By Judge Matthew J. D'Emic*

MJD-Pix.jpgI witnessed a miracle. Not a miracle heralded by angels or preceded by parting waters - but still a miracle. A miracle that happened in court: the Brooklyn Mental Health Court.

The subject of the miracle, Michael, was arrested for burglary and placed in jail pending trial in late 2005. The facts surrounding his crime were odd and at his first court appearance the trial judge ordered a psychiatric examination. The next time Michael appeared in court his lawyer confirmed he was not fit to stand trial as a result of his mental illness. The doctors examining Michael diagnosed him with chronic schizophrenia and found that, as a result of his illness and bizarre behavior, he was unable to understand the court proceedings or assist in his own defense. At that court date three years ago the defendant, handcuffed from behind, spun around and violently hurled himself against the courtroom wall. Michael was sent to a secure hospital for mental health treatment and stayed there for 18 months. Somewhat improved and now found competent to stand trial by the examining doctors, Michael did not go to a judge for trial but was referred to the Brooklyn Mental Health Court.

Mental health courts are the latest development in problem-solving courts, which seek treatment alternatives to incarceration. These courts, like drug courts, use the judge's authority for the physical and emotional benefit of the accused as well as for the benefit of society. Rather than resolving cases quickly without regard to long-term outcomes, problem-solving courts grapple with difficult problems and connect defendants with therapeutic interventions like mental health treatment.

The rise of mental health courts is, in many ways, linked to the closing of mental hospitals 40 or so years ago. Although the goal of de-institutionalization of people suffering from mental illness was commendable, as MIWatch readers know, the lack of funding for community-based programs resulted in trans-institutionalization, making jails and prisons the largest mental health providers in this country. The Department of Justice estimates that 16 percent of state and local prisoners suffer from mental illness, a figure that highlights the substantial cost the criminal justice system incurs by jailing this population. Add to that cost the substantial harm and potential injustice incarceration extracts, and the rationale for a thoughtful problem-solving or therapeutic approach to cases involving mentally ill defendants crystallizes.

In Michael's case the first step was to have him evaluated by a social worker on the mental health court's clinical team and by a psychiatrist on contract with the court. These evaluations were then given to the district attorney, defense counsel and judge.

Michael's evaluations concluded that he was suffering from schizo-affective disorder and had a history of ten psychiatric hospitalizations between the ages of 18 and 38. Michael was deemed eligible for inclusion in the mental health court and for a jail diversion program. Since he had no history of drug use, there was less concern of his compliance with his mandate while living in the community since he had no criminal lifestyle and slipping into the learned habits of hanging out with addicts. In other words his issues involved his mental illness alone and not the additional behavior associated with drug addiction. That aside, about 60% of the mental health court's participants suffer from co-occurring disorders.

The next step in the process was for the court's clinical team led by Lucille Jackson, LCSW, to formulate a treatment plan and for the Kings County District Attorney to present a plea offer. In the Brooklyn Mental Health Court, a guilty plea is required before treatment can begin. In Michael's case, it was agreed that he could live with his sister on condition that he attend a treatment program five days a week for 12-18 months, meet weekly with his community case manager and take any medication his psychiatrist prescribed. Close court monitoring was also required.

The district attorney and defense counsel, after a period of negotiation,
agreed that Michael would plead guilty to burglary, a felony, and criminal trespass, a misdemeanor. It was understood that if Michael failed his treatment mandate he would go to jail for five years. If he succeeded, however, the felony would be dismissed with only the misdemeanor remaining on his record.

The plea entered and the treatment plan in place, Michael was released to his sister. Fragile but willing, Michael walked out of jail and into the community for the first time in more than a year and a half.

Each time Michael came back to court, weekly at first, he showed improvement. Initially there was some difficulty with his medication regimen but his progress continued. Within months he was a mentor in his program. His progress, like all participants in the court, was marked by four phase certificates representing adjustment, engagement, continued progress and finally, graduation. At the presentation of each certificate by the judge, the courtroom burst into applause in recognition of Michael's growth.

Fourteen months after his plea, Michael, dressed sharply in suit and tie, his sister by his side, received his final certificate and was graduated from the Brooklyn Mental Health Court. His felony dismissed, he walked out of court for the last time free of any court mandate. No more bizarre spinning. No more banging against walls. A miracle. A miracle heralded by a new approach in criminal justice and preceded by medication, therapy and re-socialization.

In its nearly seven years of operation, the Brooklyn Mental Health Court has successfully graduated 276 defendants. Not all miracles perhaps, but all of them willing to disclose their individual hopes and dreams, fears and anxieties to a courtroom poised to listen. A recent study of the Brooklyn court found that the lives of the court's participants, measured in terms of recidivism, homelessness, substance abuse, hospitalization and psycho-social functioning improved significantly.

There are now more than 150 mental health courts in the United States and more are planned. They are not without critics and research needs to continue to assess their effectiveness. Anecdotes cannot drive public policy. Still, I witnessed a miracle.

*Judge Matthew J. D'Emic is the presiding judge of the Brooklyn Mental Health Court.

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