counteract those disadvantages, but mentally ill
offenders typically have never been in treatment, do
not stay in treatment, or do not adhere to a treatment
regimen. Lack of appropriate mental health care and
social supports for these offenders has led to their
revolving through jails, hospitals, and the streets.
Because arrest and incarceration were not stopping
repeat offenses among this population, various juris-
dictions have developed new programs to divert them
from the criminal justice system into treatment.
Following the drug court model, more than 100 juris-
dictions since the late 1990s have established mental
health courts to address the root problem (mental ill-
ness and its disadvantages) with treatment, support
services, and court monitoring.Court Structure
Mental health courts follow the drug court model in
structure, having (a) a separate docket; (b) one or
two dedicated judges who preside at all hearings;
(c) dedicated prosecution and defense attorneys; (d) a
nonadversarial team approach involving consensus
decisions by criminal justice and mental health pro-
fessionals; (e) voluntary participation of defendants;
and (f) dismissed charges or avoidance of incarcera-
tion, depending on whether the defendant enters pre-
or postadjudication, after successful completion of the
mandated treatment plan.
Some mental health courts limit eligibility to misde-
meanors, some to felonies, and some take both levels of
offenses. Some take only nonviolent cases; but others
are willing to take violent cases, depending on the cir-
cumstances and approval of the victims. Some take
only defendants with severe mental illness, with or
without comorbid substance abuse, while others also
accept those with less serious disorders. Referrals come
most often from court officers or defense attorneys who
become aware of defendants’ mental disorders in
the course of usual criminal processing, although
some courts have systematic screening after arrest.
Acceptance of defendants into mental health court
requires approval by the mental health court team with
heavy reliance on mental health practitioners for clini-
cal screening and on the prosecutor for public safety
screening. Acceptance also requires defendants’ volun-
tary consent to participate in the court and willingness
to comply with their individual treatment plans and to
be monitored by the court with regularly scheduled
court appearances, varying in duration and frequency
among jurisdictions. Explanation to defendants of courtoperation is given by their assigned attorneys and com-
monly repeated by the mental health liaison during
screening and by the judge in open court, each time
obtaining reaffirmation of defendants’ consent.The Mental Health Court Team
In most jurisdictions, the mental health court team, con-
sisting of the dedicated judge; designated prosecutor
and defense attorneys; mental health liaison; and
providers involved directly in defendants’ care, such as
mental health care managers and clinicians, social
workers, substance abuse counselors, and probation
officers, meets to review cases on the docket prior to
every court session. They discuss each defendant’s
progress, cooperation with treatment, behavioral changes,
and any needed modifications in treatment or services,
then decide what the judge should say to the defendant
in open court to ensure compliance, such as give encour-
agement and praise, offer a reward, issue a reprimand or
warning, or apply sanctions. Team members anticipate
failure in this population and offer multiple second
chances. They stand ready to help defendants try again
but employ a variety of sanctions, such as increased fre-
quency of court appearances or reporting, curfews, and
even overnights in jail, to enforce compliance and max-
imize motivation to change.
Mental health team clinicians take primary respon-
sibility for designing treatment plans, which may
include medication, group and individual therapy,
anger management, substance abuse counseling,
Alcoholics Anonymous, Narcotics Anonymous, social
services such as housing and employment assistance,
and vocational training; but all members of the mental
health court team work in unity to provide structure,
supervision, and encouragement for each defendant.Hearings
In open court as each case is called, the prosecution or
defense briefly summarizes a defendant’s interim
report; however, it is the judge speaking to each
defendant directly about required treatment coopera-
tion and behavioral change who is the central player.
The judge attempts to engage the defendant in solving
practical problems that may impede compliance and
changes, encouraging an exchange by asking direct
questions about their well-being and progress toward
treatment and personal goals. Following the mental
health court team’s recommendations, the judge uses
praise, encouragement, stern lecture, warnings, orMental Health Courts——— 489M-Cutler (Encyc)-45463.qxd 11/18/2007 12:43 PM Page 489