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

1. Problem-Solving and Collaborative Mental Health Courts: An Adjustment to Justice David Meyer, J.D. Institute of Psychiatry, Law and the Behavioral Sciences U.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 Medicine dmeyer@usc.edu 818-257-1221

2. Problem-Solving and Collaborative Mental Health Courts: An Adjustment to Justice David Meyer, J.D. Institute of Psychiatry, Law and the Behavioral Sciences U.S.C. Keck School of Medicine dmeyer@usc.edu 818-257-1221

3. 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

4. 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

5. Adversary Courts • Opposing “Sides” • Polarized • Secrets • Conflict • Binary processes • Constrained by arcane historical rules • Passive judicial role • Limited outcomes potential

6. 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

7. MHC Evidence • Decreased: • Re-arrest rate • Number of arrests • Incarceration days • Increased: • Linkage to services (all of them) • Non-custodial housing • QoL satisfaction

8. 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…

9. 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

10. 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

11. 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

12. 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

13. 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

14. 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

15. 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

16. 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

17. Problem-Solving and Collaborative Mental Health Courts: An Adjustment to Justice David Meyer, J.D. Institute of Psychiatry, Law and the Behavioral Sciences U.S.C. Keck School of Medicine dmeyer@usc.edu 818-257-1221