Harvard Mental Health Letter

Mental health courts

Since the mid-1950s mental hospitals have been emptied without sufficient provision for the care of patients in the community. Too often, no one is taking responsibility for helping them. The institutions and organizations that are supposed to serve them don't exchange information or coordinate their work. And many patients will not consent to treatment at all.

So they have begun to fill our jails and prisons. About 15% of incarcerated persons are seriously mentally ill. It's estimated that more people with major mental illness (schizophrenia, bipolar disorder, or major depression) are detained in Illinois' Cook County Jail than are admitted to all the psychiatric hospitals in the state combined.

One solution being proposed is mental health courts — criminal justice without adversarial proceedings and with a therapeutic rather than a punitive purpose. The trend that led to the establishment of mental health courts began in the 1980s, as lawyers and judges facing a flood of mentally ill and addicted defendants began to reconsider the meaning of justice for these offenders. Mental health courts are modeled in part on the drug courts that have been providing treatment instead of imprisonment for addicts convicted of crimes since 1989. The first mental health court was established in Florida in 1997. Since 2000, the attorney general has been issuing grants to states and localities for demonstration programs, and as of mid-2006 there are more than a hundred in the United States.

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