Diana was diagnosed with bipolar disorder, anxiety, and depression shortly after her son’s birth. Her condition deteriorated when her daughter was born a year later and ultimately culminated with an arrest and three days in jail. Diana eventually received the mental health treatment she required and both her children have gone on to excel in school. While Diana’s recovery is heartwarming, her story highlights our mental health system’s inability to effectively respond to mental illness before individuals are arrested, lose parental rights, or suffer some other type of crisis. Put simply, our current legal framework operates as an “inpatient model in an outpatient world.”
To address these concerns, the State Judicial Institute (SJI) recently awarded a three year, $1.1 million dollar grant to the National Center for State Courts (NCSC) to improve justice system responses to mental illness. The initiative is based on a recent policy paper[1] and involves the creation of an advisory committee between the Conference of Chief Justices (CCJ) and the Conference of State Court Administrators (COSCA). I will co-chair the committee with the Honorable Paul L. Reiber, Chief Justice of the Vermont Supreme Court.
Consistent with the Sequential Intercept Model (SIM), the committee will develop resources, best practices, and recommended standards that courts and communities can use when responding to mental illness. This includes providing training and educational materials for judges and court staff; assisting with NCSC’s endeavor to create a central repository for resources; and increasing the operational capacity for state and local leaders to implement reforms.
The SIM uses a series of intercept points, listed below, to avoid entanglement in the criminal justice system and to improve opportunities for diversion and treatment. Warm handoffs along the intercept model can reduce recidivism, improve the quality of life for those with mental illness, and reduce pressure on the criminal justice system.
Intercept 0: Prevent engagement with the criminal justice
system. This requires modifying mental
health codes to support earlier intervention and establishing a more robust
community-based treatment system. Mental
illness, by itself, does not equate to criminal activity. However, untreated mental illness leads people
to challenging circumstances that can lead to engagement with the criminal
justice system.
Intercept 1: Crisis Intervention Training (CIT) for law
enforcement, 911 operators, and emergency room personnel. CIT defuses situations, reduces the potential
for injury, and enables prebooking diversion. CIT training, when combined with prebooking
diversion, has shown to dramatically reduced jail populations.
Intercept 2: Initial detention and first court appearance. All defendants should be screened for mental
health history upon intake and, if positive, receive a comprehensive mental
health assessment along with treatment. Intercept
2 is also an opportunity for specialty court engagement.
Intercepts 3-5: Jail, prison, probation,
and parole. These intercepts focus on
comprehensive and enhanced mental health treatment for those in jail and
transitioning out of jail, including access to medications, bolstering housing
efforts, increased support systems, and the use of educational and vocational
opportunities pre- and post-release.
Our current methods for addressing mental health do not work. They cycle people in and out of the criminal justice system, destabilize families, and perpetuate a cycle of generational problems. But we can break the cycle of repeated failure. This advisory committee’s work will inform courts and communities across our nation on a more effective and humane strategy of addressing the mental health needs of our fellow citizens.
[1]
Mack, Decriminalization of Mental Illness: Fixing a
Broken System, Conference of State Court Administrators (2017).