Mental Health Court

The Mental Health Court as a problem-solving judicial system operates within the context of a comprehensive legal perspective that includes a humanistic, interdisciplinary, and therapeutic approach to criminal justice. The principles of procedural, restorative, and therapeutic forms of justice are applied relative to criminal court procedure in support of upholding the emotional and psychological health of individuals throughout the course of criminal proceedings.

The First District Mental Health Court is closely aligned with the fundamental objectives of this perspective, and embraces the overall concept as a foundation for the pursuit of mental health recovery and social reintegration of the mentally ill offender. In this sense, the Mental Health Court program brings together the interactive dimensions of the social, emotional, psychological, and behavioral functioning of the defendant into the dynamics of the legal arena, and shapes the experience of criminal justice as a therapeutic endeavor, whereby the court positions itself as an agent of change.

Eligibility for participation requires that the candidate have a serious and persistent mental illness condition and a current Axis I mental disorder (e.g., schizophrenia, schizoaffective disorder, Major Depressive Disorder, Bipolar Disorder, etc.) as the primary diagnosis. Less severe disorders (e.g., Dysthymia, Bipolar NOS, Generalized Anxiety, or Axis II mental disorders (personality disorders, developmental disorders, etc.) that are the primary focus of treatment, may not qualify as to either severity or persistence for program eligibility. Clinical eligibility is assessed prior to program acceptance and admission.

Additionally, candidates must be determined to be legally eligible to participate. Generally, the program is intended for individuals who are assessed as "high risk / high need" meaning high risk for reoffending (criminal recidivism), and high need for interventions to minimize the risk of reoffending. Measures of criminal risk (e.g., criminal history, substance use/abuse, criminal personality characteristics, pro-criminal patterns of association, etc.) are considered with respect to the assessment of high risk and high need.

Typically, the court will accept only Class A misdemeanors and felony offenses, although, violent offences and sexual offences may be grounds for program exclusion, as well as substance abuse offenses or conditions (e.g., substance addiction, DUI, etc.) that may fall within the jurisdiction of the County Drug Court program. However, all program referrals are screened on a case-by-case basis.

Program acceptance requires entering a plea of guilty, which is generally held in “abeyance” meaning that judgment and sentencing is postponed upon condition of compliance with Mental Health Court requirements and completion of the program. Following successful program completion, the defendant’s charges may be dismissed or eligible for a step reduction. As the Mental Health Court is typically a plea in abeyance system, offenses that are not legally eligible for plea in abeyance may be excluded from program eligibility (e.g., DUI offenses and sexual offenses).

A withdrawal of plea is not allowed if one terminates or voluntarily opts out of the program. In each case, the County Attorney must approve and recommend any entry into the Mental Health Court, and any step reduction or case dismissal. Removal or termination from the program short of graduation will result in a referral back to the traditional criminal justice system and the court of original jurisdiction.

Although final judgment and sentencing under a plea in abeyance program are held in reserve, this does not preclude the placement of participants under a probation agreement. All candidates admitted to the program are required to sign and adhere to a probation agreement through the Cache County Sheriff’s Office Probation services and/or the Department of Corrections, Adult Probation and Parole. The conditions of probation form a standard set of program objectives, adherence to which are ultimately necessary (among other requirements) for program advancement.

While a significant number of program participants have co-occurring conditions, substance related charges, and/or are assessed as having substance abuse issues, not all participants fall into these categories. However, as all participants are required to sign and adhere to a probation agreement, which agreement specifies the non-use or possession of alcohol or illegal drugs, all participants, whether having substance issues or not, are required to submit to random drug testing to help ensure compliance with this condition.

Admission into the Mental Health Court begins with the submission of a referral and application obtained from the District Court Clerk. Referrals are accepted from prosecuting attorneys, defense attorneys, or District Court Judges, but not from defendants or the general public. Program admission includes a series of steps as illustrated below, that ensure referrals are thoroughly reviewed as to the initial information needed to validate the candidate’s suitability for the program prior to conducting further eligibility assessments.

The referral process is not simply a rote exercise, but the first process that introduces the candidate to the program's Administrative Team, and the first opportunity to provide relevant information as to the candidate's need for, and interest in, the Mental Health Court program

Program participation for eligible defendants is a voluntary choice, it is not mandated as part of any court process or legal procedure. Entry into the Mental Health Court requires that program candidates sign a Mental Health Court Agreement that documents the defendant’s choice. This Agreement outlines the basic expectations for acceptance and involvement in the program. Signing the agreement acknowledges the candidate’s willingness to voluntarily participate in the program, while not signing the agreement indicates the candidate is electing to opt out of program participation.

Participants eligible for program admission are required to provide an Authorization for Disclosure of Information. This authorization allows for the exchange of relevant information necessary to conduct the program. Individual and case information is used by the Mental Health Court and Administrative Team for a variety of purposes, without which the program could not be adequately coordinated.

Generally, information is shared in administrative team meetings for purposes of program referral and admission, program advancement and monitoring for compliance with treatment, including participation and attendance, as well as treatment progress. Additionally, demographic and related participant data (categories of offence, types mental illness, termination rates, graduation rates, re-offence rates, lengths of program participation, etc.) are collected and analyzed relevant to program performance evaluations and outcome studies.

Finally, program ensures that confidentiality and security of participant information conforms to all applicable state and federal laws, including, but not limited to, Utah's Governmental Records Access and Management Act (GRAMA), the Health Insurance Portability and Accountability Act of 1996 (HIPAA), and 42 C.F.R. (Confidentiality of Substance Abuse Disorder Patient Records).

The Mental Health Court program is a process and not merely an event, where over the course time and through a series of phases, participants hopefully move forward in achieving mental health recovery while also distancing themselves from the risk of criminal recidivism. Fulfillment of these objectives relies on the moral relevance of truth and the willingness to change.

To help facilitate the consideration and commitment to truth and change, the court administers both a Truth Challenge and a Choice to Change Challenge as part of its admission process. These challenges represent positive affirmations of the participant's willingness to engage in the program within the contexts of honesty and integrity, which literally forms the basis for program success.

There are four areas of risk that are initially assessed prior to program admission, and revisited prior to each phase advancement. These areas include, criminal risk assessment, mental health assessment, substance abuse assessment, and situational status assessment (i.e., assessment of community supports such as residential status, health care, benefits, entitlements, employment, education, etc.). The program is focused on risk reduction in each program phase in each of the four areas of risk, so as to provide the best opportunity for continued success following program graduation.

Eligible candidates are further evaluated by a collaborative Mental Health Court Administrative team which consists of the District Judge and court clerk, representatives from Bear River Mental Health, Bear River Health Department (Substance Abuse Services), city and county law enforcement, Adult Probation and Parole, defense bar, and the Cache County Attorney's Office, among other allied stakeholders (e.g., Friends of the First District Mental Health Court and Utah NAMI).

The program's Administrative Team conducts a status conference prior to each court hearing, assesses program eligibility, approves program admission, evaluates participant progress, and determines eligibility for phase advancement and program graduation, among other administrative responsibilities.

As mentioned, the program's Administrative Team also includes representatives from additional community support systems that serve to enhance the program's resource capability. These include the Friends of the First District Mental Health Court and the National Alliance on Mental Illness.

• Friends of the First District Mental Health Court is a 501(c)(3) charitable organization supportive of the First District Mental Health Court programs currently in operation in the Cache and Box Elder County courts in Northern Utah. This organization is unique to the First Judicial District, and represents a vital resource appendage and addition to the program's ongoing development, its administration, and its expanded field of participant support services.
• NAMI (National Alliance on Mental Illness) is the nation's largest grassroots mental health organization dedicated to improving the lives of individuals and families affected by mental illness. NAMI Utah is an affiliate of the national organization and is an allied support service utilized by the MHC program. NAMI Utah offers a variety of resources designed to bring together people who live with the challenges of mental illness to empower individuals and families with the tools to build bridges of mental health recovery. NAMI Utah is an important allied support service utilized by the program to further the possibility of participant success.

The Mental Health Court team meets weekly prior to each court hearing for a status conference during which the team reviews the progress of participants on the court docket for that day. In this committee meeting the team receives input from treatment providers, probation services, defense counsel, as well as prosecution and law enforcement representatives currently involved in each participant's individual activity in the program. The status conference allows for a coordinated effort among committee members to reinforce program requirements and expectations, discuss and plan for participant needs, address program infractions and achievement, and determine each participant's service necessities.

Judicial hearings occur more frequently in the Mental Health Court than in the traditional criminal justice system. Generally, a weekly status hearing follows each Mental Health Court team meeting and serves as the forum for judicial interviewing of each defendant scheduled on the court docket for that day. The frequency of appearance for status hearings depends on the participant's current program phase, but are scheduled no less frequently than every four weeks until participants graduate.

The status hearing reinforces the seriousness of the participant's involvement with the criminal justice system and serves as a vehicle for individual progress reporting as well as a learning opportunity with respect to active, passive, or resistive program participation and their corresponding outcomes. All participants are encouraged and publicly supported in appropriate and responsible decision-making; however, participants may receive sanctions (including incarceration, and up to and including termination from the program) for failure to adhere to program expectations and conditions of probation, program infractions, and/or for violating the terms of their Mental Health Court agreement

The program duration is a minimum of 12 months and typically may require 18 months or more of participation depending on individual progress. The program has four phases and each phase will require completion of both standard and individualized program objectives. As participants advance in each phase, more is expected in terms of commitment and active participation toward mental health recovery and resolution of criminal risk. In turn, as participants advance, less is required with respect to court appearances, program supervision and monitoring, and court-imposed restrictions.

The program’s four phase system represents a stage-based design which utilizes a blend of stage-based models as a logical approach to the administration of therapeutic justice. Through the program's phase system, participants progress through stages of change while transitioning away from life-defeating conduct toward healthier and more productive values, behavior, and life-affirming choices.

This represents a paradigm shift to which the stage model of change is particularly suited. The participant's movement toward contemplating, preparing, making commitments, and taking action to change is a key program process. The role of the court then is to engage each participant, assess their readiness for change, and directly assist in the stage-based change process.

Marginal Gains philosophy is focused on making incremental improvements over time that are compounded as these improvements are repeated successively. This process reinforces the principle that success is the product of the continuous exercise of healthy daily habits, and not merely a single transformative event. Likewise, the course of the program, as an incremental journey through a series of progressive program phases, effectively mirrors the aggregate concept of a marginal gains system.

The Mental Health Court program as a whole is a systems approach to personal change focused on overcoming the risk factors that predispose mentally ill offenders to the threat of criminal recidivism. It is a systems-first risk management strategy of compounded growth to reach measurable outcomes in minimizing criminal recidivism and maximizing mental health recovery.

The risk of re-engaging in criminal conduct (recidivism) is an issue of serious public concern. The mental health court program is therefore a stage-based advancement program leading to sustained improvement in responsible living that will help minimize these risks.

In order to seriously impact the risk of recidivism, the scope of the program must include interventions that address the specific factors of risk and need that have been shown to play a direct role in a return to criminal conduct. To address and manage this risk domain, the program incorporates the Risk, Need, and Responsivity (RNR) model.

The Risk, Need, Responsivity (RNR) model is used to identify and address: (1) risks that increase vulnerability to criminal conduct, (2) needs, which represent functional gaps or deficits that predispose to criminal conduct, and (3) targeted response, or the application of interventions and services necessary to fulfill needs and thereby reduce criminogenic risk and positively impact the volume, rate, and frequency of criminal recidivism among the justice-involved mental health population.

The phase design of the program is incremental, meaning that it is an Iterative Model such that the system focuses on an initial, simplified implementation, which then progressively gains more complexity and a broader expectation set until the final system is completed in Phase 4, and the participant proceeds to graduation. Each program phase is an iteration; therefore, each phase is reiterated relative to the formation of standard and individualized objectives. This repetitive process represents a developmental lifecycle geared toward habit formation and human behavior change.

Program advancement involves a review by the Administrative Team and demonstration of completion or significant progress toward completion of the participant's standard and individualized objectives identified in each program phase. In each succeeding phase of the program, participants are assisted in the development of behavioral objectives as targeted responses to address risk and fulfill need.

From the point of program entry, participants begin to be emersed in the goal setting process so that by the concluding phase of the program, they are well versed and experienced in both the art and science of goal attainment and positive habit formation. In this way they are better prepared to approach daily living from the perspective that life is ultimately and perpetually a process of goal-directed action.

Graduation from the program is the overriding goal for all participants, however, eligibility for graduation applies specifically to participants who have completed all program requirements. In addition to completing both standard and individual objectives in each of the first three program phases, phase four includes the final requirements of completing an intentional life plan (i.e., how the participant intends to continue and sustain risk management supports).

Graduation is viewed from the perspective of the concept of valediction. Valediction represents a farewell and celebration of the participant's attainment and status as a program graduate or valedictorian. Successful program departure is an ending as well as a beginning, which more appropriately fits the recognition of the end of formal program participation and the beginning of more productive and meaningful living apart from involvement in the criminal justice system.

As stated in the introduction, the Mental Health Court is a "specialty court" that attempts to balance the need for criminal justice with the need for mental health recovery. To address both needs, the program has been designed so as to blend these two systems, whereby the needs of one neither precludes nor excludes the needs of the other. Responsibility for criminal conduct does not exclude considerations of mental health, and mental health concerns do not preclude attention to criminal responsibility. The successful work of both criminal and mental health risk reduction is the program goal, to the benefit of both the individual participant and society as a whole.

First District Mental Health Court Clerk (435-750-1300)

The District Court Clerk for the Mental Health Court manages the program's court docket, case files and progress scorecards, admission process tracking, as well as the program's referral, application, and admission forms and processes. The District Court Clerk may provide further information with respect to program referral and application as well as general information regarding court hearings.

County Attorney's Office (435-755-1860)

A Deputy County Attorney is assigned to the Mental Health Court and represents the prosecutorial arm of the program. The County Attorney's office may provide further information regarding legal eligibility, case processing, criminal procedure in the Mental Health Court, and legal outcomes with respect to program graduation or termination.

Bear River Mental Health - Mental Health Court Liaison (435-752-0750)

Bear River Mental Health (BRMH) functions as the program's primary mental health treatment provider, and assigns a specific staff representative that participates as a member of the program's Administrative Team. This individual is responsible to ensure that there is continuity between the court program and the clinical treatment program. The BRMH liaison may provide information regarding program eligibility, referral, admission, advancement, and general treatment services and treatment requirements.

Bear River Health Department, Substance Abuse Services - Mental Health Court Liaison (435-792-6500)

The substance abuse counseling arm of the Bear River Health Department (BRHD) serves as the substance abuse treatment provider for the First District Mental Health Court, and provides a representative to sit as part of the program's Administrative Team. This individual provides continuity between the court program and substance abuse services received by program participants with co-occurring mental health and substance use/abuse conditions.

The BRHD liaison may provide additional information regarding substance abuse treatment, drug testing protocols, medication assisted therapy, distinctions between drug court and mental health court, and other details specific to substance related issues.