A Morning at Mental Health Court
As all rise for Judge Robert Heffron Jr. for the mental health court of Prince George's County, there's little resemblance to a hospital unit or outpatient clinic with white-coated doctors. The judge in his black robe takes the bench, seated directly in front of the Great Seal of Maryland and the state and U.S. flags. The Tuesday morning docket lists defendants and case numbers, not patients and diagnoses. The few people who show up in scrubs, in a blazing shade of orange, are defendants transported from jail. Most of the defendants arrive in street clothes.
However, as the session moves forward, exchanges among court personnel sound a lot like discussions between health care providers and patients. Are defendants complying with treatments and taking medications as ordered, and if not, why? Issues doctors hear about all the time -- like prescription drug side effects that make people feel drowsy, lethargic and unlike themselves -- also arise in this courtroom.
[See: How Social Workers Help Your Health.]
Still, it's clear this isn't a mental health clinic, but a court of law. One case involves a woman who's having compliance issues with her psychiatric drugs, which she says cause numerous side effects. The problem, however, is that she randomly assaults people on the street when she's off her medication.
Medication does nothing for her, she insists, noting that she functions well, including showing up in court, without it. At one point she challenges the judge: "Are you a psychiatrist? Do you understand what I'm saying?"
At another point, Heffron says, "You can choose not to take your medication. And I can choose not to allow you into the community." Eventually, Jhana Bogan, a private attorney paneled through the Maryland Office of the Public Defender, asks the judge for a moment to quietly confer with her client.
After their conversation, Bogan summarizes for the court: She's explained to the defendant that she has the right not to take her medication. She has encouraged the client -- and the client has agreed -- to speak to her doctor about the medication and side effects at an upcoming appointment. "That sounds like a good plan," the judge says. "We'll take it from there."
As with health care, a multidisciplinary team approach is used in court. The psychologist who works with the court conducts competency evaluations, submits opinions and occasionally testifies, explains Marilyn Bailey, coordinator for mental health and drug courts in the county's fifth district. A clinical social worker serves as a consultant on clinical issues.
Mental health courts are one type of problem-solving court, along with drug court, DUI court and veterans court. About 350 mental health courts exist in the U.S., according to Linda Rosenberg, president of the National Council for Behavioral Health, speaking to journalists at a National Press Foundation conference on mental health in September.
Mental health courts put the power of courts to good use, says Rosenberg, who in her previous role as senior deputy commissioner of the New York State Office of Mental Health, set up one of the early such courts in New York City. She says they can prevent people with mental health issues who commit small transgressions -- like trespassing and showing up on strangers' sofas or in their yards -- from being jailed.
Major depression, schizophrenia, bipolar disorder and schizoaffective disorder are common diagnoses in these defendants (all adults) and are sometimes accompanied by substance use disorders. Some defendants with traumatic brain injuries or developmental disabilities are eligible as well.
[See: 7 Health Risks of Binge Drinking You Can't Ignore.]
Participation in mental health court is voluntary. After being referred following an arrest, those who are eligible, competent and interested sign an agreement and are assigned a case manager. Most receive pretrial releases from jail with conditions set by the program team. An individualized treatment plan is combined with ongoing monitoring by the court.
Reducing contact with the criminal justice system for participants with mental illness is a major program goal. Addressing underlying problems that can lead to criminal behavior and lowering the rate of recidivism are big-picture program aims.
While requirements vary, programs include mental health treatments, periodic status hearings and weekly check-in calls with a case manager, possibly along with drug testing or job training, depending on each participant.
Not every patient with mental illness is suitable for this pathway. "We don't do sociopaths or oppositional personality disorder," says Judge Patrice Lewis, the coordinating judge at the mental health court in Prince George's County. Launched in 2007, the court was in session monthly at first, then weekly, with cases now being heard Tuesdays and Thursdays, mornings and afternoons. The community need is there.
With the potential to improve defendants' lives, Lewis says, "It's the most rewarding work I've ever done." The goal, she explains, is to decriminalize mental illness. "I can't incarcerate you out of bipolar disorder or schizophrenia," she says.
Heffron says mental health court is a judicial approach "that really, really works," although it's not an overnight or magic solution. Sticking to routine and consistency is important for these defendants, as is patience. "Accommodations need to be made," he says.
Attorneys, naturally adversarial, are more collaborative in this particular setting, Heffron says. It's more about moving people forward than winning cases. The low-key atmosphere gives defendants who are feeling shaky a place to de-escalate, Lewis says: "Now we're in a safe space."
Another case on the morning docket involves a young man who's completed a drug-treatment program. "He's just doing it," Bogan says. "I'm proud of him." The judge congratulates him, adding, "Keep up the good work, and we'll be out of your life before you know it."
Two separate cases involve women for whom a court has issued bench warrants. One turned herself in within hours, while the other was picked up many months after failing to appear in court. With some back-and-forth between Bogan and Assistant State's Attorney Mary Grace Waldron, negotiations are made to facilitate medication discussions with doctors and clarify housing and other family and social issues. Second chances are offered.
[See: How to Help Aging Parents Manage Medications.]
An encouraging hearing goes smoothly and quickly for a young woman who's recognized for successfully completing the mental health court program (unofficially referred to as "graduating"). "Congratulations -- we knew you were a heavy lifter," the judge concludes. "We have a small exit interview, and then you're good to go."
Lisa Esposito is a Patient Advice reporter at U.S. News. You can follow her on Twitter, connect with her on LinkedIn or email her at lesposito@usnews.com.
