David Meyer, J.D.Institute of Psychiatry, Law and the

Behavioral SciencesU.S.C. Keck School of Medicine

dmeyer@usc.edu 818-257-1221

Problem-Solving and Collaborative Mental Health Courts: An Adjustment to

Justice

David Meyer, J.D.Institute of Psychiatry, Law and the Behavioral

SciencesU.S.C. Keck School of Medicine

dmeyer@usc.edu 818-257-1221

David Meyer, J.D.Institute of Psychiatry, Law and the Behavioral Sciences

U.S.C. Keck School of Medicinedmeyer@usc.edu

818-257-1221

Problem-Solving and Collaborative Mental Health Courts: An Adjustment to

Justice

Objectives Describe MHCs, their operations and

related outcomes data I.D. some specific anomalies of MHC

operations compared to traditional justice Observe the apparent ethical and practice

boundary “issues” Propose resolutions and solutions to the

anomalies and issues

Welcome to My Bias I strongly believe in Problem-Solving,

Collaborative approaches to justice A legal systems/lawyer perspective

(adjusted for error) Opportunities/Change My focus: rationalize practice boundaries

and ethical challenges in Collaborative Courts

Adversary Courts Opposing “Sides”

Polarized Secrets

Conflict Binary processes Constrained by arcane historical rules Passive judicial role Limited outcomes potential

Why Think Differently? Insanity (Einstein definition) Adversary justice is inadequate to address

mental health problems Institutional treatment does not work (in most

cases) in terms of recovery and LTC Cost:

Systems redundancy Expensive default Poor systems linkage

Time to follow the evidence

MHC Evidence Decreased:

Re-arrest rate Number of arrests Incarceration days

Increased: Linkage to services (all of them) Non-custodial housing QoL satisfaction

History An iteration of Problem-Solving Justice

derived from Drug Courts Created in Broward County Florida by

Judge Ginger Lerner-Wren Early support from DOJ and Consensus

Project Losing their identity to other specialty

courts, viz: veteran’s courts, community courts, homeless courts, elder courts…

Commonalities of MHCs A team approach that involves information sharing

among judges, attorneys, probation staff, and mental health professionals

Screening and assessment of the problem(s)occurs early in the criminal justice process

Diversion from traditional criminal justice processing into treatment

Early intervention in the criminal justice process An emphasis on problem solving and developing

interventions/ treatment to reduce the likelihood of reoffending

A focus on continuity of care with treatment tailored to fit individual needs and circumstances

Commonalities of MHCs A strong focus on supervision Defendants' understanding that the primary focus of the

mental health court is on treatment and not adjudication of their case

Understanding by mentally ill defendants that their participation in the mental health court is voluntary

More personal interaction between the judge and the mentally ill defendant than in a traditional court

The use of rewards and sanctions Restorative justice and victim involvement *Recovery, wellness & long-term mentality Ref.-- https://www.bja.gov/evaluation/program-

adjudication/problem-solving-courts.htm

Variability There are as many different types of

MHCs and there are MHCs Entry criteria vary widely Different levels and types of staffing Dependent on judge’s (everyone’s)

personality and approach Measures and outcomes Sources of funding

Legal Sacred Cows Equal access/Equal Protection Sixth Amendment issues:

Confrontation Public proceedings

Negates fact-finding function of criminal court Role of counsel; attorney no-no’s Nature of “counseling” Voluntary? Categorical funding

Clinical Sacred Cows Clinician-Patient bond Confidentiality and privacy

HIPAA, W.I.C. §5328 Informed consent Breadth of consent

Clinical practice limitations (boundaries) Therapeutic no-no’s

MHC Processes Consensus decision-making Judicial “activism” Boundary jumping Role distortion Long-term focus Interim and terminal rewards Mild and moderate sanctions Tolerance for failure “External” individual and agency integration

Rationalizing MHC Conflicts Joint practice guidelines

“Internal” supervision “External” approval

Ethical and practice safe harbors Effective consents Blended and joint-agency funding Adversary system safety nets

Resources National Center for State Courts (NCSC)--http://

www.ncsc.org Council on State Governments Consensus

Project-- http://consensusproject.org U.S. Department of Justice Bureau of Justice

Assistance-- https://www.bja.gov

David Meyer, J.D.Institute of Psychiatry, Law and the Behavioral Sciences

U.S.C. Keck School of Medicinedmeyer@usc.edu

818-257-1221

Problem-Solving and Collaborative Mental Health Courts: An Adjustment to

Justice