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On January 1, 2017, the KHI News Service became part of KCUR public radio’s new initiative, the Kansas News Service. The Kansas News Service will continue to cover health policy news and broaden its scope to include education and politics. All stories produced by the former KHI News Service are archived here. Stories and photos may be republished at no cost with proper attribution and a link back to KHI.org.

Minnesota mental health court a model

Similar diversion programs have spread rapidly across the country

By Andy Marso | October 25, 2016

Minnesota mental health court a model
Photo by Andy Marso/KHI News Service The Hennepin County Criminal Mental Health Court has become a national model since it opened in 2003. Judge Kerry Meyer, at head of table, met recently in a conference room on the 14th floor of the county judicial building with a view of the new $1 billion Minnesota Vikings stadium. At left is Allison Holbrook, court coordinator, and at right is a court clerk and Nnamdi Okoronkwo, a prosecutor.

Editor’s note: Reporters from the Topeka Capital-Journal and KHI News Service collaborated for a six-month exploration of how the state’s legal system deals with people with mental illness. This is one of the stories in a four-day series.

THE MODEL

Who: Hennepin County (Minn.) Criminal Mental Health Court.

What: A court program integrated with the mental health system that includes a plan and probation officer to help people stay in treatment rather than jail.

When: Since 2003.

Quote: “I actually get to see people succeed and watch them get some feeling of self-worth that many have never had before, or haven’t had for a long time.” — Judge Kerry Meyer.

A young woman stood in front of Judge Kerry Meyer in a Hennepin County courtroom and admitted to stealing vitamins from a store.

The woman expressed regret for her crime and said she had driven several hours from college to make the court appearance and lodge a guilty plea.

Then it was Meyer’s turn to let her know her fate.

“I’m not accepting your guilty plea today,” Meyer said, “and it is your goal that I never do.”

Meyer is the leader of the Hennepin County Criminal Mental Health Court, which has become a national model since it opened in 2003.

Few Kansas counties have tried to establish their own mental health courts. But Hennepin County provides lessons for others that might try in the future: To successfully keep people with mental health issues in treatment and out of jail, it takes partnerships with organizations outside the judicial branch and dedicated case workers.

Everyone Meyer saw in her courtroom that morning had been diagnosed with a severe and persistent mental illness, a traumatic brain injury or an intellectual and developmental disorder — including the college student who stole the vitamins.

Instead of going to criminal court, the student had agreed to abide by a treatment plan and check in regularly with Meyer and a probation officer for a set amount of time.

In return, Meyer agreed to put her guilty plea on hold during that time — a stay of adjudication — and then dismiss it if the student successfully completed the program.

The student appeared to be well on her way. She said she was stabilized on medication, holding a 4.0 grade-point average and just starting an internship.

Meyer smiled.

“You’re doing great,” the judge said. “Keep it up.”

Special courts spreading nationwide

The use of special diversionary courts for people with substance abuse problems or mental illness has expanded rapidly since the nation’s first drug court was established in 1989 in Miami.

Their goal is to keep people in treatment rather than incarcerated. Their rising popularity is driven by the increasing number of people with substance abuse or mental health issues filling jails and prisons since states began closing mental institutions in the 1960s in favor of community-based treatment options that were never properly funded.

[ Advocates of Kansas mental health courts say lives improved, taxpayer dollars saved ]

According to a September Minneapolis Star Tribune story, a recent survey of the Hennepin County Jail found that more than half of the 680 inmates had a mental illness — a far higher percentage than prior estimates.

But the use of mental health courts — and their success — differs widely across the country and sometimes even within a state.

A study by the nonprofit Treatment Advocacy Center published in 2013 found that Connecticut and Delaware were the only states in which residents of all counties had access to a mental health court.

In Kansas, only 18 percent of residents — primarily those in Sedgwick County — had access to such courts.

Establishing a mental health court is only the first step to making it work.

The Bazelon Center, a legal advocacy group for people with mental illness, published an analysis of 20 of the earliest mental health courts in 2003.

The group wrote that most of those early versions were like traditional courts except that they mandated “court-imposed treatment as a substitute for incarceration.”

“Few of the courts are part of any comprehensive plan to address the underlying failure of the service system to reach and effectively address the needs of people at risk of arrest,” the report said.

In other words, most of the early mental health courts were not integrated into the broader mental health system.

Hennepin County’s court aims to change that.

Challenges and victories

Meyer’s court reserves Wednesdays for misdemeanor offenders. Those who commit non-violent felonies are also eligible for mental health court but have hearings on Tuesdays.

Before a set of Wednesday morning hearings, Meyer sat at the head of a long table in a 14th floor conference room of the county judicial building. The court is part of the county’s judicial branch, but also receives support from a federal grant and state agencies that work in mental health.

A city prosecutor sat to one side of Meyer, a public defender on the other. Meyer’s staffers, a social worker, a person who specializes in finding housing for the chronically homeless and five probation officers filled the rest of the seats.

Three people from Meridian Behavioral Health, an addiction treatment company, sat to the side, observing, while the probation officers delivered updates on the people who had hearings later that day.

One of the new applicants on that morning was a 25-year-old with a history of multiple hospitalizations for bipolar and major depressive disorder. His probation officer said the young man became suicidal when he drinks and had resisted taking his medication but usually follows up on talk therapy.

“We can work with his goals if he’s willing to stop drinking and take his meds,” Meyer said.

She turned to the prosecutor, Nnamdi Okoronkwo, and asked if he was OK with the man entering the program.

Okoronkwo quickly reviewed his notes: The man had a limited criminal record that primarily was related to alcohol and drugs — a sign of possible self-medication. Okoronkwo gave his approval.

With that decision made, the team moved on to addressing the man’s needs. The probation officer reported that the man had no stable place to stay and needed to get sober and learn “living skills.”

One of the other probation officers suggested a group home. Another said that particular home had a four-week wait.

Several people around the table groaned and one let out a mild expletive.

Probation officers key

The probation officers are the foot soldiers in the Hennepin County mental health court’s model.

They monitor random drug and alcohol tests and medication adherence, set up stop-gap psychiatric appointments for people in crisis and help coordinate housing and employment assistance.

Meyer tells the program participants to call their probation officer if they need help.

But several of the probation officers said help can sometimes be hard to find — especially if the need is housing.

“It’s the most fulfilling part of criminal justice I’ve ever been part of. Because I actually get to see people succeed and watch them get some feeling of self-worth that many have never had before, or haven’t had for a long time.”

- Judge Kerry Meyer, leader of the Hennepin County Criminal Mental Health Court

Through the conference room’s rain-spattered windows, the group had a tremendous view of the new Minnesota Vikings stadium. It cost about $1 billion and about half of it came from public funds.

With community mental health resources limited, the success of the Hennepin County mental health court often relies on the ingenuity and the industriousness of the individual probation officers.

One of them said that if he has a participant who needs housing, he’ll work weekends to fast-track paperwork if a bed unexpectedly becomes available.

Another officer said she received a call from one of her participants whose two young children were starting school the next day and needed supplies. She made a shopping trip and delivered two full backpacks later that night.

That’s not in the job description, but she said the trust she built with that one act will go a long way if she ever needs to try to convince the woman to take her medications or go to therapy.

More successes than failures

Treatment compliance can be an ongoing struggle for some participants. If they decide not to comply with their treatment protocol, Meyer can send them back to traditional criminal court to face the charges she put on hold when they joined the program.

That appeared the likely outcome for one of the participants in September. His probation officer told Meyer that the man was refusing treatment, even though he admitted he had trouble controlling his anger and alcohol intake.

“That’s what he said: He’s not willing to do treatment and he’s not willing to do therapy,” the officer said.

Meyer sighed.

“I hope he’s willing to do time,” she said. “Because that’s about all I got left.”

Dropouts are the minority in Meyer’s mental health court. About 60 percent of those who enter the program complete it, and even those who drop out tend to require fewer hospitalizations and incarcerations afterward.

The court is funded with local dollars supplemented by state and federal grants that require extensive reporting on outcomes.

“We’re pretty well aware of our recidivism rates and our graduation rates and our relapse rates,” Meyer said. “We keep track of it, and we think we’re doing well and reducing the number of new criminal cases among our population.”

The pre-hearing briefings are collaborative rather than confrontational, with both the prosecution and defense cheering for participants to succeed and stay out of jail.

Once the hearings start and participants are face-to-face with Meyer, it’s clear that she’s emotionally invested in their lives. In addition to the routine questions about treatment and the status of their cases, she also asks about school, work, pregnancies, upcoming surgeries and other health problems.

She’s part counselor, part social worker and part judge.

“It’s the most fulfilling part of criminal justice I’ve ever been part of,” said Meyer, a former county attorney who also has presided over traditional criminal, civil and juvenile courts. “Because I actually get to see people succeed and watch them get some feeling of self-worth that many have never had before, or haven’t had for a long time.”