Tasmania’s Magistrates Court Mental Health Diversion List

1. Tasmania’s Magistrates Court Mental Health Diversion List Chief Magistrate Michael Hill

2. Overview • Origins • Procedure • Key players • Evaluation Results • Offender Interviews • Case studies

3. How the List started • Bottom-up Approach • Court-led: collaboration b/w dedicated magistrate, FMHCLO police prosecutors and legal practitioners • Re-arrangement of Court lists to divert defendants with mental illness into specialist sittings

4. Procedure • Referral: A person can refer themselves into the program or be referred into it by their Solicitor, TasPolice (including Prosecutions), Magistrates, Mental Health Case Managers, Other Service Providers, or Anyone with a genuine interest in the welfare of the person. • Assessment: In order to determine whether a person is suitable for the program they must first undergo an assessment interview by a Forensic Mental Health Court Liaison Officer. • Court Diversion: Once assessed as eligible and suitable by the FMHCLO, the person will appear before the Magistrate presiding over the List. The Magistrate will, on the basis of information provided to the Court by the FMHCLO, police and defence lawyer, decide whether to accept a person on to the program and tailor an order—usually a bail order—best suited to addressing the person’s mental health needs.

5. Procedure (cont.) • Court Review: During a person’s diversion program, a series of court reviews will take place, which the person will be required to attend unless excused by the Magistrate. This is a relatively informal process that provides an opportunity for direct interaction with the Magistrates. • Sentencing: At one of the reviews a final date will be given for the person to return to Court for finalisation of their matters. A Magistrate may take into account the person’s success or otherwise in the diversion program when considering a final sentence. • Consent: Participation in the program is at all times voluntary and any assessment will only occur after the potential participant or their legal guardian has provided written consent.

6. Key Players • Magistrates • Forensic Mental Health Court Liaison Officers • Prosecution • Legal Aid • Private Legal Practitioners

7. Magistrates • Encouragement • Support • Sympathy • Listening • Praising

8. On Magistrates: Offender Interviews • ‘They could tell that I was really worked up and they accommodated it…they got my partner to come over and sit next to me on the big round desk…they were very aware of how I was feeling I think.’ • ‘The magistrate, he was terrific. He was really good. He was understanding of me (sic) mental illness and how I’d become to get mentally ill and he was very supportive actually.’ • ‘He referred to things so that (my daughter) understood why she was there. And when you are on medication you get a bit hazy about things that have happened, so it was good that he mentioned things like that.’

9. Forensic Mental Health Court Liaison Officers • Conduct assessments • Refer participants to appropriate service providers • Monitor level of engagement/compliance • Make recommendations about changes to treatment regimes and/or bail conditions • Liaise with prosecution and defence to determine progression of the case and date of finalisation

10. On FMHCLOs - Offender Interviews • ‘The FMHCLO are, in my view, the ones doing all the work.’ • ‘She was very compassionate.’ • ‘Yeah, she’s terrific. Yeah she’s really good with the people that she deals with…I watch her and she’s really, umm how would you put it, she tries, she tries hard.’ • ‘She would always…follow up on anything that was discussed and…she would ring up and explain stuff to me before and after meeting with the lawyer. She was really good.’

11. Police Prosecutions • Dedicated police prosecutor allows the prosecutor to develop a relationship with the FMHCLO and the defence counsel • Everyone ‘…is on the same wave length.’ • ‘I certainly see it as something that is far more just and appropriate. So if a person has a mental illness and their mental illness has had a significant impact on the offence or offending behaviour, then that’s the thing that needs to be targeted – their health. So if Health and Justice can come together and work together well on that, I think that’s fabulous.’

12. Legal Practitioners • Legal aid employee / private practitioner • Still speaks on behalf of the defendant in many circumstances • Enters pleas in mitigation when matter is being finalised. • Acts as an interpreter to ensure that D is aware of what is being decided, D’s obligations and bail conditions

13. On Legal Practitioners – Offender Interviews • ‘I can understand about 70% of (what is said in court), but when they go through this paragraph and that paragraph, I’ve got no idea, but after court the lawyer comes out and he sort of explains it to me in layman’s terms.’ • ‘The solicitor was real good; they worked well with the mental health team.’ • ‘She (explained what was being discussed) that day when I went to court and I couldn’t understand what the judge was saying. She got up and talked for me’

14. Collaboration & Cooperation • In the initial period between referral and appearance informal discussions take place between the FMHCLO, prosecutors and defence counsel. • Once the FMHCLO’s recommendation of eligibility/suitability confirmed by the Magistrate, and the appropriate order made, the quality and integrity of the health interventions are maintained by the role of the FMHCLO. • Monthly case management meetings between the FMHCLO, prosecution and lawyers to review progress.

15. Selected Results - May 07- Dec 09 Acceptance/Completion • 154 referrals • 126 participants accepted onto/completed MHDL: 16 active cases and 110 completed • 28 non-completions – reasons for non-completion - no mental illness or otherwise unsuitable, program non-compliance or withdrawal of consent - referred back to the general list Of the 126 participants 56% - 1-2 criminal charges 44% - 3 or more criminal charges

16. Results continued • Referrals received from: 43% lawyers 33% FMHS/MHS staff 18% Magistrates 1% Police 5% Other

17. Results continued Representation 64% Legal Aid 27% Private lawyer 9% Unrepresented Finalisations • 110 of the 126 completed (May 07 – Dec 09) – 135 sentences recorded: • 74 (55%) Conditional release order – 16 with conviction recorded & 58 without conviction recorded • 16 (12%) Charges dismissed • 13 (9%) Tender No evidence • 12 (9%) Suspended sentence • 20 (15%) Other including license disqual., community service order, recognisance

18. Results continued Appearances The average number of appearances prior to finalisation was 2.8: • 79 of the 110 finalised cases being disposed of in 1-3 hearings, and • 27 cases involving 4-5 hearings before disposition.

19. Results continued • Diagnosis of participants: 44% schizophrenia 15% bi-polar disorder 9% depression 8% post traumatic stress disorder 6% personality disorder 6% psychosis not otherwise specified 3% obsessive-compulsive disorder 9% other

20. Results continued • Treatment provider: 67% Forensic Mental Health Services/ Mental Health Services 12% Private psychiatrists 11% Private psychologists 8% GPs 2% Other

21. Evaluation (May 2009) - Early Recidivism Data • Results show a reduction in the number of MHDL participants who offended post-program compared to pre-program as well as a reduction in the actual number of incidents charged against these offenders. • From a sample* of 52 MHDL participants who completed their program: • 82.7% were found to have committed an offence in the six months prior to their participation, compared with just 7.7% in the six months after participation. • 78.8% of these participants had reduced their offending level post-participation (i.e. they recorded fewer incidents) • 5.8% exhibited an increase in the number of offences they committed post-participation. * Small sample size prevents the statistical significance of the data being calculated

22. Comparison of number of offences committed pre- and post- participation by participants who have successfully completed the MHDL.

23. Evaluation - Case Study - “Aaron” • 43 y.o. male diagnosed with delusional disorder • Firearm & property offences + one count of stalking • Before participating on the List Aaron kept his mental health issues “all bottled up” • He understands about 70% of what goes on in the courtroom and the rest is explained to him afterwards • Finds that having the Mag. talk to him directly and give him encouragement helps him feel more relaxed • Has been able to continue his work and has started to re-engage in social activities

24. Evaluation - Case Study – “Isabel” • 45 y.o. mother of four with bi-polar disorder • When unmanaged her BPD causes her to be abusive to others, esp. her family • Charged with breaching restraint orders taken out by mother & children • Repeat appearances in normal court lists caused pain & anguish that could have been avoided if she was referred to the List earlier • Since being on the List Isabel has received proper care and follow–up – her medication has been re-assessed & changed, her memory has improved and she is motivated to get out of bed • Has started to repair relationships with her children and other family members • Being in the MHDL meant she felt more at ease in court and was not worried about what the Mag. was going to say to her

25. Evaluation - Case Study – “Caroline” • Diagnosed with psychosis - sees a private psychologist for this. At the time of offence, she was particularly unwell and subsequently spent a considerable amount of time in hospital. • Charged with one count of stealing; has no prior convictions or charges • Extremely embarrassed about her charge and court appearances • Only required to make one appearance on the List • Caroline sees 2 benefits of participating on the MHDL: • She had no conviction recorded (the prosecution tendered no evidence and the matter was dropped). This enabled Caroline to continue with the various voluntary social /community roles. • She needed to seek treatment in a more ‘diligent’ manner. If she did not participate in the MHDL she would not have admitted the incident to anyone else, including psychologist, and would have instead just pretended that it did not happen.

26. Case Study – “Annie” • A 45 y.o. homeless woman (generally slept in bus shelters), who had been wandering the streets of Hobart for about 3 - 4 years. Over that period of time appeared many times in Court on very minor offences, e.g. disorderly, swear at police, resist and minor shoplifting. When her pension cheque came in she spent a night or two in cheap lodgings, the rest of the time she was on the streets. • Appeared before a Mag. on very minor charges and it was clear she did not know where she was or who she was, so the FMHCLO was called and she was immediately diverted to MHDL. • Appeared on the MHDL about 3 to 4 times. Turned out she was a well-educated woman whose marriage had broken down. She suffered emotionally and mentally and her children could not assist her. She had been seen by doctors and diagnoses made and some medication given - turns out they were all inappropriate. • After MHDL assessment she was referred to a psychiatrist who properly diagnosed and medicated her for the first time for many years. She was given housing and other assistance. • When she last appeared in MHDL, she was well-dressed and groomed and very articulate. She thanked all who had helped her over the previous few months and acknowledged that for the first time in years she knew who she was and felt like a member of the community. She was in good accommodation on her own. • This was about 9 months ago. She has not re-offended since.

27. The Future • Extension of the List to other court registries • Rotation of Magistrates through the List • Higher level of data collection • Continued monitoring of the resource impact • Re-consider eligibility criteria.

28. Thank you for your interest today. http://www.magistratescourt.tas.gov.au/divisions/criminal__and__general/mental_health_diversion