Well-intentioned mental health courts may struggle to reach their goals

Mental health courts connect people to treatment and keep them out of jail. But they often have to pay the price of being convicted, and participants say this feels like coercion.


More than 2 million people in U.S. prisons each year are diagnosed with a serious mental illness. In recent decades, programs have sprung up across the country to divert people from jail and connect them with help that can keep them out of prison. They are called mental health courts. Sam Whitehead reports with our colleagues KFF Health News that well-intentioned courts may struggle to achieve those goals.

SAM WHITEHEAD, BYLINE: It’s an early December afternoon and Donald Brown (ph) is nervously waiting for a mental health court hearing to start in Gainesville, Ga. In a matter of minutes, the 55-year-old man will find out whether he has been kicked out of the diversion program and possibly sent back to prison for not completing work and community service mandates.

Donald Brown: I have no words. I am scared of death. I mean, I don’t like prison. So I got a taste of being outside. Getting back in is just – it’s really hard.

WHITEHEAD: Brown has struggled with depression. Last year he was threatening to kill by showing a gun. His family called 911 for help, police arrived and Brown was arrested and charged with aggravated felon in possession of a firearm. After months in jail, Brown was offered access to court. If he pleads guilty, he will be connected to services and will be spared jail time upon completing the program.

BROWN: You know, you’ve been there for 10 1/2 months. You have no idea how you’ll get out. It’s almost like forced, you know? Here, sign these papers, you can come out of jail.

WHITEHEAD: Brown says the diversion program has helped him stay sober and take medication for his depression, but meeting the program’s requirements has also been stressful. If he’s let out, Brown worries he’ll face years in prison.

Brown: I’ve learned a new way of life. You know, instead of just getting high, I’m now learning to feel things and try to better myself. Being in jail for this is like being kicked in the stomach.

Whitehead: You can find mental health courts in over 650 communities. There is no set way to run these, but participants generally receive treatment plans and access to counseling and medication. Judges and mental health therapists monitor their progress. Lee Johnston is a professor of law at the University of Florida. She says jails and prisons are not a place for people with mental illness.

Lee Johnson: But I’m also not sure that mental health courts are the solution.

WHITEHEAD: Johnson says the programs could distract policymakers from more meaningful investments.

Johnson: The bigger problem is that they’re diverting attention from more important solutions that we should be investing in, like community mental health care.

Whitehead: According to the National Treatment Court Resource Center, about 60% of participants have completed the program as of 2019. Researchers there say there is little evidence whether diversion programs improve mental health outcomes or impact recidivism in the long term. Kristen DeVall co-directs the organization. She says the courts can’t work as well when the social safety net is full of loopholes. Finding stable housing, counseling, and recovery services can be difficult in many communities.

Kristen DeWall: If all these necessary supports aren’t invested, it’s kind of a waste.

WHITEHEAD: Critics of mental health courts say the price of participation shouldn’t come at the expense of a guilty plea. Raji Edayathumangalam, a licensed clinical social worker with New York County Defender Services, says judges are often not trained to make informed decisions about participants’ care.

Raji Edayathumangalam: This is unfair. We’re all licensed to practice our various professions for a reason, right? I can’t come to get a hernia operation just because I read about it or sit with a hernia surgeon for 10 days.

WHITEHEAD: Some mental health court participants praised the programs for helping them get their lives back on track. During a recent hearing in the Metro Atlanta mental health court, several participants personally thanked Judge Shana Rooks Malone. But a woman walked out of the courtroom crying. She was sentenced to seven days in jail for being dishonest about whether she was taking court-required medication. Malone, a lawyer by profession, says that he does not like being in jail.

Shana Roux Malone: ​​But that particular contestant had some challenges. I’m supporting him, but all the little punishments aren’t working.

WHITEHEAD: The final step, Malone said, would be to remove him from the program altogether and send him to prison. Meanwhile, Donald Brown worries that his fate will ultimately be the same. He avoided jail in early December. A hearing on whether he can remain in mental health court is expected to be held in the coming weeks.

MARTINEZ: That was our partner Sam Whitehead with KFF Health News.

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