Treatment vs. incarceration: Mental health court making difference, one life at a time
It was February 2016, the day before the Super Bowl.
Tessa Trimble was home. She was drunk, disappointed yet again after people in her life let her down. She tried to find a sympathetic ear, and eventually found a co-worker who heard she was thinking about killing herself.
The friend called the police, who went to Trimble’s apartment to check on her. She wound up hitting one of the officers, which led to a felony assault charge, along with wanton endangerment, resisting arrest and disorderly conduct. She went to jail that night and stayed for five days.
Prior to her second court appearance, Trimble’s attorney told her about a mental health court program. It wound up being an opportunity that saved Trimble’s life.
Through a highly-structured program including mental health treatment, counseling and regular check-ins, Trimble found a way to get help and get treatment for depression, post-traumatic stress disorder and anxiety.
A year and a half later, Trimble is in the final phase of the program. She’s working full-time and taking care of her kids, ages 3 and 2.
“Eighteen months ago, I thought I was indestructible and I could get away with anything without consequences,” Trimble said. “I know I’m not indestructible. I know my kids can be taken away.”
“I’ve always had concerns about how court treats people with mental health issues,” Clark District Judge Earl-Ray Neal said. “You see people come into court with AI (alcohol intoxication), PI (public intoxication), terroristic threatening … and it’s often them self-medicating. They’re processes and their issues are never addressed.”
A couple years ago, Neal attended a conference session about speciality courts, like drug court, and heard about other states with a mental health court.
“I got back and talked to (Clark County Attorney Brian Thomas) and a representative of NAMI,” Neal said. “I just said we’re going to do it and I’ll preside over it.”
While there are a handful of state mental health court programs, Clark County’s program is a “rogue” operation, funded by a grant from The Greater Clark Foundation.
In two and a half years of operation, the results have been dramatic.
According to program coordinator Betty Bryant, 21 people have participated in mental health court. Five have graduated. Ten are presently in the program. One was discharged for health reasons, two were voluntarily terminated and four were involuntarily dismissed from the program.
The successes are many. A dozen participants are holding down jobs. One graduate now serves as a peer support specialist for other participants in drug court.
Drug testing is a key part of the program, but for a different reason than in traditional courts.
Rather than looking for illegal drugs, Neal said the testing is to make sure participants are taking their prescribed medication.
“I have not seen more dramatic changes in folks as quickly as in mental health court,” Neal said. “They get in counseling. They get their medication right. No one wants to wake up with voices in their head. It’s life coaching.”
Not everyone is accepted into mental health court. First, there has to be a referral, Bryant said.
“I do an assessment similar to one drug court does,” Bryant said. “I figure out their basic needs: stable housing, transportation. They’re also assessed by a mental health provider.”
Their mental health issue must be a separate issue, and not brought on by substance abuse, she said.
After the assessments are complete, Bryant presents the information to the mental health court team, which includes a variety of people including representatives from law enforcement, the public defender’s office, Bluegrass.org (formerly known as Comprehensive Care), a social worker, Thomas’ office, a peer support specialist, Neal, two clerks, the clergy and a community representative.
The group hears the report, offers any information they may have and votes on whether or not to accept the person, Thomas said.
“By having such a diverse group, we can vet some of them out,” Thomas said.
Bryant said most participants spend between 12 and 18 months in mental health court, moving through the three phases.
The first phase is stabilization which includes making sure they have stable housing and employment. They have nightly curfews. They can be at four places: home, work, Bluegrass.org or volunteering. Community service is required as part of the program, she said
“This program expects a lot of you,” Bryant said. “They have to get used to a curfew. Most people have been allowed to do what they want when they want for as long as they want. They’re getting used to structure.”
There are required court appearances and weekly visits and daily contact with Bryant. They have to participate in a treatment plan. They may be required to start a 12-step treatment program as well.
Phase two is education and treatment growth and making short-and long-term goals. The daily check-in calls are reduced to three a week, but the rest of the terms continue.
It continues for the third phase, designed for self-motivation and preparation for life back in the real world.
The team and the judge decide when participants are ready to move on to the next phase, or what sanctions must be enforced for infractions.
“We monitor all these things,” Thomas said. “We might call their employer. If they have child support, we’ll make sure they’re paying.”
Sanctions can come for drug testing issues, missing court or the weekly meeting, curfew violations, not completing a journal, having romantic relationships with felons or mental health court participants or having new criminal charges.
The severity varies depending on whether its a first or multiple offense and whether it was self-disclosed or court officials found out. Sanctions can run from writing a paper to jail time, additional therapy or possible demotions.
“(Phase two) was when my rebellious streak went away,” Trimble said. “It wasn’t worth it. When you comply with the program, your life will be better and the charges will be erased.
“(In) phase one, I was sanctioned a lot. I wrote a lot of papers.”
Trimble’s goal was clear.
“Nothing is worth missing out on time with my kids.”
The team meets every other Wednesday, the same day Neal handles the mental health court docket. The team meets first, followed by court itself.
“Each court (session) is a continuation of the prior court,” Thomas said.
Bryant gives the team a summary of her contacts with the participants including their successes and any problems, he said.
“We discuss all of the options and we vote on how (Neal) is going to reward or discipline the participant,” Thomas said.
In the courtroom, the participants will meet with the judge and have a conversation.
“We want to know how the person is coping,” Thomas said. “What is the high point of these two weeks? We have the discussion about what’s going on and we let them know what the team decided.”
Sometimes, it takes a while for the participants to realize the team is there to help, rather than to look for violations. Eventually, they learn and respond to the program.
“We don’t want people to fail,” Thomas said. “We’re measuring this in progress, not perfection.”
One person who wasn’t paying restitution and damaging property has completed 2,700 hours of community service and is now holding down a job, Bryant said. Another graduate is now working with the program as a peer support specialist.
During court, group sessions and working with Bryant, Trimble eventually learned to trust people again, after a lifetime of being let down by everyone.
“(Neal) congratulates you for your accomplishments,” she said. “He lets you know you’re doing well.
“It blows my mind that people take time out of their lives to volunteer for this. It makes you appreciate people more. I started looking at Betty like a mother figure. She offers the guidance a mother does. She knows when to be compassionate and when to put her foot down. I never had that.”
Thomas and Bryant said they would love to see the program grow and continue helping people.
“I’d like to see our community step up and provide opportunities for these people,” Thomas said. “I’d like to see the number of participants double or triple. There is a stigma. It’s hard for people to say, ‘I have a mental illness.’ People think ‘He’s crazy.’ It deters people from getting into the program.”
Trimble believes the need is overwhelming.
“Every county needs a program like this,” Trimble said. “There are success stories. There are people who get out and don’t go back to the same reckless behavior. So many people have mental illnesses and they don’t know it.”
Mental health and court
The issue of mental health conditions among the court and criminal justice system is extensive. According to a 2006 study by the federal Bureau of Justice Statistics, among more than half of all inmates nationwide have a mental disorder of some type. The percentages were highest in county jails, which reported 64 percent, or 479,900 people with a mental heath issue.
The numbers were lower for state prisons (56 percent or 705,600 people) and federal prisons (45 percent or 78,800 people). The Bureau attributed the difference to longer sentences in prisons, which allow for more treatment opportunities for inmates.
The study also found at least 25 percent of all prisoners with mental health issues had been incarcerated three or more times previously. More than a third of all prisoners with mental health disorders used drugs at the time of their offense.
There is evidence the programs work.
“The most promising programs we reviewed provided structured continuation of care from prison to the community setting, as well as multidisciplinary teams to help mentally ill ex-offenders adapt to life outside of prison without having to go back and forth between multiple different agencies to receive services,” according to a report published by the Urban Institute, which recommended expanding mental health courts.