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Appeared in the Lawyer’s Journal, The Journal of the Allegheny County Bar Association
Vol. 9 Issue 19

September 14, 2007

On March 1, 2007 the RAND Corporation released results of its research study, Justice, Treatment, and Cost – An Evaluation of the Fiscal Impact of Allegheny County Mental Health Court. When all the data was crunched, the picture was encouraging. The Allegheny County Mental Health Court was found to be a fiscally responsible alternative to traditional incarceration for persons with mental illness who, because of committing non-violent crimes, get involved in the criminal justice system. The news was met with great enthusiasm by those who have believed for more than a decade that the concept of Mental Health Court was one that favored not only social responsibility but also community safety.

Said Allegheny County Chief Executive Dan Onorato, “Helping offenders with mental illness exit the criminal justice system once and for all through treatment and supervision is good for the individual and the community. Now, we have proof that it’s fiscally prudent as well.”

In 2001, the Allegheny County Jail stood as the third largest mental health facility in southwestern Pennsylvania when inmates with mental illness accounted for 20-25 percent of the jail population. Several concerns supported experimenting with a special Mental Health Court (MHC) to deal with offenders with mental illness. First, persons with mental illness were kept in jail longer before their trials than other offenders because of an inability to post high bail bonds and a general fear of this population. Second, many critical supports that were needed to escape the pull of recidivism were commonly lost during incarceration including medical, financial and housing.

Mental Health Court is based on the more familiar Drug Court model. Both offer offenders with behavioral health diagnosis a special docket of criminal court that diverts them to treatment rather than incarceration with several critical goals: maintaining effective communications between the human services, behavioral health and criminal justice systems; slowing the revolving door of recidivism; maintaining treatment, housing, benefits supervision and community support services for the individuals; and supporting public safety.

MHC relies on the active and cooperative participation of the Allegheny County Department of Human Services (DHS) Office of Behavioral Health (OBH), the Allegheny County Court of Common Pleas, and the Offices of the Public Defender, the District Attorney, and Adult Probation and Parole. In order to enable the court to more carefully monitor the progress of offenders and develop expertise related to mental illness and treatment, MHC became a specialty court with its own judge, assistant district attorney, public defender, court monitor, forensic support specialist and probation liaison. Each team participant is an integral player in the process. All participants have embraced the concept having spent decades watching the same individuals enter and re-enter the criminal justice system with little hope of eventual community reintegration. As stated by Heather Kelly, Allegheny County Assistant District Attorney for MHC, “As a prosecutor, it is a unique perspective to be able to monitor our Mental Health Court defendants during the term of their probation and to evaluate their progress while protecting the community and maintaining public safety. It is very gratifying to ultimately see a defendant graduate from Mental Health Court.”

While no studies have been published tracking recidivism rates for individuals who have diagnosed mental illness and have gone through the traditional incarceration experience, several statistics point to the value of MHC in slowing the revolving door. Since mental health and substance use disorders are extremely common among jail inmates and the recidivism rate for the general inmate population hovers around 67 percent, the fact that data from the Allegheny County MHC reveal recidivism rates for participants at 5.5, and 14 percent after two and a half, and five and a half years respectively, indicates MHC participation may be working to reduce recidivism.

MHC intervention is essentially probation with close supervision and mandatory treatment. A court-approved service plan, intended to promote recovery, guides treatment and is a mandatory element of the offender’s probation. Most MHC service plans stipulate where offenders live during their probation. Offenders must agree to participate in outpatient treatment, which may include individual therapy, vocational rehabilitation, drug and alcohol counseling, and other services. They are also required to abstain from using drugs and alcohol, to take their medications as prescribed, to cooperate with their case managers and to meet with probation officers, doctors, and forensic specialists. Other requirements may also be added, such as an order to look for a job, or work toward earning a GED.

MHC participants get extra support, coordination, and supervision from the MHC program itself. Once they are released into the community to serve out their probation, they are kept on the court’s radar by their Probation Officer and a Probation Liaison. The Liaison updates the court on how MHC participants are progressing and helps them stay in contact with probation officers, visit their doctors as scheduled, and otherwise comply with their service plans. Liaison reports are critical to the outcomes of reinforcement hearings before a MHC judge, which offenders are obligated to attend during their probation.

The progress of each offender is reviewed in these reinforcement hearings held at least every three months and more frequently if necessary. Outcomes are categorized as either positive or negative and, accordingly, can cause a modification in the terms and conditions of an individual’s probation. Of the 600 reinforcement hearings held in 2006, positives outweighed negatives by more than two to one.

Summarizing remarks made by Mental Health Court Judge John A. Zottola, “We feel a connection to each individual. If a person is on the right track, there are rewards like a gift card to a local store or even a reduction in the term of probation. If things aren’t going so well, we all get together and decide how we can help this person get back in line. Sometimes we have to resort to incarceration. It’s a matter of working through the options.”

Assisting MHC participants and graduates in securing and maintaining a suitable lifestyle is a critical function of the MHC program. Before being accepted into the program, every candidate undergoes a full social assessment. Their lifestyle before arrest is analyzed for its strengths and shortcomings. If, based on available information, a candidate is accepted as a MHC participant, he or she is assigned a MHC Forensic Support Specialist (FSS).

Said Amy Kroll, Director of Forensic Services at DHS, “The FSS will do whatever is required to secure any services and supports that are needed to give these folks the best chance for success in life before and after MHC graduation. We help them find a place to live, get their utilities connected and help them feel secure about food and clothing. We also walk them through the process of becoming productive citizens, whether through helping them earn their GED, or arranging for job training or employment. If we agree that employment is impossible we make sure other financial supports are in place. It’s a personal process. We get involved.”

Said DHS Director Marc Cherna, “In mid 2005, our nation’s correctional facilities housed more than 2.2 million persons and more than three-quarters of them had a history of mental health problems, substance dependence or abuse, or both. State prisoners and jail inmates who have a mental health problem are very likely to serve multiple incarcerations. We’ve got local jails operating just below capacity and state and federal prison systems generally operating over rated capacity. Mental Health Court offers an alternative to this upward spiral of cost associated with relying on incarceration alone to curb criminal activity. MHC gives participant the opportunity for a new way of life that generates a sense of well-being, independence and pride, possibly for the first time in his or her life.”

And the good news coming from Allegheny County is that Mental Health Court is the fiscally responsible choice as well.

Written by Bobbi Donovan