Manhattan Mental Health Court offers lifeline to those with serious mental illness — but they have to get in

When people experiencing homelessness in Mesa, Ariz. are charged with low-level offenses such as trespassing or public intoxication, they have the option to participate in community court to get their case dismissed if they agree to seek help from government programs and services. Participants are assigned a "navigator" to help them obtain required identification documents, search for housing, or apply for jobs, and more than 90% of those who graduated from community court in 2021 have not ended up back in the legal system.

Eagle County's two problem-solving courts put treatment ahead of punishment when addressing crimes committed by people with substance abuse problems. Originally set up as one court, they now function separately to address drunken driving and drugs and serve people "teetering on the edge of serious prison time" for repeat offenses. More than 90 percent of participants in 2020 maintained sobriety and more than 80 percent avoided new legal troubles. While the threat of punishment is used to win compliance with rules, prosecutors say they're more interested in permanently curing the underlying disease.

Kansas' only veterans treatment court started small, but it has proved the concept to Sedgwick County officials who want to copy its success. Veterans courts provide treatment in lieu of conviction and punishment for veterans charged generally with non-violent, less-serious offenses. The costs are much lower than for incarceration, with greater benefits to the defendants. National statistics show a 14% recidivism rate, much lower than for the criminal justice system overall. In Johnson County, 41 veterans have gone through the 18-month program; none have reoffended.

Like standard drug courts, the Penobscot Nation's Healing to Wellness Court refers people facing drug-related criminal charges to substance abuse counseling as an alternative to punishment. But this court and other tribal wellness courts are steeped in indigenous customs, blended with restorative justice approaches, to emphasize rehabilitation based on trust, support, and native traditions. The threat of punishment looms over participants should they fail in their counseling program. But no one has been jailed in the past two years in the Penobscot program.

Drug courts can help some people with serious drug problems who face serious criminal charges, if such court programs are run carefully, based on evidence-based approaches. But, too often, such courts – which push criminal defendants into treatment as an alternative to incarceration – can do more harm than good. The proof of drug courts' effectiveness is mixed, and fairly thin. Thousands of such courts exist, based on widespread political support for an approach seen as less punitive. But many critics say the courts' track record overall is weak and their approach can be just another form of punishment.

A nonprofit consulting firm, Prosecutor Impact, advances the cause of reducing incarceration and related reforms by helping reform-minded elected district attorneys confront one of the greatest obstacles to change: their own staff's opposition. In Columbus, a two-week curriculum educated front-line prosecutors about local services that can serve as problem-solving alternatives to punishment. It also taught them about poverty's challenges and engaged them in dialogue with prisoners, to make them more open to alternative approaches, which a local defense lawyer says was successful.

Since 2015, Project Reset has diverted potential criminal cases to programs that change behaviors without imposing punishment or staining people's records with criminal convictions. Art classes, behavioral therapy, and restorative dialogue have made 16- and 17-year-olds in the program significantly less likely to commit new offenses, while 98% of those admitted to the program have completed it. Offered in Manhattan, Brooklyn, and Bronx, the program helped the Manhattan district attorney nearly cut in half the number of prosecutions of low-level misdemeanors and violations.

A Forensic Assertive Community Treatment (FACT) team tackles one of the toughest challenges at the intersection of mental health and criminal justice: how to help people whose mental illness has landed them in criminal trouble, without resorting to jail or brief hospitalizations. A Rochester, New York, program that showed promise in improving those odds by connecting people with needed services is now being replicated in Hennepin County, Minnesota. So far, about half of the 60 people in the program returned to jail. So it's only working for some people.

Pima County, Arizona, eased its jail overcrowding with reforms that reduced the jail population by 400 people. Its Community Collaborative put key players from the criminal justice system, plus formerly incarcerated people, on a team that created programs to divert cases from incarceration to treatment, screen people to detain fewer people before trial, and a new court to reduce the problems working people had in making court dates. A new jail was no longer needed. But a federal border program that gave the county incentives to make needless arrests undercut some of those reforms.

Like the Assertive Community Treatment (ACT) teams that help seriously mentally ill people avoid costly long-term hospital stays, Forensic Assertive Community Treatment (FACT) teams try to help the same population avoid jail also. By providing intensive case management to avoid the pitfalls that lead to criminal charges, and connecting people living in the community with needed services, these teams have shown early indications that their patients spend less time in both jails and hospitals. They are more expensive than outpatient clinics, but in the long run may be cheaper than hospitals and jails.