John was in police custody and did not want to be brought into the courtroom. He had received two citations and seven charges in warrant status. He also had a history of mental illness.
Daniel was an older man who had been homeless for years and lived in a box in front of a local high-end shopping center. Over time Daniel had picked up multiple charges and was deemed a “public nuisance.” Daniel also had schizophrenia. He would go to a local mental health center each Monday to take a shower, but he would not engage with any social services while he was there.
Cases such as those of John and Daniel prompted Kansas City, Missouri, to institute a mental health court in 2002. The court diverts individuals such as John and Daniel out of the criminal justice system and into a supportive environment where they can receive the services and resources necessary to lead a productive life. Legal Aid of Western Missouri has become an important component of this mental health court system.
Jackson County, Missouri, which includes Kansas City, has more than 30,000 residents with a mental illness. On any given day at least 50 percent of the Kansas City jail population has some type of mental illness. Many of them are frequently arrested, and those arrests add up to cost the city a great deal of money. A single incident involving a homeless person—many of whom have a mental illness—in which first responders are called can cost several thousand dollars. A local documentary, Lost Minds: KC’s Mental Health Crisis, shows the city’s serious mental illness problem and what is being done to remedy it.
Meeting the Need
In the early 2000s a family member of a person with a mental illness slipped a newsletter under the door of Richard Nadeau, a Kansas City psychoanalyst. The newsletter detailed a mental health court program in Florida. Nadeau took the idea to Katherine Shields, the Jackson County executive, who then appointed a committee to research the possibility of forming a mental health court in Kansas City. At the time there were only four such mental health courts in the country.
The committee began studying the four established mental health court programs and started collecting the necessary resources to get started. The committee gathered input from many community players, including the Missouri Department of Mental Health, the Jackson County Community Mental Health Fund, community mental health agencies, and the National Alliance on Mental Illness. The committee involved the Jackson County circuit and municipal courts. The group decided that the municipal courts of Kansas City and Lee’s Summit would implement the first mental health court programs in Jackson County.
The committee secured three years of guaranteed funding from the Jackson County Community Mental Health Fund and the Jackson County antidrug tax. Judge John B. Williams was selected as the Kansas City municipal court judge to preside over the program. Swope Health Services was the first agency to earn a contract to monitor participants who entered the program. Legal Aid of Western Missouri received a grant to represent indigent defendants entering the Kansas City mental health court program. As the program grew and more participants entered the program, the need for community support increased. Three other community mental health agencies received contracts to monitor participants throughout the program. Legal Aid increased its representation and added a second mental health court attorney.
Legal Aid’s Role in Mental Health Court
The mental health court team at Legal Aid is two attorneys—Danielle Elam-Jobe and I—and our paralegal, Pam May. Clients are referred to us from mental health agencies, Kansas City municipal court judges, probation officers, and crisis intervention officers, to name a few. However, most referrals come from our colleagues on the municipal defense unit at Legal Aid. Often after our colleagues converse with certain defendants or observe their behavior, our colleagues will call us in to speak with the defendants to see if they likely qualify for the mental health court. To qualify a defendant must have a serious and persistent mental illness, a city ordinance violation in Kansas City, Missouri, and an interest in receiving treatment.
After we determine that a client likely qualifies for mental health court and the client has demonstrated an interest in the program, we begin the referral process and request a mental health court date. We send a referral to the participating mental health agencies to give them the client’s basic information and allow them to come to court prepared with any notes they may already have on the client. At the client’s first mental health court appearance, the client will be connected to the appropriate mental health agency based on the client’s residence or catchment area. The agency will then ensure that the client has a diagnosis that qualifies the client to participate in mental health court. The most common diagnoses I see in mental health court are schizophrenia, bipolar disorder, posttraumatic stress disorder, and co-occurring disorder, which is a serious and persistent mental illness along with substance abuse.
Once the agency determines that the client does in fact have a qualifying diagnosis, Legal Aid works with the city prosecutor to determine if the client is legally eligible for mental health court. The court began as a diversion-only program, which meant that upon successful completion of the program, the client’s charges would be dismissed. However, over the years court officials determined that a probation track needed to be added to allow participation by those clients who would otherwise be eligible for the program but for either their criminal history or the nature of their charges.
If the client is deemed both clinically and legally eligible for mental health court, either Danielle or I have a conversation with the client about the legal ramifications of entering mental health court. We discuss the requirements and expectations of the client throughout the program. Mental health court requires monthly court appearances, monthly meetings with the client’s court monitor (a qualified mental health professional from the supporting agencies), medication compliance, and compliance with any therapy and medical appointments. Mental health court participants must complete urinalysis or breathalyzer tests or both. Participants may be required to complete substance abuse treatment. The minimum length of time required to complete the program is six months; however, the average length of time a participant spends in the program is eleven months.
When a diversion client completes the program, the client is released from the program and all charges against the client are dismissed. When a probation client completes the program, the client is released from court appearances and continues on probation until the end of the probation term. However, the judge considers each participant on a case-by-case basis. When a participant puts a great deal of effort into the program, the judge will often terminate the probation early to reward the participant’s behavior and effort in the program. Some mental health court participants go above and beyond the program and make drastic changes in every aspect of their lives; closing the probation early is a great way to reward such behavior.
While Legal Aid does not represent every defendant who goes through mental health court, we do represent a vast majority. Legal Aid represents those clients who are indigent and cannot afford to hire private counsel. The clients I represent often face many problems—unemployment, homelessness, domestic violence, lack of health benefits, guardianship, lack of competency—in addition to their mental illness. Homelessness or lack of stable housing is a persistent issue that affects clients’ emotional stability and physical well-being. Similarly many participants need medical coverage to pay for mental health treatment. Although some clients may know about Social Security Disability Insurance (SSDI) and Medicaid, many do not know how to obtain these benefits, particularly if their benefits applications had been denied or if their benefits had been terminated. Our team will refer clients to different Legal Aid attorneys for assistance on Medicaid and SSDI appeals, housing matters, or orders of protection for victims of domestic violence.
Although most of my clients are mental health court participants, some are too ill to participate or too incompetent to be ethically enrolled in the mental health court program. In these circumstances Danielle and I work with the city prosecutors to devise a plan to meet the city’s need to protect the community and at the same time to get the client connected to desperately needed services. Clients often get engaged with one of our agencies outside court, and with the appropriate releases the agency will report to the prosecutors on the client. After a period of reported compliance, connection with needed services, and no additional charges in the interim, the city will elect to dismiss the charges against the client.
We have seen real success stories come from mental health court. Take, for example, the cases of John and Daniel.
Legal Aid was assigned to represent John, the client who was in police custody and did not want to be brought into the courtroom. We worked to have his charges transferred to the mental health court. Engaging John in mental health court took several months, but he was finally admitted on the probation track. John was connected to a court monitor, who ensured that John saw a doctor and took his medications as prescribed. As part of his mental health court service plan, he was connected to a community support specialist—a caseworker—who helped him obtain stable housing and guided him to learn basic life skills such as how to use a microwave and how to manage money. During one visit to John’s apartment his caseworker noticed that John’s bed looked untouched. After asking John about this, the caseworker learned that John had been sleeping on the floor. His caseworker was heartbroken to discover that John had been homeless for such a long period of time that he felt more at ease sleeping on the floor than on a bed. As a result of his participation in mental health court, John’s mental health was stabilized, and the quality of his life was greatly improved by being linked to community services, obtaining housing, and starting classes at a local community college. And John is now sleeping in the comfort of a bed. With the patience and dedication of the mental health court team, John graduated from mental health court, and his charges were resolved.
As for Daniel, the client who would shower at a mental health center but would not engage with any services, after many attempts from different individuals at the mental health center and Danielle and me, he finally agreed to give mental health court a try. He entered the program on the diversion track. He appeared in court, took his medication, and worked to the best of his abilities with his mental health provider. After a great deal of time working with him, we learned that he was receiving SSDI and that a family member was his court-appointed payee. When his SSDI benefits arrived, Daniel would go to the family member’s house and would be given alcohol, while the family member would take most of Daniel’s money and tell him to leave. He was not allowed to return to the family member’s house until his SSDI check arrived the next month. Nearly a year after entering mental health court, Daniel graduated from the program. By that time he was living in a group home, was medication-compliant, and had assigned a new SSDI payee. He has not picked up any new charges in over a year and is still doing well.
The Research Development Institute, the agency responsible for collecting data on Kansas City’s mental health court, reports a recidivism rate of only 8 percent of the 77 participants who completed the program in 2013. That is, only 6 of the 77 graduates picked up a subsequent charge within a year of completing the program. By comparison, 21 of the 44 participants who entered but did not complete the mental health court program picked up a new charge within a year—a recidivism rate of 47 percent (Research Development Institute, Jackson County Mental Health Court 2014 Annual Report).
More communities across the country should consider implementing a mental health court to end the criminalization of mental illness and instead help individuals with such an illness access the treatment they need.
Mental Health Court Attorney, Municipal Defense Unit
Legal Aid of Western Missouri
1125 Grand Blvd. Suite 2000
Kansas City, MO 64106