At Half Capacity – Strict Eligibility Hurting Mental Health Court?

From the Portland Mercury, July 29 2009

At Mental Health Court last Thursday, July 23, a 32-year-old man only wanting to be identified as “A.K.” for this article sat next to his lawyer, Metropolitan Public Defender Liz Wakefield, in Judge Richard Baldwin‘s chambers. Wearing denim shorts and a black leather belt with silver studs, A.K. sat with his arms crossed on the table, leaning on them. Pursing his lips, he waited for Baldwin to speak.

“Is there anything new?” Baldwin asked.

“Yes, Your Honor,” A.K. said. “I made a mistake three weeks ago.” He went on to say that he and his wife had gone to Bagby for a day trip. There were people there, he said, passing around jars of whiskey and coke. A.K. told the judge he drank some whiskey.

It was the first time A.K. had made this confession to anyone. Since October, he has been participating in mental health court—a program designed to divert mentally ill people who repeatedly offend away from the criminal justice system and into treatment—because of what he only refers to as “an incident” involving an alcohol blackout and his wife. The result was misdemeanor charges and a no-contact order.

Determined to quit drinking and improve his relationship with his wife, A.K. was ashamed that he relapsed.

“I just got caught up in the moment,” A.K. told Baldwin. “I have no excuse.”

Judge Baldwin encouraged A.K. to think about why his relapse happened and what he can do to prevent similar occurrences in the future.

Because of his participation in mental health court, A.K., who is bipolar and also suffers from major depression, is participating in a treatment program at counseling service LifeWorks Northwest. He’s also in couples counseling with his wife. Their relationship has improved dramatically, he says. “It’s helped us open up lines of communication where there were none,” A.K. says.

Participants like A.K. have been able to use the mental health court to develop a treatment plan individually designed to address issues that may contribute to their criminal behavior, as well as to access housing and mental health services. Since mental health court began last September, 22 people have joined the program. According to Heidi Grant, a coordinator with mental health court, there are 10 pending clients.

“That isn’t very many, is it?” says Doris Minard, a mental health advocate and past president of Oregon’s chapter of the National Alliance on Mental Illness (NAMI).

For a program that has a capacity for 75 people at one time, mental health court is off to a slow start, diverting less than half the people it has the capacity to assist. Many say the eligibility requirements are too strict.

“As an attorney, I think it’s frustrating because I see clients with a much broader spectrum of diagnoses,” Wakefield says, suggesting those clients would also benefit from mental health court.

To participate, one must already be on probation for a misdemeanor or non-person felony. The person must also be diagnosed with schizophrenia, schizoaffective disorder, bipolar disorder, or major depression. Classified as “axis one” disorders, they are the most severe mental illnesses a person can have. Many people point to the district attorney’s office as the reason why the eligibility requirements are as strict as they are.

“You’re taking a culture of locking people up, particularly in the DA’s office, and asking them to have some faith that a mental health court can work,” says Chris Bouneff, the executive director of NAMI Oregon. “There seems to be more reticence at this point to really open up the criteria so you can reach a maximum number of people.”

“I think we’re getting plenty of referrals, and we’re getting new clients every week,” says Jeff Howes, the senior deputy district attorney handling the mental health court caseload. Howes notes that people “with a long or a violent criminal history with a demonstrated history of non-compliance with court orders and obligations” are not good candidates for mental health court.

“I would have liked for there to be additional people by now,” Judge Baldwin says, adding that momentum is gaining.

In the past two months, Baldwin has begun hosting settlement conferences, or meetings between the judge, defense attorney, and prosecutor of individual cases. Discussing the case and the defendant, settlement conferences decide whether or not the defendant could benefit from mental health court. Twelve people have entered mental health court through settlement conferences.

“This is the only way cases are getting in,” Wakefield says.

Mental health court is also finding participants through the probation office’s Mental Illness Offender Unit and people currently on bench probation (a less strict form of probation not requiring a probation officer). According to Grant, 18 people falling into those categories are either participating or about to participate in mental health court.

“We are steadily increasing our numbers,” Grant says. But mental health advocates remain unconvinced.

“We expected this to be online a decade ago,” says Jason Renaud of the Mental Health Association of Portland. “It was a program that promised so much and has delivered so little. Hundreds of similar programs are in operation around the country and all they had to do was adopt the procedures of one of those, and pay for it.”