In the late 1960's, California's 33rd governor, Ronald Reagan, began to de-institutionalize mental health care in the state in favor of community-based treatment programs.  In many communities, however, these treatment programs failed to materialize, leaving people with mental health disorders with no place to go.  Homeless and mentally ill, some of these individuals landed in jail for misdemeanors and crimes they committed because of their diseases.  As a result, over the next three decades, California's correctional facilities saw an increasing number of mentally ill offenders pass through their doors.

In 1999, some California counties set out to combat this problem by creating mental health courts designed to keep mentally ill offenders out of jail and instead help them obtain treatment for their diseases.  San Bernadino County emerged as one of the leaders of this charge.

San Bernadino County's mental health court is modeled after drug court treatment programs that spread across the country in the 1990's with the aim of reducing inmate populations and recidivism by treating offenders with substance abuse problems rather than incarcerating them.

"[Drug courts] proved to be an incredibly effective way to solve the problems of addiction and criminality," said San Bernadino County Superior Court Judge Patrick Morris who runs the mental health court.

Many drug court participants, however, suffered from mental illness in addition to substance abuse problems and required a broader scope of treatment options than drug courts were designed to provide.

"That population of folks within the addict community who were dually diagnosed were being helped by a drug court, but not as effectively as they could have been," Morris said.  "There are special features about their problems and complications that made it desirable to have a separate experience for them."

San Bernadino County's mental health court was the product of this idea and offenders who qualify for the year-long, voluntary program are sent to mental health treatment programs rather than correctional facilities.

Involving the Mentally Ill

All offenders in San Bernadino County undergo a mental health evaluation when they are booked by law enforcement to determine if they are eligible for mental health court.
If they are not deemed eligible at that point, a prosecutor or probation officer can still refer them to the mental health court later on, if they see signs of a mental illness, but it is desirable to identify their mental illnesses right away, said Morris.  "We try to get them at the earliest moment."

Once an offender has been referred to the mental health court, the court staff review the case and decide whether or not he qualifies for the program.

Offenders are admitted to the program if they have a diagnosable Axis I mental illness such as schizophrenia, mood or anxiety disorders, certain impulse control disorders or major depression.  Although they can't have a history of violence, participants must have had frequent contact with the criminal justice system, the mental health system or both. 

"We essentially want to get the most bang for our buck," Morris said, calling offenders "frequent flyers" who continually return to the system.  "We wanted to deal with those who cost the system the most."

Because of this philosophy of addressing the needs of the county's most chronic and costly offenders, the mental health court typically deals with offenders who have committed felonies rather than misdemeanors.

"Those are easy calls," Morris said about dealing with misdemeanor offenders.  "They haven't documented themselves as real problems in the community," he said.  "We deal with far more serious offenders," he added.  "We get a better pay-off if we can resolve their issues."

The Road to Rehabilitation

Mental health court participants are ordered to rehabilitate at an augmented board-and-care facility as a condition of their probation.  Offenders are transported there directly from their arraignment to ensure that they begin their treatment.

"You put them out on the street and it's right back to the street life in a heartbeat," Morris said.  "It's very effective to have an unbroken chain of events," he added.  "The client views it as continued oversight."

The county has contracts with male and a female augmented board-and-care facilities and the mental health court is allotted 24 beds between the two.  Once offenders settle in, they start attending a day treatment program where they begin to confront a difficult issue: the fact that they have a disease.

"One of the biggest challenges is that a lot of these folks initially deny their illness," Morris said.  "[One goal of treatment is] to help them acknowledge that, like cancer, this doesn't go away."

Another goal in treating mental health court participants is helping them to re-connect with their families so that after they have completed the program, they will have a support system in place.

"You have to begin to rebuild a social structure for these folks," Morris said.

In addition to rebuilding their family lives, the program strives to help offenders become literate, obtain a GED or even pursue higher education in some cases.

"Some of them are remarkably brilliant," Morris said.  "They're good folks."

While in treatment, offenders are also urged to give back to the community by working at places like the Salvation Army or volunteering in a soup kitchen.  The experiences they gain there, Morris hopes, will give them the skills they need to stay active when their treatment is over. 

"We have them engage in a positive activities," Morris said.  "[So they have] something to occupy them constructively every day of their lives."

To urge them along and commend them for their accomplishments as well as to monitor their progress through the program, Morris sees offenders frequently during their first few months of involvement and then, later on, about once every other month.

"Once they've demonstrated improved conduct, they're given weekend passes to be with family and friends," Morris said.  And, when they are ready, we move them to sober living homes or they can go home to their parents, he said.

Each time a mental health court participant advances to another step in the program, by getting a job or becoming more independent, Judge Morris' courtroom erupts into applause.

"They just beam," Morris said.  "You have to be much more positive [with mental health court participants than with drug court participants.]  Positive strokes go much further."

This upbeat attitude helps to drive offenders through the program and, after a year, they graduate from mental health court.  Offenders are invited to speak before their families and friends at their graduation ceremonies, which are held quarterly in the San Bernadino County Board Chambers.

Since its inception in 1999, nearly 60 offenders have graduated from mental health court and, in the last four years, 76% of all graduates have not returned to the system.

"It's wonderfully humane," Morris said about the mental health court.  "I think that it is every bit as efficacious as the drug court model," he added.  "I would hope [mental health courts] would spread through the land."

Resources:

To learn more about the San Bernadino County Mental Health Court, go to www.courtinfo.ca.gov/programs/collab/mental.htm