The Alaska judicial system has given rise to one of the first four mental health courts in the country. Two district court judges, Stephanie Rhoades and John Lohff, are now guiding the development of a therapeutic court in Anchorage that is attempting to alleviate some of the problems posed by mentally ill individuals charged with criminal offenses. Without many previous practical models to build upon, this effort—the Court Coordinated Resources Project (CRP)—is grappling with issues of administration, funding and staffing as it erects a new framework for court handling of mentally ill misdemeanor offenders.
For a variety of reasons, the mentally ill have become a sizeable component of the population appearing in criminal courts, both in Alaska and in the country as a whole. Most justice system professionals—police, correctional personnel, attorneys and judges—have recognized that the routine shuffling of mentally ill offenders in and out of jails and prisons that occurs within the ordinary justice system process has little positive effect on offender behavior and may exacerbate mental instability, leading to further criminal behavior.
By engaging offenders with an appropriate routine of care, the mental health courts now appearing in various parts of the country seek to prevent unnecessary jailing of the criminal mentally ill, while at the same time protecting the community as a whole from further criminal behavior. The first four courts arose in Broward County, Florida in 1997; in King County, Washington in 1999; in Anchorage in 1999 and in San Bernardino, California in 1999. All except the San Bernardino court deal with misdemeanor offenders only; all try to intervene as soon as possible after an individual has been arrested or charged. Each of the courts provides more intensive supervision of offenders than occurs usually with misdemeanants. Each relies on a team approach, with the judge at the center providing overall direction and monitoring. The team comprises prosecution and defense attorneys, case administrators and mental health treatment providers. An important characteristic of these courts is that they are creating a new web of relationships among components of the justice system and the mental health community.
The Structure of the Anchorage Mental Health Court
The Anchorage mental health court project, officially structured by a court administrative order in 1999, is a post-conviction/post-plea sentencing court, not a trial court. A defendant makes the decision to enter the program with the assistance of counsel. The court ascertains that the defendant is competent to make the decision and that the decision is voluntary. In most cases, the defendant enters a plea of guilty or no contest to the misdemeanor charges in exchange for a plea agreement that the sentence will not involve jail time. An offender can choose to end his participation in the mental health court process at any time and return to the regular district court process for sentencing.
Defendants in mental health court have been charged with a wide range of offenses—many of them low level assaults or property crimes. Table 1 presents a list of some of the offenses with which defendants who have appeared in the court have initially been charged. (Charges are often reduced later in the process as part of the plea and sentencing agreement.)
The Anchorage mental health court project has developed with two paths of entry to the court. The first—through the Jail Alternative Services program (JAS)—is limited to forty participants at a time. A participant must meet the following criteria: be confined in jail on a misdemeanor charge and be diagnosed as suffering a major mental illness with a history of psychosis or an organic brain injury. Defendants may have prior records. A Department of Corrections staff member serves as case manager for JAS participants.
The second path to participation in the health court project is not as restrictive as JAS in the required medical diagnosis. Offenders must be charged with a misdemeanor and be diagnosed with or exhibit obvious symptoms of mental illness, organic brain syndrome or developmental disability. There need be no history of psychosis to enter the court through this administrative path. At this time the court has not had to set a limit on the number of participants it can handle from this administrative side. Participants include JAS-eligible offenders who cannot enter the JAS program itself because of its size restrictions and others referred by judges, jail personnel, attorneys, police, families and other sources. A second case manager monitors the progress of these participants during their time with the court. Figure 1 illustrates the path a cases takes through the CRP process.
The aim of the court with both groups is to provide an alternative to jail by establishing a treatment plan for the offender to follow as part of a suspended sentence with a probationary term. In general, following treatment conditions is a condition of probation. Although plans vary with the needs of the individual offender, they commonly include provisions for taking necessary medication, establishing and continuing contact with a mental health treatment provider, meeting at scheduled times with the case manager, and appearing in court for periodic status hearings. Failure to meet the conditions of the plan—or committing a new offense—will trigger reassessment of an individual's probationary status. Case managers stay in regular contact with treatment providers, defense attorneys, prosecutors, and the court's program administrator regarding the progress of participants. Treatment plans can be revised if an offender's condition or behavior indicates a need for modification. The court project recognizes that setbacks are to be expected with the mentally ill and that there will be an ebb and flow of stability in an individual's life.
Because it is common for mentally ill defendants to have a number of cases open at once, the mental health court attempts to bring all of these together for consideration by one judge at the same time; however, in practice, this is not always accomplished. As of February 2002, the court, which sits on Tuesday, Wednesday and Thursday, was handling 110 defendants, with one to six cases per defendant.
The judges handle mental health court hearings with more flexibility than ordinary district court proceedings, permitting and eliciting more discussion among participants in the process. With the understanding that the treatment plan provides the framework for an offender's probationary status and determines a process which may cover a long period of time, the adversarial positions of counsel are muted.
Because of their illnesses, very few defendants are employed, and many have precarious housing arrangements. They live on the streets, in the shelters such as Brother Francis, or in cheap motels. The thrust of the treatment plans devised as part of sentences in mental health court is to guide each defendant into a routine of care and medication, if necessary, and to help each build a daily structure of activities that will provide some safeguard against instability leading to further criminal behavior.
The two case managers for the mental health court project work with most of the major treatment agencies in Anchorage to implement defendant treatment plans—Southcentral Counseling, Hope Cottages, Arc of Anchorage, Southcentral Foundation and others. One treatment problem that arises regularly is that defendants often demonstrate substance abuse problems in addition to mental illness. There are few resources for assisting offenders with these dual problems, although Clitheroe does accept such cases. In most cases the costs entailed by the treatment regimens are covered by entitlement programs—Social Security, Medicaid, VA benefits. Occasionally a defendant has private insurance.
Funding and Administration
The mental health court has required some redirection of court system resources and personnel and, with perhaps more impact on a day-to-day basis, some redesign of procedures to facilitate the functioning of the court.
The Alaska Mental Health Trust Authority has provided some funding for the project through fiscal year 2003. This money has permitted the creation of a program manager position with general responsibility for coordinating the administration of the court and acting as a liaison with other agencies involved with the project. Trust monies are also funding the JAS program through the Department of Corrections, the second case manager position (through the Office of Public Advocacy, for administrative purposes) and a program evaluation being conducted by the Alaska Judicial Council.
To a great degree, devising and instituting new administrative and clerical procedures to permit the CRP to function with consistency has been the one of the largest tasks involved in establishing the court. The project has necessitated modifications in the administrative routines of the court system at many levels. For example, a procedure for reviewing daily district court arraignment schedules to identify possible candidates for the court was put in place, and new paths for file handling were needed to ensure that cases remained under the mental health court judges. Such behind the scenes administrative changes, which demand personnel time, combine slowly to provide necessary stability and daily continuity in the program.
The other branches of the justice system involved with CRP and the various treatment agencies have also made changes in operations to accommodate the design of mental health court. The treatment plan focus, with the regularly scheduled status hearings, requires more court appearances on the part of attorneys, case managers and treatment providers. Further, the need for stability among the team of justice professionals dealing with each defendant requires that one prosecutor and one defense attorney be assigned throughout a particular defendant's involvement with the court. The state Public Defender has been able to dedicate one attorney position to the court, also with funding from the Mental Health Trust. The Municipality of Anchorage and the state District Attorney's office have also dedicated attorneys to the program but these positions do not have external funding.
Evaluation of Mental Health Courts
Neither the Alaska project nor any of the other mental health courts throughout the country has been in existence long enough to derive a clear picture of the effectiveness of this approach to handling the criminal mentally ill, the demands on court administration, or possible legal challenges. An article providing a theoretical and legal overview of Alaska's various therapeutic court projects, including the mental health court project, will appear in the June 2002 issue of the Alaska Law Review. In addition, a descriptive report by the Bureau of Justice Assistance on the first four mental health courts—"Emerging Judicial Strategies for the Mentally Ill in the Criminal Caseload: Mental Health Courts in Fort Lauderdale, Seattle, San Bernardino and Anchorage"—summarizes the background, history and approach of each court and presents some initial quantitative data, but at the time of the report's publication, the first of the courts, in Broward County (Fort Lauderdale) had been in existence less than three years and the others for even shorter periods, so the analysis is very preliminary.
More extensive examinations of the first mental health courts are now underway, including one being conducted by the Alaska Judicial Council. As the article on the Judicial Council study, "Evaluating the Anchorage Mental Health Court," details, to evaluate these courts it is necessary to decide first what points and factors will provide valid measures of effectiveness.
The preceding article was based on interviews with personnel of the Alaska Court System, the Alaska Department of Corrections, and the Alaska Judicial Council, on court documents, on data assembled by the U.S. Department of Justice, and on observations in court hearings.