June 26, 2001
BROWARD COUNTY (FLORIDA) MENTAL HEALTH COURT
By: Saul Spigel, Chief Analyst
You asked for a description of a Florida mental health court.
Broward County's mental health court was established in 1997. It was the first such court in the nation. It is a special division of the county criminal court that handles cases involving nonviolent, misdemeanor defendants identified as mentally ill or developmentally disabled. It is a voluntary pre-adjudication program, that is, it diverts people into treatment before they face trial if they agree to follow the court's direction. The court takes this approach as a way to avoid criminalizing mental health problems.
The court operates part time. Judge Ginger Lerner-Wren reports that she presides during lunch hours (she maintains a full-time criminal docket). The county court provides no additional staff. The state Human Services Department funds a full-time clinician, and the county social services department pays for 1.5 court monitors. The state paid $1.5 million to develop a transitional residential facility for homeless defendants and pays about $750,000 to operate it.
Potential clients are usually identified and referred to the court within 24 hours of arrest. Screening is conducted by a psychiatrist who works for the private firm that provides health services to the county jail or by doctoral students who are assigned to the Public Defender's office. These jail screening and pre-court evaluations determine whether a defendant is eligible to participate in the mental health court, is legally competent, or needs to be admitted involuntarily to a hospital.
Once deemed competent and eligible for participation, and after agreeing to it, the defendant, his family, court personnel, and clinicians determine the services the defendant needs. Most are referred to local community mental health centers where a variety of treatments are available. The court maintains a residential facility on the grounds of one of these centers for homeless defendants. Court monitors receive periodic reports from treatment providers, and the court holds periodic reviews during the treatment period to make adjustments as necessary. Typically, when the court determines a defendant has made sufficient progress it “withholds” his adjudication, meaning there is a record of the arrest and court disposition, but no judgment is entered.
The court took in about 650 new cases during the 1999-2000 fiscal year; about 30% ended with an “adjudication withheld” disposition.
Broward's court is one of four the U.S. Department of Justice looked at in 2000 report on “Emerging Judicial Strategies for the Mentally Ill in Criminal Caseloads.” The report is available at http://www.ncjrs.org/pdffiles1/bja/182504.pdf.
BROWARD COUNTY MENTAL HEALTH COURT
The Broward County, Florida (which encompasses the Fort Lauderdale vicinity) mental health court was established in June 1997. It was the first court of its kind in the nation. It grew out of (1) the findings of a county grand jury that was formed to investigate a series of incidents in 1994 involving mentally ill offenders, including several jail suicides, and (2) the subsequent recommendations of a multiagency task force that a county Circuit Court judge convened in response to the grand jury's probe. The grand jury found serious shortages of services for this population, particularly a lack of affordable housing. These factors led to a “revolving door” for mentally ill petty offenders.
The court's goals are to:
● Create effective interactions between the criminal justice and mental health systems
● Ensure legal advocacy for mentally ill defendants and that they do not languish in jail because of their condition
● Balance the defendants' rights with public safety
● Divert mentally ill defendants with minor criminal charges to community-based services and create centralized services to increase their access
● Reduce mentally ill defendants' contact with the criminal justice system
● Monitor the delivery and receipt of services and treatment
● Encourage defendants and their families to participate in court decisions
The court uses a team model in making intake, eligibility, evaluation, treatment alternative, and case management decisions. The team includes the judge, a prosecuting attorney, a representative of the county jail, the public defender, a court monitor, a forensic social worker, and a case manager. All are specifically assigned to the court and have considerable background, experience, and interest in the problems of mentally ill people in the criminal justice system. They are not rotated through other court assignments, so they gain even more expertise in this area.
Eligibility. The court accepts mentally ill, developmentally disabled, or brain injured misdemeanor defendants (a misdemeanor in Florida carries a maximum one year jail term). Mental illness is defined as an “Axis I” diagnosis, that is one that is usually first made in childhood; it includes schizophrenia, mood and anxiety disorders, some impulse control disorders, and major depression.
Because it was designed to deal with people who, because of their illness, return frequently to the criminal justice system, the court accepts defendants with prior convictions. Those whose criminal histories include violent crimes are carefully screened to avoid those who pose an extreme threat to public safety. But the court will admit some people with violent histories if they express a genuine desire to participate and do not present conditions that would prevent therapeutic success.
Intake. The court deals with defendants before they are tried. Instead of criminalizing their behavior, it attempts to link them to appropriate diagnostic and treatment services. Most clients are identified while in jail after arrest or at the probable cause, bond-setting hearing that is typically held within 24 hours after arrest. Referrals also come from judges in other courts and from police, family members, and attorneys dealing with defendants on pre-trial release.
Anyone who exhibits mental health symptoms during jailing or who admits a past history of mental illness is assessed by a psychiatrist employed by the private contractor that provides health services to the jail. Every morning, jail officials send a list of the previous day's detainees to two regional mental health centers to check against their records. And clinicians (mainly doctoral students from a local university) assigned to the Public Defender's Office screen defendants before the hearing. Those who are deemed stable are referred to the mental health court.
When an evaluation finds that a defendant poses a danger to himself or others the psychiatrist seeks an order to send him to a crisis center for treatment or evaluation for involuntary commitment. By law, the evaluation must occur within 72 hours of arrest. Patients kept at the crisis center for stabilization are returned to the mental health court when they are stabilized. Patients who are committed involuntarily are typically not returned to the court after their hospitalization (which may be for up to six months), and their criminal charge is usually dropped.
Competency. When a defendant is believed to be incompetent, the judge orders an evaluation. If he is found incompetent, the court orders a conditional release subject to treatment and supervision or outpatient services. An incompetent defendant who has no place to live is placed in the court's transitional housing facility, Cottage in the Pines. The state maintains jurisdiction over the defendant's case for 12 months during which time the court monitors his compliance with the release conditions and receives periodic reports on his progress. If he remains incompetent, the charges are dropped and he is evaluated to see whether civil commitment is necessary. If his competence is restored, he returns to court for disposition of his case.
Disposition and Treatment. Once competency is resolved, the court holds a probable cause hearing to review the basis of the charges. Defendants are told about the court's treatment process, what can be done for them, and what is expected of them. Family members are encouraged to participate in the hearing, which discusses the defendant's criminal history, public safety, what community services the defendant is looking for, and housing. The judge considers this information and that presented by the prosecutor, public defender, and mental health professionals to determine whether the court's services can help the defendant and what services might be needed.
The defendant's participation is purely voluntary. If he agrees, the state holds the charges in abeyance pending ongoing review of the defendant's treatment progress.
The court refers most defendants to two publicly supported community mental health centers. Their services include short- and long-term residential treatment, including supportive housing; substance abuse treatment; and assertive community treatment. The latter uses a community-based, intensive case management team that includes a psychiatric nurse, peer recovery counselor (someone who has been in treatment), a psychiatrist, and a case manager who support a small group of defendants on a 24-hour basis. The court has recently started a gender-specific program for female defendants with histories of sexual and assaultive abuse. It addresses physical and mental health issues as well as child rearing skills and other family issues. The court also operates its own transitional housing program, which is located on the grounds of one of the mental health centers. It contains 24 beds that can house defendants for up to five months.
Developmentally disabled defendants are referred to treatment through the Development Services Division of the state Department of Children and Family Services.
Monitoring and Dismissal. The court can monitor treatment for up to one year. A case manager stays in contact with defendants and makes sure the court's recommendations are followed. If violations occur, he reports to the court monitor who then asks the judge for a hearing to resolve the issue.
The court also holds regular status review hearings so the judge can review their progress. They typically begin at two-week intervals, and as defendants progress satisfactorily they are reduced to monthly reviews. During the review the court team seeks to resolve treatment-related concerns and criminal justice issues the defendant's may be facing and to encourage the defendant to continue participating fully in his treatment process.
Once treatment is completed (and after consultation with the treatment team, justice officials, and family), the judge can resolve the charges. Defendants with minor charges and no criminal history may have their charges dismissed with the prosecutor's consent. In most cases, adjudication is withheld, meaning there is a record of the arrest and court disposition, but no judgment is entered.
Defendant and Outcome Data
Between the court's inception in July 1997 and June 30, 2000, the court opened 1,534 cases. In FY 1999-00, it opened 632 new cases, an average of 54 a month. Nearly 70% of the defendants are men. Over one-third of the defendants are between age 41 and 54. A significant portion, 26%, is homeless.
Over half of the defendants (54%) in FY 1999-00 were diagnosed with a significant and persistent mental illness. Sixteen percent also presented substance abuse problems, but 40% acknowledged previous substance abuse (primarily alcohol).
The court's annual report contains the following outcome data (http://www.co.broward.fl.us./ojss/jsi00700.html).
Table 1: Broward Mental Health Court Outcome Data, FY 1999-00*
Time served, adjudication withheld
Inappropriate for Mental Health Court
Involuntary commitment after evaluation
Ordered for involuntary commitment evaluation
Linked with community mental health providers
Failed to appear in court after release on bond
Returned to jail on other charges
Awaiting competency evaluation
Refused community mental health services or to participate in Mental Health Court
Receiving private psychiatric care
* A defendant may be counted in more than one category.