1. David Meyer, J.D.David Meyer, J.D. Institute of Psychiatry, Law and the Behavioral Sciences U.S.C. Keck School of MedicineU.S.C. Keck School of Medicine dmeyer@usc.edu 818-257-1221 David Meyer, J.D. Institute of Psychiatry, Law and the Behavioral Sciences U.S.C. Keck School of Medicine dmeyer@usc.edu 818-257-1221

2. David Meyer, J.D. Institute of Psychiatry, Law and the Behavioral Sciences U.S.C. Keck School of Medicine dmeyer@usc.edu 818-257-1221 Problem-Solving and Collaborative Mental Health Courts: An Adjustment to Justice

3. Objectives Describe MHCs, their operations and related outcomes data Describe MHCs, their operations and related outcomes data I.D. some specific anomalies of MHC operations compared to traditional justice I.D. some specific anomalies of MHC operations compared to traditional justice Observe the apparent ethical and practice boundary “issues” Observe the apparent ethical and practice boundary “issues” Propose resolutions and solutions to the anomalies and issues Propose resolutions and solutions to the anomalies and issues

4. Welcome to My Bias I strongly believe in Problem-Solving, Collaborative approaches to justice I strongly believe in Problem-Solving, Collaborative approaches to justice A legal systems/lawyer perspective (adjusted for error) A legal systems/lawyer perspective (adjusted for error) Opportunities/Change Opportunities/Change My focus: rationalize practice boundaries and ethical challenges in Collaborative Courts My focus: rationalize practice boundaries and ethical challenges in Collaborative Courts

5. Adversary Courts Opposing “Sides” Opposing “Sides” Polarized Polarized Secrets Secrets Conflict Conflict Binary processes Binary processes Constrained by arcane historical rules Constrained by arcane historical rules Passive judicial role Passive judicial role Limited outcomes potential Limited outcomes potential

6. Why Think Differently? Insanity (Einstein definition) Insanity (Einstein definition) Adversary justice is inadequate to address mental health problems Adversary justice is inadequate to address mental health problems Institutional treatment does not work (in most cases) in terms of recovery and LTC Institutional treatment does not work (in most cases) in terms of recovery and LTC Cost: Cost: Systems redundancy Systems redundancy Expensive default Expensive default Poor systems linkage Poor systems linkage Time to follow the evidence Time to follow the evidence

7. MHC Evidence Decreased: Decreased: Re-arrest rate Re-arrest rate Number of arrests Number of arrests Incarceration days Incarceration days Increased: Increased: Linkage to services (all of them) Linkage to services (all of them) Non-custodial housing Non-custodial housing QoL satisfaction QoL satisfaction

8. History An iteration of Problem-Solving Justice derived from Drug Courts An iteration of Problem-Solving Justice derived from Drug Courts Created in Broward County Florida by Judge Ginger Lerner-Wren Created in Broward County Florida by Judge Ginger Lerner-Wren Early support from DOJ and Consensus Project Early support from DOJ and Consensus Project Losing their identity to other specialty courts, viz: veteran’s courts, community courts, homeless courts, elder courts… Losing their identity to other specialty courts, viz: veteran’s courts, community courts, homeless courts, elder courts…

9. Commonalities of MHCs A team approach that involves information sharing among judges, attorneys, probation staff, and mental health professionals A team approach that involves information sharing among judges, attorneys, probation staff, and mental health professionals Screening and assessment of the problem(s)occurs early in the criminal justice process Screening and assessment of the problem(s)occurs early in the criminal justice process Diversion from traditional criminal justice processing into treatment Diversion from traditional criminal justice processing into treatment Early intervention in the criminal justice process Early intervention in the criminal justice process An emphasis on problem solving and developing interventions/ treatment to reduce the likelihood of reoffending An emphasis on problem solving and developing interventions/ treatment to reduce the likelihood of reoffending A focus on continuity of care with treatment tailored to fit individual needs and circumstances A focus on continuity of care with treatment tailored to fit individual needs and circumstances

10. Commonalities of MHCs A strong focus on supervision A strong focus on supervision Defendants' understanding that the primary focus of the mental health court is on treatment and not adjudication of their case Defendants' understanding that the primary focus of the mental health court is on treatment and not adjudication of their case Understanding by mentally ill defendants that their participation in the mental health court is voluntary Understanding by mentally ill defendants that their participation in the mental health court is voluntary More personal interaction between the judge and the mentally ill defendant than in a traditional court More personal interaction between the judge and the mentally ill defendant than in a traditional court The use of rewards and sanctions The use of rewards and sanctions Restorative justice and victim involvement Restorative justice and victim involvement *Recovery, wellness & long-term mentality *Recovery, wellness & long-term mentality Ref.-- https://www.bja.gov/evaluation/program- adjudication/problem-solving-courts.htm Ref.-- https://www.bja.gov/evaluation/program- adjudication/problem-solving-courts.htm

11. Variability There are as many different types of MHCs and there are MHCs There are as many different types of MHCs and there are MHCs Entry criteria vary widely Entry criteria vary widely Different levels and types of staffing Different levels and types of staffing Dependent on judge’s (everyone’s) personality and approach Dependent on judge’s (everyone’s) personality and approach Measures and outcomes Measures and outcomes Sources of funding Sources of funding

12. Legal Sacred Cows Equal access/Equal Protection Equal access/Equal Protection Sixth Amendment issues: Sixth Amendment issues: Confrontation Confrontation Public proceedings Public proceedings Negates fact-finding function of criminal court Negates fact-finding function of criminal court Role of counsel; attorney no-no’s Role of counsel; attorney no-no’s Nature of “counseling” Nature of “counseling” Voluntary? Voluntary? Categorical funding Categorical funding

13. Clinical Sacred Cows Clinician-Patient bond Clinician-Patient bond Confidentiality and privacy Confidentiality and privacy HIPAA, W.I.C. §5328 HIPAA, W.I.C. §5328 Informed consent Informed consent Breadth of consent Breadth of consent Clinical practice limitations (boundaries) Clinical practice limitations (boundaries) Therapeutic no-no’s Therapeutic no-no’s

14. MHC Processes Consensus decision-making Consensus decision-making Judicial “activism” Judicial “activism” Boundary jumping Boundary jumping Role distortion Role distortion Long-term focus Long-term focus Interim and terminal rewards Interim and terminal rewards Mild and moderate sanctions Mild and moderate sanctions Tolerance for failure Tolerance for failure “External” individual and agency integration “External” individual and agency integration

15. Rationalizing MHC Conflicts Joint practice guidelines Joint practice guidelines “Internal” supervision “Internal” supervision “External” approval “External” approval Ethical and practice safe harbors Ethical and practice safe harbors Effective consents Effective consents Blended and joint-agency funding Blended and joint-agency funding Adversary system safety nets Adversary system safety nets

16. Resources National Center for State Courts (NCSC)-- http://www.ncsc.org National Center for State Courts (NCSC)-- http://www.ncsc.org http://www.ncsc.org Council on State Governments Consensus Project-- http://consensusproject.org Council on State Governments Consensus Project-- http://consensusproject.orghttp://consensusproject.org U.S. Department of Justice Bureau of Justice Assistance-- https://www.bja.gov U.S. Department of Justice Bureau of Justice Assistance-- https://www.bja.gov

17. David Meyer, J.D. Institute of Psychiatry, Law and the Behavioral Sciences U.S.C. Keck School of Medicine dmeyer@usc.edu 818-257-1221 Problem-Solving and Collaborative Mental Health Courts: An Adjustment to Justice