Florida Partners in Crisis

Judge says teamwork makes St. Lucie County Mental Health Court work

April 20, 2010

Cox gives congratulatory hug to mental health court graduate Kristina Kamann, while Yuri Cormier waits for his certificate

Circuit Judge Cynthia L. Cox says the one day a week she presides over the St. Lucie County Mental Health Court is the "most fulfilling" time she spends as a judge.

"It's an awesome feeling to see these people succeed…to have people come up to you and say, 'Thank you, you changed my life.'"

Operated by St. Lucie County, the mental health court began in June of 2006 as a diversionary program for people diagnosed with a severe mental illness or developmental disability who were charged with either a misdemeanor or felony. 

The initial mental health court program was expanded after the county received a Criminal Justice Mental Health and Substance Abuse Reinvestment Act implementation grant in July 2008.

When planning on the program began, the county jail was overcrowded and the area's community mental health system was backed up, according to Lisa Fonteyn. Fonteyn is director of the 19th Judicial Circuit Office of Public Defender's Client Services Program, which plays an integral role in the mental health court program.

The jail population was 1,500 when the mental health court began operations, Fonteyn said.  It is now averaging about 1,300 inmates. Over 20% of them have a severe and persistent mental illness, she said. 
Since its inception, more than 900 people have been diverted into the program. The caseload consistently averages about 200 people.

Offenders facing both misdemeanor and felony charges are eligible. About 45% have been charged with felonies; and about 55% with misdemeanors.  Of those with felony charges, most are in the program as a condition of probation.

The mental health court also provides monitoring and supervision for defendants on conditional release because they have been found to be not guilty by reason of insanity or incompetent to stand trial and for other who are on probation but need services and treatment to succeed. 

Fonteyn said that about 70 to 80% of participants also have a co-occurring substance use disorder, so the program provides substance abuse treatment to those who are uninsured or can't afford to pay for treatment. 

Analysis shows reduced jail time for graduates

One example of the mental health court's effectiveness is a random analysis of recidivism among 50 people who had graduated from the mental health court as of May 2009. Prior to enrolling in mental health court, the group had collectively spent 446 days in jail. After completing the program, they spent a total of 15 days in jail. 

Overall, the recidivism rate of graduates varies from month to month. Currently, it is only 7.2 percent. 

"It's a huge tax savings to the citizens, and it's also a safety issue" said Judge Cox, who led the effort to establish the mental health court. "It costs about $130 a day to house someone with a severe and persistent mental illness at the St. Lucie County jail, including the cost of medications."

Leifman

Cox credited Miami-Dade Judge Steve Leifman, who is a special advisor on mental health to the Florida Supreme Court, with planting the seed for the idea. She saw Leifman at a conference and his message about finding alternatives to jail for people with mental illnesses struck a chord with her. (See video clip of Leifman interview at YouTube.)

Cox said it took some time to convince local policy makers "to understand that it's cheaper to treat and solve someone's problems than to incarcerate them. We had to try to show them that it would be cost-effective.  At the time, no one else was doing this same model."

"These people have had the cards dealt against them," Cox said, noting the high incidence of co-occurring substance abuse disorders among mental health court participants. "Are we going to let people with mental illness be incarcerated when they didn't realize what they were doing because they were sick?"

"Our mental health court team is what makes the difference," Cox said. "It's a specialized and cohesive team and each of us contributes something that's unique. The buy-in from every agency is really the key."  

In addition to Cox, the team includes representatives from the Offices of the Public Defender and the State Attorney, the Department of Children & Families Substance Abuse and Mental Health Program, jail personnel, New Horizons of the Treasure Coast, the area's community mental health agency, transitional housing/faith-based providers and substance abuse providers.

Public Defender's Office provides services

At the core of the mental health court is the Client Services Program operated by the Office of Public Defender Diamond Litty. The program provides court supervision and social services for participants through a collaborative partnership with state, county, and local non-profit service agencies.

After someone is referred to the program, a needs assessment is conducted by a mental health court case manager within seven days after the referral. Clients in jail who need medications prescribed are seen by the jail psychiatrist or an ARNP, while the team arranges a psychiatric appointment at New Horizons for those who are not in jail. The case managers also immediately assist them in applying for or reinstating any eligible benefits.

Mental health court team members work with clients to develop a Plan of Care that outlines specific treatment and support services needed to achieve stability and independence, as well as the conditions of supervision. While a minimum of six months is required for the program, the length of stay depends upon the severity of the clients charges, and their progress in meeting treatment goals.

Those clients who successfully complete the program receive a Certificate of Graduation signed by the judge and, following review by the State Attorney, the graduate's charges are either dismissed or documented as "time served."

The mental health court contracts with New Horizons for the team's clinical staff. There are four case managers— two are court liaisons and two are service engagement case managers who focus on helping people get benefits they need to live independently, along with making home visits and medication checks. The team also includes two peer specialists and a licensed mental health clinician. 

A shared database that allows court, jail staff and providers to stay updated on participants and their progress is also an important tool for communicating and coordinating among team members.

Clients are seen every week when they first come into the program, then the level of support gradually tapers off to bi-weekly and then monthly. Transition team clients who would have been eligible for graduation but are having difficulty in adjusting to independent living are seen every six weeks until their issues are resolved. 

Housing is a critical to success

Housing is critical to the participants' success, according to Anne W. Posey, the mental health clinician who is program manager for the New Horizon’s mental health court staff. Unless the client has safe and stable housing, it's difficult to effectively provide treatment and other supports, she said.

The county contracts with three nonprofit community providers to provide transitional housing for mental health court participants. Transitional housing is funded through a combination of grant money and county funding. When clients have the ability to contribute, they share in the cost of their housing.

There are usually 15 to 20 participants in the housing program, with the average stay from two to three months, Posey said. Those who are still in transitional housing after three months are evaluated to determine what stumbling blocks are preventing them from moving out on their own.

Posey said that since many mental health court participants can't afford substance abuse treatment and there is a lengthy waiting list for indigent care, some of the grant money goes for treatment. The housing providers also offer some type of support through Alcoholics Anonymous or their faith-based curriculum. 

Program participants are referred to the state Division of Vocational Rehabilitation and the state's Workforce Solutions program for help in getting a job/job training or education. A couple of participants attend Indian River State College; one is in barber school, Posey said.

Baker listens to speaker at picnic for mental health court participants

 "I've seen a lot of successes—that's one of the joys of this job," said Lewis Baker, one of the peer specialists on the mental health court team.

Baker, 43, is also one of those successes. He graduated from the mental health court in January, 2009 after three years with the program.

During that time, he learned to manage the symptoms of his bipolar disorder and the angry outbursts that sometimes got him in trouble with the law. He also learned to overcome his fears of interacting with others in the community and of living alone. For the first time in his life, he now lives in his own apartment.

Like many of the people he now helps, Baker said he was unemployed, living with relatives and didn't have a car to get to appointments with his doctor or other treatment providers. He said his illness took a back seat to "just trying to live."

Baker leads two groups a week, helping clients understand and cope with their illnesses and develop a wellness plan as a guide to their recovery. Since many of the people he works with have been homeless and out of the mainstream of the community, much of their time is spent on such basics as how to keep track of medications and how to use public transportation.

"We deal with a lot of fears," he said. "Some people are afraid to get on a bus and go pay a light bill or they're afraid to live alone. We encourage them to be able to get up in the morning and get to the bus and go to the doctor's office or to the courthouse to see the judge."

But a continuing concern is how people in the community will react to them as people with a mental illness who have been involved with the justice system. "I wish that people would understand that a person with a mental illness can function in the community," Baker said.