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A Mental Health Court Judge’s Perspective: WIIFM (“What’s in it for me”)?
by Hon. Stephen S. Gross

I have presided over a felony mental health court program for five years. Like many pilot projects, we collect data on the probationers to determine if our efforts are helping reduce recidivism and inpatient mental health hospitalizations. The data collection reveals we are making inroads on these issues. In evaluating our program in order to improve outcomes, we also look at the positive impact the treatment court has on the participants. In order for the program to succeed, a willing and committed trial judge is a key element. A valid question from a prospective, would-be, mental health court judge is “What is in it for me?”

When speaking to judges about mental health court, I invariably get at least one comment to the effect that “I am not a social worker.” I agree. There is a very practical way to look at cases involving these chronically mentally ill offenders. Recall the motor oil commercial in which the catch phrase was “pay me now or pay me later.” The same is true with this population. Most criminal courts have a core group of familiar faces. These persons often have mental health issues and a co-occurring substance/alcohol abuse problem. They cycle in and out of the jail and our courtrooms. They come in for a drug test failure on probation or a misdemeanor charge stemming from being off their mental health medicines. They are in jail for 60 to 90 days and we try to get them seen by a treatment professional. They are hard to deal with in the jail because of their mental state. When they finally get under appropriate medical treatment and stabilize, they are released from jail for time served or are restored to probation. Many times they leave the jail without medicines or the resources to get their medicines. In days or weeks, the cycle begins again. The judge is dealing with the mentally ill offender multiple times in a cycle. “Pay me now or pay me later.” Either way, the judge still has to deal with this chronically ill defendant. It can either be done on an ad hoc basis using a revolving door approach, or in a more stabilized and coordinated fashion.

Effective docket management is not the only issue for the trial judge. Related to the advantage of having a coordinated method for dealing with these cases is seeing tangible personal improvements. When studying before and after effects of mental health court participation over a two year plus period, we found the average felony participant occupied 136 days a year in our local jail before coming into the program. Many times this would be two or three, separate thirty to sixty day stays, a year, coinciding with outbursts stemming from non-compliance with medicines. Approximately forty-one percent of these chronic defendants were not rearrested after placement in the treatment court program. Even those defendants with repeat arrests experienced less prolonged jail stays. Our costly in-patient forensic bed stays at the state hospital dropped after the mental health court program got established. From a judge’s perspective, one can see positive results. Many times judges are handling so many cases that we deal with the immediate problem in litigation, but we never really know how it all turned out after the lawsuit. I analogize this to the job of mowing the lawn. One may hate the task, but there is a sense of closure to the job. You can see how the lawn looks when you start and how good it looks a couple hours later when finished. While you may have to do it again in a week or so, you get a sense of satisfaction out of seeing you got something accomplished. A mental health court judge can see improvement in these probationers’ lives, even in a short span of several months. They look better when they return to court for review hearings, they are staying out of legal troubles, and their lives stabilize.

As a trial judge, one can get tired of seemingly never-ending domestic disputes and the repetitive probation violations in criminal court. However, most judges have anecdotal stories where a parent approaches them years later in the grocery store advising that the judge had helped turn around their troubled teenager, who has now graduated from college and started a career. These events help carry and  re-energize a trial judge. Personally, and in talking with other mental health court judges, I find that I have a better energy level in dealing with these cases, because I see some improvement in the situation. I do not feel like I am just processing the next case on the docket. I can see improvement in the person’s case and in their living situation. When I started this program, I was surprised at the number of tired, senior citizen, parents, and family members, who are grappling with a loved one suffering from mental illness. It is not uncommon to see a couple in their late sixties or early seventies come to court at their wits end. They have a forty year old schizophrenic son they have had to continue parenting, since he became ill at age twenty three. Typically, this son would be looking at helping his aging parents with some issues. In this case, these aging parents have had to continue in the role of supervising their debilitated adult child, and they are losing physical and emotional capacity to keep it up. Seeing that the program is providing these frustrated family members some relief and assistance is rewarding for the judge. This also creates goodwill in the community, because many people have a friend or loved one with such a chronic problem, and the citizens believe that the judge is trying to make head way with this problem.

What is in it for me? Practical benefits include a more coordinated method of handling chronic cases the judge is going to deal with in any event, along with a reduction in the jail stays for these mentally ill probationers. Intangible rewards include a higher degree of satisfaction, because of the positive impact the program has on its participants and the relief it provides to friends and family members of the mentally ill offender.

In early 2006, our program was designated by the United States Department of Justice Bureau of Justice Assistance and the Council of State Governments as one of five national Learning Sites (Albany, Georgia; Bronx, New York; Akron, Ohio; Idaho Falls, Idaho; Reno, Nevada). This Learning Sites Initiative is part of an ongoing effort to collect data on these new mental health court programs that are rapidly cropping up across the country. Additionally, these five courts have agreed to share information and to serve as mentoring locations for jurisdictions starting new programs. More information about these programs can be found at http://consensusproject.org/mhcp/. The website for our program is http://albanycsb.org click on “treatment court.