Wednesday, August 23, 2006

Mental health courts and mental health "advocates"

Mental health courts (highlighted this week in the Wall Street Journal and on NPR’s All Things Considered) have been popping up with more and more frequency around the country as the nation struggles to find ways to minimize the number of people with mental illnesses who land in jails and prisons. They are designed to get treatment for those who might otherwise land behind bars, and possibly help them regain their lives. The emerging research and anecdotal evidence to date is that they work exceptionally well for certain people.

And yet.

“If that’s the way you access services for individuals,” said a Bazelon Center spokesperson on NPR, “you are going to encourage arrest.”

Hello? This is already happening in communities without mental health courts. At TAC we often hear from families who are told by mental health professionals that the only way to get help is to have their loved one arrested. This is a practice that started long before mental health courts were conceived.

Bazelon’s website says “court-based diversion … is not a panacea.” Well of course not! It’s time to come down from the ivory tower and face reality.

What is needed is a broad spectrum of options that can be tailored to individual needs and address real problems. Does Bazelon mean to wait for perfect mental health systems to materialize before helping real people who are currently suffering? Realistic reform targets real improvements, and mental health advocates should get on board and stop trying to marginalize tools like mental health courts and AOT – proven in study after study to make dramatic changes in quality of life for those suffering.

Bazelon’s knee-jerk rhetoric does suggest a more subtle and helpful message. There is no panacea. It would be a mistake to think that mental health courts are the answer to all of our problems. In fact, it might cause more people to turn to the criminal justice system for treatment. But, the reality is that too many people are there already because the mental health system is failing them.

What is also needed is a focus on shifting the responsibility for caring for the most difficult patients back to the mental health system. One proven means of doing so is assisted outpatient treatment. It is not a panacea either. But, the Wall Street Journal article demonstrates why it is so important. Harry Rivera, who did so well for five years under the criminal court supervision, was back in jail only six weeks after he was returned to the mental health system. Assisted outpatient treatment can do what the mental health court did for Mr. Rivera - before he ends up back in jail.

Perhaps there is another benefit to mental health courts – they can teach the mental health system how to help the most severely mentally ill.

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