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The largest inpatient mental health facility in the nation is the Los Angeles County Jail. Think about that. It is not a hospital where treatment is the goal, but a facility to hold people for trial. A Severe and Persistent Mental Illness (SPMI) such as Schizophrenia can result in behaviors that are likely to get people arrested. While this is not everyone with the disease, it is enough to flood the jails. As a therapist, I don’t think this is the best option.
We are all aware of the war on drugs in this nation. Not only are many drugs illegal to possess, but people will engage in illegal activities to obtain them, such as theft, assault, and worse. Of course, the biggest drug causing problems is the legal one, alcohol, which can still lead to illegal violence or things such as drunk driving.
Treatment Courts special courts set up to address people with mental health and substance abuse issues. (There are also Veteran Courts with similar functions). Their goal is to get people out of the jails and prisons and back into the population as productive citizens. These are set up by the State either in felony or misdemeanor courts. These serve the individuals accused. Admission to the court is through a referral process, usually by the person’s attorney. Space is limited, so not everyone gets in. Screening is usually done around illness. Someone who does not appear to have an actual addiction or SPMI will not be accepted. Someone accused of significant violence would not be approved either. The goal was people caught for non-violent crimes. If you do not know, it is not hard for theft to be a felony. The person who is approved enters a guilty plea and they are sentenced to the court. It is voluntary. At any time, the person can withdraw from the court and get a normal sentence.
The court team is composed of care providers and court personnel. The head of the team, naturally, is the judge. Rounding out the court side is a probation officer, an assigned deputy, a public defender, someone from the DA’s office, and one to three other court personnel. The treatment side is usually lead by a case manager supervisor and representatives of the treatment organization. In our case, we had residential and day program reps there. The team would meet once a week to discuss clients, then court would be held for any clients who were due in front of the judge. Sometimes this meant someone was going from court back to jail for a limited time as a sanction. Both sides work together closely. Without this collaboration, it will not work. One judge I know called the court the “head” and the providers the “heart”.
The treatment was tailored to the individual’s needs. Usually there as some level of group and individual therapy. Often, clients were also on some sort of medications to help with symptoms. You would be amazed at the number of substance use disorders that are in part self-medication of other issues. Clients would be mandated to follow the treatment recommendations of the treatment team, but in any good treatment, the clients had some say. And again, this was all voluntary. At any time, the individual could withdraw from the program. For a felony court, that would mean more jail or prison time. Drug tests are conducted by the court at the courthouse and in visits in the field by court staff. Diluted screens are considered a positive as are refusal to produce a sample.
When I took over as CEO of my community organization, I started attending the Mental Health Court meetings. There was some friction between my staff and the Court staff. I was there to help settle things down. Personal friction is something we have all experienced at work. I am pleased to say in a couple of months, things were fine. I knew we had turned the corner when the probation officer was willing to let a client’s outburst slide, and my staff were adamant that there was a consequence. “Head” and “Heart” reversed, and everyone was a team.
Please ask me any questions you have below. I am happy to answer them.Published in