Crossing the Mental Health Court Chasm to Community Mental Health

By Judge Ginger Lerner-Wren
May 4, 2016



Welcome to mental health court“Welcome to mental health court,” I say in a voice and tone intended to communicate authentic caring as I begin to describe the nature and goals of Broward County’s Misdemeanor Mental Health Court.

Yesterday, a young man diagnosed with schizophrenia appeared in court with his mental health community case manager. This case manager was part of a newly created RAISE (Recovery After an Initial Schizophrenia Episode) team. The young man was vibrant and proudly reported he is doing much better. Applause filled the courtroom. Not simply because he is complying with his treatment plan. We understand what is at stake in a state and nation which has little heart and political will to remedy and eliminate barriers to care.

I will never forget the first time I learned about the horrific trend called the criminalization of people with mental illness. I was a young lawyer attending a South Florida mental health conference. I was appalled. I thought, it couldn’t be – not in America.

For this individual and the tens of thousands that Broward County’s misdemeanor mental health court has served over the past 18 years, jail diversion and the ability to gain access to individualized community mental health treatment and supportive services determine whether one will end up trapped in a criminal justice system or a revolving door of acute care psychiatric hospital admissions, substandard housing and homelessness.

The young man’s improved health status and obvious pride in his progress with us confirms the truth about mental illness, that with precise psychiatric care, many people gain stability and recover to live their best lives.

On this day, the news is beyond good and unprecedented. Virtually all of the previously homeless mental health court participants residing at the Rainbow Rehabilitation Center, operated by Henderson Behavioral Health Center, have secured jobs and are working.

An Inter-Disciplinary Court Process

The Mental Health Court process is highly individualized and requires a specialized knowledge base in a myriad of subjects. Court review and discussions continually shift between legal process, psycho-social triage, clinical service integration, treatment matching, storytelling to give voice to participants, family engagement (if family is present) and psycho-education.

Court values include preference to honor consumer choices and the promotion of dignity along with informed consent, as the court is voluntary. Court process also includes matters of jail coordination, including monitoring on a case by case basis for those individuals who are followed by the court.

Courts and Therapeutic Jurisprudence

The court applies the philosophy of Therapeutic Jurisprudence (TJ), a scholarly law reform science developed in the late ’80s by two mental health law professors, the late Professor Bruce J. Winick of the University of Miami School of Law and David B. Wexler of the University of Arizona.

TJ theorized that the court process is a social force that produces emotional reactions and behaviors, and this force could be applied in a therapeutic way – for example by active listening, validation and allowing for storytelling – to make the court a therapeutic agent.

From a historical perspective, TJ and the problem solving court movement has revolutionized the law. It was first applied in the problem-solving drug court in 1989 in Miami, where substance abuse treatment was offered over punishment. The popularity of problem solving courts has evolved at an accelerated pace, particularly as policy and social service gaps widen and the need to seek collaborative solutions to untreated mental illness, intellectual and developmental disabilities, victimization, childhood trauma and domestic violence exist across all systems.

As America’s policy makers debate prison reform and mass incarceration in America, the need to restructure the approach to criminal justice has become an urgent national priority. Through prison reform, forensic psychologists, mental health counselors and practitioners in addictions and peer recovery will play an important role in this rehabilitation dynamic.

Broward County’s Mental Health Court

Broward County’s Misdemeanor Mental Health Court, the first in the nation, was established in 1997. While the court borrowed from the drug court model in terms of offering diversion and treatment, its goals and objectives are responding to the injustice of the criminalization of people with mental illness. The inspiring story behind Aaron Wynn and the creation of the mental health court can be more fully reviewed in the 2005 PBS Frontline Report. Aaron Wynn, a mentally troubled 25-year-old who pushed a woman outside a supermarket in 1993, is the unlikely savior for a new system of justice and the catalyst behind Broward County’s mission to use the court process to centralize scarce resources, create access to care and promote system accountability to mental health consumers and their families.

The court is an outgrowth of a scathing 153-page grand jury report after the woman died of injuries from the push and Wynn was convicted of manslaughter. The 1994 report found Broward County’s community-based system of care to be chronically underfunded, deplorable and accountable to no one. Broward County and the State of Florida were not alone in failing to overcome barriers and prioritize mental health care. While Florida currently ranks at 49th in the United States for mental health funding, the debate on how best to reform mental health care in America is on-going.

Conclusion: Access to Community Care is a Matter of Justice

While there will always be an important role for problem solving courts, they are not and were not intended to be a substitute for the development of comprehensive community systems of behavioral health care. Mental illnesses and co-occurring substance disorders are medical problems. I believe it is time for all mental health experts and policy makers to cross the criminal justice chasm and recognize that community access to care is more than a health care issue – it is pathway to justice.

 

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Judge Ginger Lerner-Wren is the pioneer of America’s first mental health court. She is a County Court Judge of the 17th Judicial Circuit, Florida. The Court was chosen as the model for the National Mental Health Court Demonstration Act of 2000. Judge Lerner-Wren is on the executive committee of the National Action Alliance for Suicide Prevention, served on The President’s New Freedom Commission on Mental Health and is an adjunct professor of the Nova Southeastern University College of Psychology and the university’s Criminal Justice Institute, graduate divisions. She writes for Huffington Post and speaks nationally and internationally on therapeutic justice and mental health, criminal justice reform and leading cultural change.

 

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