a period of training and orienta-
responsible for overall administration of the court, tion before engaging fully with the court.
which can help promote communication, efficiency, Periodic review and revision of court processes
and sustainability. Regardless of the composition of must be a core responsibility of the court team.
the team, the judge’s role is central to the success of Using data, participant feedback, observations of
the mental health court team and the mental health team members, and direction from the advisory
court generally. He or she oversees the work of the group and planning committee (see Element 1), the
mental health court team and encourages collabora- court team should routinely make improvements to
tion among its members, who must work together the court’s operation.
to inform the judge about whether participants are
adhering to their terms of participation.
8 Improving Responses to People with Mental Illnesses
19. 9 monitoring adherence to
court requirements
Criminal justice and mental health staff collaboratively monitor participants’ adherence to court
conditions, offer individualized graduated incentives and sanctions, and modify treatment as
necessary to promote public safety and participants’ recovery.
Whether a mental health court assigns responsibil- is common. But nonadherence should never be
ity for monitoring compliance with court conditions ignored. The first response should be to review
to a criminal justice agency, a mental health agency, treatment plans, including medications, living situ-
or a combination of these organizations, collabora- ations, and other service needs. For minor viola-
tion and communication are essential. The court tions the most appropriate response may be a
must have up-to-date information on whether partic- modification of the treatment plan.
ipants are taking medications, attending treatment In some cases, sanctions are necessary. The
sessions, abstaining from drugs and alcohol, and manner in which a mental health court applies
adhering to other supervision conditions. This infor- sanctions should be explained to participants prior
mation will come from a variety of sources and must to their admittance to the program. As a partici-
be integrated routinely into one coherent presenta- pant's commission of violations increases in fre-
tion or report to keep all court staff informed of par- quency or severity, the court should use graduated
ticipants’ progress. Case staffing meetings provide sanctions that are individualized to maximize
such an opportunity to share information and deter- adherence to his or her conditions of release. Spe-
mine responses to individuals’ positive and negative cific protocols should govern the use of jail as a con-
behaviors. These meetings should happen regularly sequence for serious noncompliance.
and involve key members of a team, including, Mental health courts should use incentives to
when appropriate, representatives from the prosecu- recognize good behavior and to encourage recovery
tion, defense, treatment providers, court supervision through further behavior modification. Individual
agency, and the judiciary. praise and rewards, such as coupons, certificates for
Status hearings allow mental health courts completing phases of the program, and decreased
publicly to reward adherence to conditions of partic- frequency of court appearances, are helpful and
ipation, to sanction nonadherence, and to ensure important incentives. Systematic incentives that
ongoing interaction between the participant and the track the participants’ progress through distinct
court team members. These hearings should be fre- phases of the court program are also critical. As par-
quent at the outset of the program and should ticipants complete these phases, they receive public
decrease as participants progress positively. recognition.
All responses to participants’ behavior, whether Courts should have at their disposal a menu of
positive or negative, should be individualized. incentives that is at least as broad as the range of
Incentives, sanctions, and treatment modifications available sanctions; incentives for sustained adher-
have clinical implications. They should be imposed ence to court conditions, or for situations in which
with great care and with input from mental health the participant exceeds the expectation of the court
professionals. team, are particularly important.
Relapse is a common aspect of recovery; non-
adherence to conditions of participation in the court
The Essential Elements of a Mental Health Cour t 9
20. 10 sustainability
Data are collected and analyzed to demonstrate the impact of the mental health
court, its performance is assessed periodically (and procedures are modified
accordingly), court processes are institutionalized, and support for the court in
the community is cultivated and expanded.
Mental health courts must take steps early in the plans for staff turnover helps safeguard the integrity
planning process and throughout their existence to of the court’s operation.
ensure long-term sustainability. To this end, per- Because sustaining a mental health court with-
formance measures and outcome data will be out funding is difficult, court planners should iden-
essential. Data describing the court’s impact on tify and cultivate long-term funding sources early
individuals and systems should be collected and on. Court staff should base requests for long-term
analyzed. Such data should include the court’s out- funding on clear articulations of what the court
puts, such as number of defendants screened and plans to accomplish. Along with compiling empiri-
accepted into the mental health court, as well as its cal evidence of program successes, mental health
outcomes, such as the number of participants who court teams should invite key county officials, state
are rearrested and reincarcerated. Setting output legislators, foundation program officers, and other
and outcome measures are a key function of the policymakers to witness the court in action.
court’s planning and ongoing administration (see Outreach to the community, the media, and
Element 1).6 Quantitative data should be comple- key criminal justice and mental health officials also
mented with qualitative evaluations of the program promotes sustainability. To that end, mental health
from staff and participants. court teams should make community members
Formalizing court policies and procedures is aware of the existence and impact of the mental
also an important component of maintaining men- health court and the progress it has made. More
tal health court operations. Compiling information important, administrators should be prepared to
about a court’s history, goals, eligibility criteria, respond to notable program failures, such as when
information-sharing protocols, referral and screen- a participant commits a serious crime. Ongoing
ing procedures, treatment resources, sanctions and guidance from, and reporting to, key criminal jus-
incentives, and other program components helps tice and mental health leaders also helps to main-
ensure consistency and lessens the impact when tain interest in, and support for, the mental health
key team members depart. Developing additional court.
6. The next edition of this document will include benchmarks that Outcome Data, May 2005, published by the CSG Justice Center
will help courts determine whether this is taking place in their and available at www.consensusproject.org/mhcourts/
jurisdictions. For guidance on collecting outcome data, please see MHC-Outcome-Data.pdf.
Henry J. Steadman, A Guide to Collecting Mental Health Court
10 Improving Responses to People with Mental Illnesses
21. Conclusion
In courtrooms across the country, judges, prosecu- as variation is the hallmark of this country’s crimi-
tors, and defense attorneys are seeing increasing nal justice system, and one of its strengths. At the
numbers of defendants who have serious untreated same time, experts in criminal justice and mental
mental illnesses charged with committing low-level health practice agree that there are essential ele-
crimes. Traditional court processes do little to ments to mental health courts, which enable them
improve outcomes for many of these people. They to span both the criminal justice and mental health
cycle again and again through jail, courtrooms, and systems effectively and to ensure that the rights of
our city streets. participants and community members are
As an alternative to the status quo, court offi- respected. This publication describes and explains
cials, working in partnership with leaders in the these essential elements of a mental health court.
mental health system and local and state policy- To design and implement a mental health court
makers, have designed problem-solving mental with attention to each of these elements is a chal-
health courts. These courts depart from the tradi- lenge for those just starting a conversation about a
tional model used in most criminal proceedings. possible mental health court, as well as for those
Instead, as a team and under the judge’s guidance, who have operated a mental health court for years.
prosecutors, defense attorneys, and mental health Yet seasoned and new mental health court teams
service providers connect eligible defendants with alike have demonstrated a willingness to address
community-based mental health treatment and, in such complicated challenges. The essential ele-
lieu of incarceration, assign them to community- ments described in this document are written for
based supervision. them and others following in their footsteps, all of
The number of mental health courts in the whom work tirelessly to make communities health-
United States has grown significantly. These pro- ier and safer, promote the efficient use of public
grams share much in common from one county to resources and tax dollars, and improve outcomes
another. There are also aspects of each mental for people with mental illnesses who are involved in
health court’s design and operation that are unique, the criminal justice system.
The Essential Elements of a Mental Health Cour t 11
22. The Bureau of Justice Assistance, Office of Justice Programs,
U.S. Department of Justice, provides leadership training, techni-
cal assistance, and information to local criminal justice agencies
to make America’s communities safer. Read more at
www.ojp.usdoj.gov/BJA/.
The Council of State Governments (CSG) Justice Center is a
national nonprofit organization serving policymakers at the
local, state, and federal levels from all branches of government.
The CSG Justice Center provides practical, nonpartisan advice
and consensus-driven strategies, informed by available evidence,
to increase public safety and strengthen communities. Read
more at www.justicecenter.csg.org.
The Criminal Justice/Mental Health Consensus Project is an
unprecedented national effort coordinated by the CSG Justice
Center to improve responses to people with mental illnesses who
become involved in, or are at risk of involvement in, the criminal
justice system. Read more at www.consensusproject.org.
23.
24. Council of State Governments
Justice Center
100 Wall Street 4630 Montgomery Avenue
20th Floor Suite 650
New York, NY 10005 Bethesda, MD 20814
tel: 212-482-2320 tel: 301-760-2401
fax: 212-482-2344 fax: 240-497-0568
www.justicecenter.csg.org
