Implementation of the National Judicial Task Force to Examine State Courts' Response to Mental Illness Report and Recommendations

The Task Force made a number of important findings, with corresponding recommendations, supported by over 100 new resources for courts and our partner stakeholders. Going forward each Behavioral Health Alerts will revisit a Task Force recommendation and an accompanying resource.

Finding: Well-Being of Judges and Court Personnel Sixty-three percent of judges have at least one symptom of secondary or vicarious trauma and 50% of court child protection staff experience high or very high levels of compassion fatigue. Daily interactions with individuals, children, and families who are reliving trauma takes an emotional toll on justice system practitioners and places them at high risk for experiencing secondary trauma.

Recommendation: Courts should examine Task Force resources on the well-being of judges and court personnel that provide guidance, best practices, tips, and support for mental health. Courts should engage in an organizational assessment to gauge the strengths and gaps across areas of workplace mental health including leadership, access, culture, and awareness. Courts should promote best practices in the workplace including communicating effectively about employee assistance programs (EAP), lawyer assistance programs (LAP), and educational resources.

Courts should implement secondary trauma prevention and intervention strategies, including adopting policies that promote self-care, ensuring a safe work environment, providing secondary trauma education, establishing peer-mentoring programs, offering supportive services, and setting manageable work and caseload expectations.

Task Force Recommendations Implementation - Resources and News

2023: Hot Topics in State of Judiciary Addresses As of May 1, twenty-one chief justices delivered their state of judiciary speeches to their respective legislatures this year. These speeches generally describe the previous year’s accomplishments and outline several goals for the judiciary. Mental health was the second most prevalent topic, behind only judicial and staff salaries.

Top-to-bottom changes to mental health system needed, says expert May is Mental Health Awareness month, and emeritus scholar at the American Enterprise Institute, Norm Ornstein, joins Morning Joe to discuss necessary reforms to the mental health system. He highlights the Miami Model and the work of Task Force member Judge Steve Leifman.

Healing Minds NOLA Interviews Judge Leifman about the Miami Center for Mental Health and Recovery As we approach Stress Awareness Month in May, learn how Miami is helping its most vulnerable population take back their lives. Join me in welcoming The Honorable Judge Steve Leifman of the Eleventh Judicial Circuit as we discuss mental health in Miami’s homeless community and the opening of the Miami Center for Mental Health and Recovery, a pioneer facility that will change lives and assist Miami in achieving its goal of functional zero. The facility, I like to refer to as a resort because of its thoughtful decor and amenities, will be a one-stop shop for primary care and psychiatric services for unhoused people with acute mental illnesses who are in the criminal justice system or at risk of entering it.

Fall 2023 dates announced for visits to engage with the Miami Model In the past 15 months almost 300 individuals on teams from jurisdictions in 27 states have attended structured tours of the Miami Center for Mental Health and Recovery, and facilitated discussions about “what works” across the Sequential Intercept Model, as operationalized in Miami. These visits have served as the catalyst for dozens of new initiatives in those jurisdictions. To support and encourage even broader change, the National Center for State Courts will continue to coordinate these visits this fall. The visits are two full days, and are scheduled for October 26-27, November 8-9, and December 14-15. For registration information and to reserve a spot please contact Rick Schwermer at rschwermer@ncsc.org.

Research and Resources

Propelling Change: A Prosecutor Call to Action Propelling Change is a national call to action for prosecutors that aims to break the cycle of arrest and incarceration for people with behavioral health needs and change the status quo toward more fair, just, and equitable outcomes. By committing to support equitable behavioral health diversion efforts and work with partners to foster connections to community-based care, prosecutors can improve public safety in their communities, connect people to appropriate treatment, champion equity in diversion opportunities, reduce court backlogs, and save resources.

“People make mistakes” stakeholders and participants’ perceptions of the acceptability, appropriateness, and feasibility of diversion and deferred prosecution programs The current study contributes to the continuing process of deferred prosecution program implementation, evaluation, modification, and dissemination of evidence through a multisite investigation of DPP stakeholders’ perceptions of programming. Stakeholders and participants found DPPs to be acceptable, feasible, and appropriate based on their experiences of perceived benefits and challenges. Although the national adaptation of DPPs is in its early stages, DPPs are expanding considerably as criminal justice jurisdictions seek to identify more efficient ways to process cases and reduce incarceration rates while enhancing public safety.

Behavioral Health Conditions Reach Crisis Levels: Counties Urge Stronger Intergovernmental Partnerships and Outcomes This extensive NACo report finds that our nation’s counties are facing an acute escalation of the mental and behavioral health crisis, that limited access to services inhibits county residents from receiving the help they need, that the crisis is exacerbated by a lack of behavioral health workers throughout counties, and that while counties work to respond, the financial and human cost of behavioral health is compounding across all county systems, including courts, jails, law enforcement, and hospitals.

Equivocal findings in forensic evaluations One of the most vexing yet rarely discussed problems in forensic assessment is the equivocal result. Ultimately, data often lend themselves strongly to just one conclusion, or sometimes, with multiple evaluators, to competing conclusions. In a smaller number of cases, the data are equivocal; that is, they may be interpreted in several ways or fail to converge to a clear conclusion. We propose a typology and framework for conceptualizing equivocal data drawing on perspectives from the Federal Rules of Evidence and medical field while considering the incremental usefulness of those data in the decision-making process. We offer five alternate approaches to ethically and effectively navigate equivocal findings, including a discussion of when and how to defer an opinion for further inquiry and considerations for reporting and testifying about equivocal findings.

Mental Illness and Criminal Justice This paper assesses some of the critical issues relevant to the connection between the mental health and criminal justice systems. Throughout the entirety of this paper there will be a comparison between the Unites States, France, and the Netherlands. This article will examine the current statutes, case law, and public policies in place in the criminal justice and mental health systems. It will offer a comparison between the balance of needs of individuals suffering from mental health issues and the maintenance of public safety.

Jail Health and Early Release Practices People in jail have substantially higher levels of medical need than individuals in the general population, with large numbers having serious mental illnesses and substance use disorders. This Article describes insights from qualitative interviews with jail medical staff in four states, to explore what challenges face delivery of healthcare, but more specifically, when health-based needs require counsel releasing individuals from jail. The Article describes widespread informal and unwritten mechanisms for health-based releases from jails. The Article will present the data and how such practices have implications for reforming the legal rules surrounding jail healthcare.

SMI Advisor New Learning Portal is Now Live You may begin to register for upcoming live webinars and browse hundreds of OnDemand activities. Access our education catalog the same way you did before the transition via www.smiadviser.org and the SMI Adviser mobile app.

Limiting Employer Liability: Addressing the Perceived Risks of Hiring Workers with Criminal Histories This CSG brief examines the legislative action that states have taken to limit the risks—real or perceived—of negligent hiring liability faced by employers that hire workers with criminal histories. It also identifies models for reform that other states can use to mitigate that risk. Addressing this perception of risk can be of particular interest to courts and their behavioral health partners as they integrate peers into their workforces.

Prosecution-led Diversion: Best Strategies for Working with Persons with Substance Use Disorders Prosecutors are in a unique position to disrupt the revolving door of persons with substance use disorders (SUDs) into and out of jails. They can create “exits” by intercepting those with SUDs and referring them to appropriate community treatment programs. Prosecutor-led diversion programs can reduce the burden on the justice system while providing high- and low- risk individuals with access to needed treatment and recovery supports. This webinar will focus on sustainable diversion practices including the importance of using data, the target population for diversion, and program policies that prioritize treatment and recovery of participants.

Control, Connection and Meaning: Toward a Trauma Informed Approach Preventing trauma and correctly identifying and responding to it has tremendous potential to impact the physical, behavioral, social, and economic health of all. Kim Kehl brings his wealth of knowledge on trauma-informed care practices to the realm of AOT both in and outside of the court room. Join us for this webinar next Thursday, May 18 at 3 p.m. ET.

TAC Research Weekly: Intensive outpatient program reduces symptoms of psychosis The UCLA Thought Disorder Inpatient Outpatient Program utilizes Cognitive Behavioral Social Skills Training (CBSST), which is a combination of social skills training and cognitive behavioral therapy, as well as medication management. CBSST, combined with group therapy, case management, and medication management can greatly reduce symptoms in five out of the eight categories on the CRDPSS. Evidence also suggests that CBSST leads to improvements in social skills and daily functioning.

In the News

How WA seeks to stem flow of people from jails to state hospitals Washington state lawmakers wrestled with and ultimately passed a bill recently that is intended to ease a persistent crisis — the state is failing to provide required mental health services for people detained in jail and awaiting trial. The bill creates a new position for clinical intervention specialists — mental health professionals who have the ability to prescribe medication. They’d work at local jails to stabilize defendants awaiting trial. The specialists would be contracted or employed through DSHS and coordinate treatment with jail health staff and state hospital workers. It also prohibits jail and juvenile detention facilities from discontinuing psychiatric medication and requires courts to first consider diversion programs for people with nonfelony charges before sending them to a state hospital for inpatient services.

Behavioral Health, the Bench, and Beyond This Illinois courts newsletter details the numerous behavioral health-related initiatives currently underway, including updates on the Illinois Mental Health Task Force, and recent efforts to improve the competency to stand trial processes in Illinois.

Congress urged to tackle ‘ghost networks’ amid mental health crisis Medical experts urged Congress to hold insurance companies accountable for inaccurate medical directories that can hamper access for patients seeking mental health treatments. The problem, referred to as a “ghost network,” occurs when health insurance providers ostensibly provide coverage, but direct customers to nonexistent or unavailable doctors and providers. Committee staff found that more than 80 percent of mental health providers found in insurance directories from 12 plans in six states were unreachable, not accepting new patients or were not in-network, according to a secret shopper study.

What the Public Does Not Know About Involuntary Hospitalization The ethics of involuntary treatment are the same for psychiatry as for other medical specialties. The ethical principal is the same for psychiatry as for other branches of medicine: individuals with severe and life-threatening illnesses can refuse treatment, but only if they are in their normal state of mind to do so. They can refuse if and only if they are able to think through and implement the decisions they would make when in their healthy state of mind. Otherwise, family, medical professionals, or other legally designated individuals must make the decision on the patient’s behalf.

Chief Justice Paul Newby Proclaims May 2023 as Treatment Court Month for the North Carolina Judicial Branch “Treatment Court Month is our chance to celebrate the work of recovery happening in treatment courts across our state,” said Chief Justice Newby. “For 28 years, North Carolina's treatment courts have been working to restore lives and families and have expanded to include adult, family, and juvenile drug courts, mental health courts, and veterans treatment courts. I applaud our Branch’s personnel for their effort in this restorative work.”

County agencies working to reduce jail population with mental health strategies Jails are meant to be housing for the courts systems, but they have long been known as de facto mental health and detox facilities — an unofficial status that county agencies, judges, and members of the public advocating for jail reform have sought to change. Earlier this year, Montgomery County launched a task force to address behavioral health issues that have risen dramatically in the area since 2019. “There are people who touch multiple systems. They may or may not be restricted to mental health and criminal justice, so we invited a very broad group to our initial meetings to talk about who needs to be at the table, what systems need to be able to share data, and how might we come around that,” Jones-Kelley said.

How to build a mental-health system that saves people like Jordan Neely The death of Jordan Neely, a homeless man diagnosed schizophrenic, has prompted forceful calls for accountability. Neely deserved to be helped before it was too late. The public deserve to feel safe. These are not separate ends, and accountability is the solution for both. We need a public mental-health system obligated to prioritize individuals with serious mental illness in crisis.

Wellbeing

NJ Supreme Court forms committee on mental health in legal community The New Jersey Supreme Court formed a special committee that will develop a series of recommendations to help support the mental health of attorneys, judges and other members of the legal community. Chaired by Justice Lee Solomon, the broad-based group will examine specific risks faced by all law professionals and resources available for dealing with heightened rates of mental health challenges, substance abuse and self-harm so that it can identify strategies to address unmet mental health needs.

Maine Bar changes application questions about mental health after a discrimination complaint Applicants to the Maine Bar will no longer be asked about their history, diagnosis or treatment of mental health or substance use disorders following a disability discrimination complaint filed with the Maine Human Rights Commission. The Department of Justice has previously ruled that similar questions in other states violated the Americans with Disabilities Act. A mental health diagnosis does not correlate to inability to practice law. In addition, questions like these are a serious deterrent to people who need access to mental health and substance use treatment but are afraid to get that help.

Prioritize mental health in the workplace The idea is to create a culture that prioritizes mental health and fights the stigma of mental health. Make it clear to employees that you are there to support them in their mental health journeys. Promote and educate your workforce on the importance of good mental health practices. Treat mental health hand-in-hand with other wellness initiatives. Focus on stress and mental health management, not stigmatization. Create a healthy workplace culture of trust, encouragement and support.