The Law Library on the second floor of San Francisco’s Hall of Justice was flooded with natural light coming in through the three large windows that face east. From my chair, there was a clear view of the mammoth “Yahoo!” billboard alongside highway 80. The steady swoosh of traffic managed to seep in through the double panes.
The room was divided. On one side was an audience of eight psychology trainees, a psychiatrist and a program director from OMI Family Center, where I am presently fulfilling my Practicum II placement. On the other side were six professional women seated at a conference table. They were discussing the fate of a long list of individuals who have histories of mental health issues and substance abuse and have been arrested for various crimes.
Judge Mary Morgan, who heads the Adult Behavioral Health Court (ABHC), sat at the head of the table. She is an attractive woman, about 50 years old with short curly hair, rosy cheeks and a warm smile. Also present were three representatives from the District Attorney’s office and two case managers – one from Jail Psychiatric Services and one from the Citywide Case Management Forensic Program. A rotating cast of legal counsel for the defendants, mostly public defenders, shuffled in and out of the room over the next two hours. The actual defendants were not present but would be in court later when it convened in Department 15.
Line by line, down the roster, cases were presented and discussed in a collaborative, interdisciplinary fashion as clinicians and legal counsel worked together to determine the best route to rehabilitation for each individual. Case managers sat at their open laptops, accessing a specialized database and relaying each defendant’s most recent clinical report.
One defendant was off heroine and had titrated from 145 mg to 45 mg of methadone; another had only missed one session of group therapy in the past week. Another had been attending anger management classes and hadn’t broken the terms of his restraint order. Everyone expressed concern or praise for each participant’s status. It was clear that Morgan’s court is different from most.
The ABHC team members have ongoing relationships with the adjudicated. Team members expressed compassion and their concern appeared genuine. They explained that their goal is to keep the participants out of jail. Jail Psychiatric Services and Citywide case managers work in close contact with the defendants’ community clinic case managers to keep the defendants in the appropriate treatment facilities.
When participants “graduate” from the program, charges are usually reduced or expunged. ABHC members stated that they want to mitigate as much as possible the damage that can result from a criminal record.
Adult Behavioral Health Court gets results
The ABHC in San Francisco began at the end of 2002. It now handles about 200 cases per year. Each participant receives an individualized treatment plan with a case manager who assists the participant in finding housing, getting the appropriate medication and getting sober.
The theory is that if a person can be managed in the community rather than being incarcerated it is better for the individual and society in general. Data are beginning to offer empirical validation to the theory. According to an article in the San Francisco Chronicle in November 2007, a study by UCSF published in the American Journal of Psychiatry revealed that 18 months after completion of the program, the risk of defendants being charged with a new violent crime was 54 percent lower for ABHC graduates than for mentally ill people in the regular court system.
During the case conference, the ABHC team identified defendants who had been complying with treatment and making progress toward their goals. About 10 such defendants were placed on the “Honor Roll.” Many of these individuals would be offered movie or museum tickets later that day when court convened.
At one point during the case conference, a philosophical debate erupted. The case involved a woman who had been exhibiting some irrational behavior but seemed to be getting by. There was talk of remanding her, that is, removing her from the community and placing her in custody again.
Morgan paused to check the team’s motivation: “What is it we’re trying to do here?” she asked. She explained that she wanted to make sure the team wasn’t simply trying to mold the defendant’s behavior into something that mimicked their own. She wanted to be sure that they weren’t using a definition of rationality and socially acceptable behavior that was too narrow. After about five minutes of discussion, it was decided to give the defendant one more chance.
Another defendant had moved to Sacramento. The team decided to transfer mental health treatment to a facility close to his new home, but not to transfer his legal proceedings. The reason: The courts in Sacramento might end up throwing him into jail without giving him the option of community mental health treatment.
According to Morgan, San Francisco’s ABHC is one of the 150 to 200 behavioral health courts across the nation. It is more individualized than most. Except for homicide cases and sex offenders, San Francisco ABHC doesn’t issue blanket statements about what sort of offenders can qualify for its programs. If a judge, attorney or Jail Psychiatric Services staff member refers a defendant to the ABHC, a representative from the DA’s office then contacts the victim of the crime and explains that the perpetrator is mentally ill and has been offered rehabilitation treatment.
The judge said, most victims are supportive of the program. They usually respond that they are happy that the court is working toward the perpetrator’s rehabilitation to ensure that others aren’t victimized the way they were.
At 2 p.m. court at Department 15 convened. Before the judge entered the courtroom there was murmuring chatter. It was clear that many of the defendants knew one another. The two women sitting in the front row smiled at each other when the judge entered the room.
Morgan started with the Honor Roll. Each Honor Roll member was called in turn and congratulated on individual accomplishments. Congratulations were followed by applause throughout the courtroom. These are choreographed moments, designed to build each participant’s self-esteem.
As the judge explained, “Many of the participants have never experienced any positive attention from people.” But it’s not all candy and kisses. Morgan can also be stern.
During case conference the team discussed how it is necessary to use very simple, concrete language with many of the participants. The judge even advised the participants’ public defenders how to speak to their clients. In the courtroom, she exemplified the speaking style. When speaking with participants who were at risk of noncompliance, she spoke very deliberately without compromise. Several times, I heard the following statement, “If you do not comply with your treatment plan, you cannot be in behavioral court, which means you go back into the criminal system. That means you go back into custody. Do you understand?”
The pace was rapid. Most cases were heard in a matter of minutes and many of the defendants were told to come back in a week for another check-in. Morgan offered encouragement and positive reinforcement to the ABHC participants. There was a maternal quality to the way she praised their accomplishments. Many participants openly shared recent events in their lives and thanked the judge for her help.
One woman, when called to the podium, handed the DA a package wrapped in foil. The DA relayed the package to the judge. The defendant explained it was homemade honey-buttered corn bread she made specifically for the judge. Morgan’s eyes lit up as she thanked the woman.
Dave Pursell is a third year trainee in clinical psychology following the forensic track at the California School of Professional Psychology at Alliant International University/San Francisco Bay Campus. He may be reached by e-mail at firstname.lastname@example.org.