Good grades

Officials: mental health court reduces logjam

By Casey Farrar
Sentinel Staff
Published September 9, 2009
In the nearly six years since the mental health court in Keene became the first to open in the state, more than 200 people who otherwise would have ended up in jail instead have entered a program designed to treat their mental illnesses.

Mental health court officials say the program is successfully helping reduce overcrowding in the Cheshire County jail in Westmoreland, saving money and improving the mental health of the people it serves.

G. Gail Coburn, director of adult services for Monadnock Family Services, also credits the court with helping to reduce the stigma surrounding mental illness here.

Monadnock Family Services is a Keene-based mental health agency involved with the court since its inception.

“I think the fact that the community and the court system even support this kind of program speaks well of what I describe as the mental health-I.Q. of the community,” Coburn said. “It is higher than the average community because these programs are put in place and it’s sort of brought to the forefront that there are these mental health issues and, you know, the community can be part of resolving these issues.”

Other local mental health providers say that’s one of the unexpected benefits of the court, which they say has improved community awareness of mental illnesses and increased collaboration between local criminal justice officials and mental health agencies.

The program, which has 30 participants, is designed to identify criminal defendants with mental illnesses and get them needed treatment while keeping them out of jail.

As a state commission begins a study of the mental health courts in the state — including programs in Keene, Nashua and Portsmouth — local mental health officials say they’re continuing to evaluate the success of the local program.

The commission is expected to establish statewide mental health court standards. A preliminary report is due in November, with a final report following a year later.

The mental health court deals with people who have mental illnesses such as schizophrenia, bipolar or borderline personality disorders, post-traumatic stress disorder or major depression — and who often also have substance abuse disorders.

Most participants are accused of misdemeanor-level crimes that do not involve violence, says Michael H. Potter, the director of Keene’s alternative sentencing program who is also on a subcommittee of the group looking at the state’s mental health courts.

Participants are referred to the program by court officials, mental health providers who have previously treated them or even by family members.

Mental health court officials perform an evaluation of the defendants and, if a mental illness is identified, the defendant is given the choice to join the program or go through the standard judicial process and the possibility of jail time.

Those who choose to enter the mental health court are assigned a case manager, who sets up the different components of treatment with mental health providers and substance abuse counselors, if needed.

Participants who later choose to stop taking part in the program are sent back to court, where they may face their original jail sentence.

Along with Monadnock Family Services, the county has contracts with several mental health care providers, including the Keene-based Mountain Wellness Associates, MAPS counseling services and licensed alcohol and drug abuse counselors.

While participants are required to complete at least three months of treatment, some remain in the program up to a year depending on their progress in treatment and needs.

“We know the longer people are in some sort of treatment the better the chances are that they’re not going to relapse or re-offend,” Potter said. “So it behooves the county to keep them involved because, in the long run, it’s cheaper if these people can make a success.”

The average length of participation in the Keene mental health court is 156 days, or just less than six months.

The county spends an average of $26.92 per day for each participant of the mental health court system; inmates in the county jail cost $64 per day.

Noticing some telling trends

Court officials are identifying mental illnesses that may be contributing to crime and may not have been identified without the special court, Potter says.

About 34 percent of the people who entered the program since January 2008 had no previous mental illness diagnosis.

With the experience of the past several years, he says, court officials are also getting better at identifying those illnesses.

Mental health court officials have also noticed some interesting trends in recent years, including a rise in the number of women in the program, an increase in participants diagnosed with both a mental illness and a substance abuse disorder, and more military veterans — both male and female — suffering from post-traumatic stress disorder.

Women in the court

Of the 85 participants during the last 21 months, about 45 percent are female. Just two years ago, there were far fewer women in the program, Potter said.

While he can’t explain the recent increase, he thinks it could be that there is a rising number of women entering the criminal justice system in general.

The findings of a national study recently released by the Council of State Governments Justice Center and Policy Research Associates shows that there may be more to it than that. The study found a higher percentage of female inmates — about 31 percent — have a mental illness than their male counterparts, of which about 14.5 percent have a mental illness.

Dual diagnoses

About 64 percent of the participants in the mental health court over the last year and a half have both a mental illness and substance abuse disorder.

Often people with mental illness use alcohol or drugs to self-medicate, and court officials have now been working with these people long enough to get better at identifying underlying mental illnesses, Potter said.

Using treatment to reduce crime

Mental health providers also say the court system has helped people with mental illness access treatment more easily.

Coburn, who began working at Monadnock Family Services in January, previously worked at a mental health center in Emporia, Kansas, where there was no mental health court.

“There, you were either in the criminal court or you were being sent to the hospital,” she said. “So I think that this system helps to reduce the number of folks who otherwise might be sent to jail or the hospital, you know, because we’re getting them hopefully at a time when they really are looking at, ‘How did I get myself into this mess? How did I find myself here?’ ”

With the mental health court program, offenders suffering from a mental illness have more choice to take control of their mental illness and reduce the chance of continuing to land in hot water, Coburn said.

“It’s real basic social work that’s happening here,” she said. “It’s looking at that individual and the systems they live in: their family system, their work system, all of those areas in their lives that they affect and that they’re affected by.”

By working together with other agencies, the system works more smoothly, Coburn said. She points to a recent case in which a couple was at risk of having their children permanently taken away because of substance abuse issues.

Officials from the Department of Children and Families working with the mental health providers and court officials were able to come up with a plan for the children to be cared for temporarily while the parents received substance abuse treatment and later outpatient rehabilitative treatment.

“That to me is a successful outcome,” Coburn said. “At least a beginning.”

Potter points to the program’s 84 percent completion rate as a measure of the program’s success. He also has been gathering information since 2007 from the N.H. Department of Safety to determine the rate at which people who have completed the program commit more crimes.

While he said he hasn’t been doing the study long enough to release figures, the results so far have been promising.

“If you can reduce the number of arrests or increase the length of time between arrests, there is some success to that,” Potter said. “The reality is, because of the individuals we’re working with and the disease that we’re working with, a mental health disorder or an addiction disorder is characterized with having relapses. That’s expected; we expect it here.”

Mental health court officials and mental health providers hope that once participants have completed the program, they’ll continue with the services they’ve started. Case workers often refer program participants to support groups to build a network they can rely on after leaving the program, Potter said.

“That puts the foundation underneath and it gives the person a stabilized group to become familiar with and friends with because they understand and they’ve been there,” he said.

And mental health court officials are looking at ways to build relationships with local housing officials and educational and employment resources to expand those foundations.

“If you help people satisfy their basic needs and give them a reason to be proud about themselves then generally the recidivism percentage will decrease,” Potter said.

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