Press Room
The Consensus Project is coordinated by:
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| PROGRAM TITLE: |
Jackson County Mental Health Court |
| AGENCY/ORGANIZATION: |
Office of the County Executive |
| STATE: |
Missouri |
| YEAR ESTABLISHED: |
2000 |
| LEVEL OF JURISDICTION: |
County |
| ISSUE AREA: |
Courts: Adjudication and Sentencing |
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Program Overview
Jackson County's Mental Health Courts Program aims to mobilize the County to implement innovative and collaborative efforts to bring systemwide improvements in the way it addresses offenders with mental disabilities or illnesses. Program objectives include: fostering public safety; improving the care and treatment of persons with mental illness who are involved in the legal system; decreasing the frequency and duration of contact with the criminal justice system by mentally ill individuals in our community; increasing cooperation and coordination between the mental health treatment system and the criminal justice system; easing the burden on the criminal justice system and more efficiently utilizing resources.
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Recent Dialogue
Question for
Bruce Eddy
Contact Person
UPDATE - Please contact me at the following address:
baeddy@jacksoncountycares.org
- Bruce Eddy
04/28/08 01:15 PM EST
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Program Description
When the federal government closed state mental hospitals in the 1970's, the intent was humanitarian. Unfortunately funding for local support services never materialized, and across the nation, county and municipal jails became de facto mental institutions. Jackson County is a leader in its treatment of the mentally ill while inside the jail, but officials realized treatment inside the jail is only a partial solution for a larger community problem.
Jackson County opened a mental health wing in its County Detention Center (for felons) in 1997 as a response to overcrowding. Inmates housed in the unit had several commonalities: lack of access to services; co-occurring disorders; frequent homelessness; need for medication; and disengagement from treatment. Sixteen percent of inmates had symptoms of mental illness and 11 percent had a serious mental illness. At the Kansas City Municipal Correctional Institution (for misdemeanor offenders) an initial review found 15 to 20 percent of the average daily census of 300 were mentally ill. A more rigorous study conducted in 2001 by Resource Development Institute of Kansas City, Missouri later established the prevalence at 35 percent. These inmates also evidenced a lack of access to services, co-occurring disorders, and need for medication.
County Executive Katheryn Shields appointed a special task force in the Fall of 2000 to begin developing a "mental health court" -- a diversion program for the non-violent mentally ill. On February 12, 2002, funding was awarded to Swope Health Services, along with Comprehensive Mental Health Services, to take responsibility for implementing this program. Resource Development Institute (RDI) was selected to carry out program monitoring and evaluation.
Jackson County chose to apply innovative problem-solving methods to address the needs of people who are disabled by mental illness. Our therapeutically oriented mental health court approach shares common characteristics with other mental health courts: identification of candidates early in the criminal justice process; voluntary participation of defendants; demonstrable mental illness or disability of defendants that likely contributed to their crimes; deferred prosecution pending completion of a prescribed treatment protocol; concern for public safety in arranging services for offenders in the community.
The Jackson County Mental Health Court Diversion Program is a partnership between city and county court systems and mental health providers; its mission is to assure that people with diagnosed mental illnesses and involvement in the criminal justice system receive appropriate treatment in a setting that promotes the dignity and respect of the individual, fosters community safety and decreases the likelihood of recidivism.
At the center of the service delivery system is the case manager, who offers centralized case management. Community involvement includes, but is not be limited to: educational, recreational, and mental health systems; drug and alcohol treatment programs; and employment and housing assistance. Through the Mental Health Courts Program, Jackson County aims to decrease an offender's frequency of contact with the criminal justice system by improving his or her social functioning through stable employment, housing, treatment, and support services.
The program is made possible through the cooperation of the following organizations: The Honorable Katheryn Shields, County Executive; CIT/Law Enforcement; Community Backed Anti-Drug Tax (COMBAT); Jackson County Mental Health Levy Board; Comprehensive Mental Health Services; Municipal Correctional Institute; National Alliance for the Mentally Ill of Greater Kansas City (NAMI); ReDiscover; Resource Development Institute; Swope Health Services; Truman Medical Center Behavioral Health Network; and Western Missouri Mental Health Center.
Related governmental initiatives complement the Mental Health Court; these include a Drug Court, Crisis Intervention Teams, Rapid Response, Project Dual Focus, and professional evaluations.
Who can participate? Jackson County residents who are charged with a municipal offense and/or a low class felony and are experiencing one of the following: severe and persistent mental illness; brain trauma/injury; mental retardation; dual diagnosis (SPMI/substance abuse).
Outcome Data
Outcomes at the Discharge Stage: Information about program completion was available for 129 clients. Six of these (5%) had withdrawn from the program. A little over one half (52%) were judged by the Monitor to have been successful. The other 43% had been terminated from the program. The term success does not imply that a client no longer requires care. It indicates only that the client has completed a specific plan of treatment that resulted in the dismissal of pending charges. Nearly all of those who completed their plans are expected to require care following graduation. Client satisfaction ratings were available from 45 persons. The results indicate that most clients were satisfied with their treatment in court and with their mental health care. On both items, 89% gave the answers satisfied of very satisfied. All 45 clients said they were better as a result of participation in the program.
Most of the completed surveys are from clients who finished the requirements of their treatment programs. MHC staff has not had contact with clients who have not completed their programs and therefore has been unable to request that they complete the satisfaction survey forms.
Factors Related to Program Completion: Although the numbers were too small for reliable conclusions to be drawn, several tests were carried out to determine whether clients who completed the program significantly differed in several ways from those who did not. Results are summarized as follows:
(1) the completion rate among Caucasians was slightly higher (61%) than the rate for Blacks (48%);
(2) a much higher proportion of females were found to have completed their programs (69%) than males (46%);
(3) those who completed their programs were statistically significantly older (average age 35 years) than those who did not (31 years);
(4) the completion rate was highest in cases coming through Lee's Summit (63%, or 12/19). For the Kansas City Court, the value was 54% (53/98) --of 11 clients coming through the Drug Court, for whom ratings were available, 18% (2 clients) were rated successful; 8 (73%) had been terminated from their treatment programs;
(5) as might be expected, 92% of the 25 clients who had not completed their treatment plans, and had been rated by the monitor, were rated as having poorly complied with the program. Of the 45 who had completed their treatment plans and had been rated, 84% were rated as having complied well;
(6) no reliable differences in completion rates could be assigned to variations in primary psychiatric diagnoses. For persons with schizophrenia, bipolar disorder or depression, the overall rate of completion was about 57%. A slight trend appeared for the rate of completion to be higher among those with paranoid schizophrenia (60%) than for those with other types of this disorder (47%). The rate appeared to be lowest among those with a primary diagnosis of character, adjustment or personality disorder (about 20%), but there were only 10 cases upon which to base this determination (this diagnosis typically appeared as secondary rather than primary);
(7) the GAF ratings of persons who completed their treatment programs were only slightly higher (average 44.3 points) than those of persons who had not (average 43.1 points).
Challenges / Areas for Improvement Identified
The Jackson County Mental Health Courts had to address the following to implement a functional program:
(1) development of strategies for identification of mentally ill defendants;
(2) implementation of early screening processes;
(3) efficient, timely and accurate identification of mentally ill defendants;
(4) establishment of cooperation and coordination of private and government mental health service providers and agencies;
(5) establishment of due process safeguards for defendants;
(6) procedures to determine voluntariness, competency, and client understanding of the process beyond the legal definition of competency;
(7) procedures to address and settle conflicts between social service agencies and between social service agencies and the criminal justice system;
(8) identification of measures of success with the understanding of the special nature of mental illness and its inability to be "cured" in the short term;
(9) securing the needed resources in order to give mental health court judge options beyond those that already exists and are available to any judge (the increase in and creation of new resources to deal with mental health patients is key to the success of mental health court);
(10) training for police and court personnel in how to deal with mentally ill defendants and how to recognize criminal behavior that is the result of a mental illness.
Early in the evaluation process it was recommended that the following actions be taken to address program challenges:
(1) identify unmet financial needs (includes limited staff) and develop strategies for tapping available and new resources;
(2) hire an additional full-time Monitor and a full-time Administrative Assistant;
(3) construct a comprehensive data base that would link Swope Parkway Health Services electronic tables;
(4) incorporate assessment personnel at court dockets; and
(5) formally identify specific outcome measures to facilitate accurate data collection and dissemination of findings.
Documents
In 1992, NAMI and Public Citizen's Health Research Group released a report, entitled Criminalizing the Seriously Mentally Ill: The Abuse of Jails as Mental Hospitals, which revealed alarmingly high numbers of people with schizophrenia, bipolar disorder, and other severe mental illnesses incarcerated in jails across the country. Most of these people had not committed major crimes, but either had been charged with misdemeanors or minor felonies directly related to the symptoms of their untreated mental illnesses, or had been charged with no crimes at all. Unfortunately, the problems described in that report have worsened in the ensuing years.
A report issued by the United States Department of Justice in 1999 revealed that 16 percent of all inmates in state and federal jails and prisons have schizophrenia, manic depressive illness (bipolar disorder), major depression, or another severe mental illness. This means that on any given day, there are roughly 283,000 persons with severe mental illnesses incarcerated in federal and state jails and prisons. In contrast, there are approximately 70,000 persons with severe mental illnesses in public psychiatric hospitals, and 30 percent of them are forensic patients. Additionally, police are increasingly becoming front-line respondents to people with severe mental illnesses experiencing crises in the community.
Conditions in jails and prisons are often terrifying for people with severe mental illnesses. These settings are not conducive to effectively treating people with these brain disorders. Many correctional facilities do not have qualified mental health professionals on staff to recognize and respond to the needs of inmates experiencing severe psychiatric symptoms. Correctional facilities frequently respond to psychotic inmates by punishing them or placing them in physical restraints or administrative segregation (isolation), responses that may exacerbate rather than alleviate their symptoms. Inmates with severe mental illnesses usually do not have access to newer, state-of-the-art, atypical antipsychotic drugs because of the costs of these medications. Federal and state prisons generally do not have adequate rehabilitative services available for inmates with severe mental illnesses to aid them in their transition back into communities.
These alarming trends are directly related to the inadequacies of community mental health systems and services. The widespread adoption of systems with proven effectiveness in addressing the needs of people with the most severe mental illnesses, such as assertive community treatment programs, would sharply decrease the numbers of people with severe mental illnesses involved in criminal justice systems. However, since these programs are available only sporadically throughout the country, NAMI's strategies for reducing criminalization focuses both on improving community mental health services and on addressing the treatment and support needs of people with severe mental illnesses in criminal justice systems.
In addition to the Mental Health Court described herein, NAMI, a key organization member, is pursuing the following strategies for reducing the criminalization of people with severe mental illnesses:
(1) adopting programs such as the Memphis Police Crisis Intervention Team (CIT) program to train police officers who come into contact with people with severe mental illnesses in the community to recognize the signs and symptoms of these illnesses and to respond effectively and appropriately to people who are experiencing psychiatric crises;
(2) creating authority in state criminal codes for judges to divert non-violent offenders with severe mental illnesses away from incarceration into appropriate treatment. This includes authority for judges to defer entries of judgment pending completion of treatment programs and to dismiss charges and expunge the records of individuals who successfully complete treatment programs;
(3) training probate, civil, and criminal court judges and personnel about severe mental illnesses and legal issues affecting people with these illnesses;
(4) creating specialized divisions or units within departments of parole and probation with specific responsibility for coordinating and administering services for people with severe mental illnesses who are on probation.
(5) providing specialized training to parole officers about severe mental illnesses, the needs of people with these illnesses on probation, and treatment resources and benefits available to these individuals.
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Staff from the Consensus Project, GAINS EBP Center, and GAINS TAPA Center have not conducted an empirical evaluation of any of the profiles provided in the directory. Accordingly, the Consensus Project, GAINS EBP, and GAINS TAPA do not promote any of these programs as "models" or "best practices." Nor does the directory reflect an inventory of all relevant efforts underway across the country. Administrators of the programs included in the directory are largely responsible for maintaining information about their initiative current. Accordingly, staff cannot guarantee that the information in the directory is completely current.
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