Monday, March 1, 2010

Montana finds success with mental health courts

From The Billings Gazette in Montana:


When Jeff Eccles (pictured) took the stand in a Billings municipal court recently, he was greeted with more than a perfunctory announcement of his name and case number.

“Hi, Jeff. How are you today? What have you learned this week?” asked Municipal Judge Mary Jane Knisely.

Eccles told her about his week, which was spent working on a parenting plan for his 9-year-old daughter and sticking to a busy schedule of five therapy groups and AA meetings. Walking back to his seat, he smiled as those waiting on hard benches for their turn on the stand broke the normal silence of a courtroom to give him a round of applause.

“At first it’s pretty scary. Any other time I used to sit in front of a judge, I was in trouble,” Eccles said. “But to hear a judge say she sees a change in me and that I’m doing really good makes me proud.”

Eccles, who has bipolar disorder, is one of a handful of people convicted of misdemeanor offenses who are participating in the new Billings Adult Mental Health Court, a criminal justice diversion program that is less than a year old.

Before entering the program, he had been hospitalized three times over the previous year for alcohol-related maladies: pancreatitis, ulcers, acute liver disease, tremors and hallucinations resulting from his self-medication with liter after liter of whiskey. He racked up misdemeanor charges to match his mounting despair. And most painful, he lost the right to see his daughter after a domestic assault charge.

Now, held to a rigorous treatment schedule by the new Mental Health Court, Eccles has hit the milestone of 96 days sober.

“These people get up every day, I think, and wonder, ‘How am I going to get through the day with my mental illness,’ ” Knisely said. “They will have this forever, and they just need to learn how to manage it.”

The Billings Adult Mental Health Court started last year with the goal of using treatment to stem recidivism among mentally ill, nonviolent offenders. After the city received a three-year Bureau of Justice Assistance grant for $249,000 from the federal government, it screened its first mental-health court participant in March.

Now, through the new program, 14 people who once would have been jailed are learning skills to live with such mental disorders as agoraphobia and schizophrenia.

“Everybody would see the same folks over and over,” Knisely said. “They would keep committing petty misdemeanor crimes. Then, in jail, they would [deteriorate] as they lost their housing, their medication, their access to services.”

Mental-health courts are not new. Modeled after drug treatment courts, they began emerging in the late 1990s, along with new theories about rehabilitation and the recognition that jails had become ad hoc housing for the mentally ill.

Today, there are nearly 200 such courts, according to the Council of State Governments Justice Center, a national research nonprofit.

Not long after Eccles stood before Knisely, another man stepped forward to offer a rambling – and presumably imaginary – account of his family ties to the Queen of England. A woman burst into tears when asked how she was doing, prompting a conversation about expectations and a police officer to offer a tissue. And most unusual of all, little gifts of candy and household items were given to those who had met their requirements for the week.

“The reason that we pursue charges and jail time is to teach people a lesson and not to do it again, but people with mental-health conditions don’t always understand that,” said Billings Police Capt. T.J. Vladic, one of the department’s liaisons with the new program.

Even if they do, they’re often no less likely to re-offend when they’re released from jail because they have not learned how to control the behaviors that landed them there in the first place. By tying them into a nexus of available programs and closely monitoring their progress, treatment courts aim to give them life skills that may keep them out of jail.

“It’s taught me why I was drinking the way I was drinking, why I used drugs the way I used drugs,” said Aaron Davidsen, a 23-year-old participant in the mental-health court. “I didn’t know how to cope with the little things. Just daily stress in life was an excuse for me to get sideways drunk.”

Davidsen was on his way to amassing a long rap sheet of disorderly conduct and theft charges, and had already cycled in and out of jail 10 times, when he came to the mental-health court in July. Like many others caught up in the criminal justice system, Davidsen was drinking heavily to counter his untreated mental disorder, a common enough pitfall that specialists have termed substance abuse a “co-occurring disorder.”

Since opting to give the mental health court jurisdiction over his case until mid-2011 instead of facing a possible sentence of 60 days or six months in jail, Davidsen has juggled a busy weekly calendar. And he works part-time.

At first, an intensive outpatient program for addiction filled his time. Now, he is required to attend three therapy groups that each meet for three hours every week, one of which specifically explores the ties between addiction and mental illness. He must take his medication, the cost of which is partly covered by financial aid the court found for him. Regular check-ins with his probation officer, appearances before the court and meetings with a case manager are mandatory.

If he is late or makes a larger mistake, he faces sanctions: the threat of jail time, community service or writing assignments on topics designed to force thinking about actions and consequences.

“A lot of people think this is a way out of jail, but you can’t get through it unless you’re really dedicated,” said Davidsen, who credits the program with keeping him sober and stable for more than 90 days.

Of course, not all of the first participants have done as well as Davidsen.

Curtis Bevolden, the city prosecutor on the court team, said there have been several cases where the court has been forced to issue a bench warrant.

Still, early numbers suggest significant reductions in recidivism, with only 10 percent of participants re-offending, compared to the 60-percent-plus rate common among those on ordinary probation.

“Some of our real frequent fliers are in there,” Billings Police Lt. Mark Cady said. “Now, instead of just being in the system, they’re part of the system of change.”

To participate in the new Billings court, those facing one or more misdemeanors must plead guilty or agree to a pre-trial diversion, giving the mental-health court at least one year of jurisdiction over their lives. They must also be diagnosed with a clinical mental disorder, such as schizophrenia, bipolar disorder or major depression, and they cannot have a history of sexual or violent offenses.

Though it is available to only 14 people in its first year, planners hope to expand the Billings Adult Mental Health Court in its second year to serve 40 people. The target for the third year: 70.

If the new court proves successful, its boosters contend that part of its ongoing costs could be covered by savings associated with decreasing jail stays, calls for law enforcement intervention and emergency medical service.

Those are savings that bank on the long-term success of the participants.

“People lower their expectations simply because someone has a mental illness,” Knisely said. “Our clients when they’re medicated, and they’re plugged into services, they are very, very bright and they’re very, very capable and they want to give back to the community.”