Implementation of the National Judicial Task Force to Examine State Courts' Response to Mental Illness Report and Recommendations
The Task Force made a number of important findings with corresponding recommendations supported by over 100 resources for courts and our partner stakeholders. Each Behavioral Health Alerts revisits an original Task Force resource or a new resource that supports a Task Force recommendation.
Connecting Care for Better Outcomes Because multiple systems may be involved in a single individual’s case, judges have a unique opportunity to examine whether service providers for detainees, defendants, and inmates with behavioral health conditions are connected sufficiently to assure uninterrupted services and support during handoffs between systems. When such connections are absent or insufficient to promote successful transitions, continuity can be built into court dispositions. This Mental Health Facts in Brief reviews the meaning and significance of continuity of care for individuals moving among health, homelessness, criminal justice and other systems, and presents considerations for improving handoffs that may produce more beneficial individual and public outcomes.
Task Force Recommendations Implementation - Resources and News
Miami-Dade Judge Steve Leifman, Expert on Criminal Mental Health, Retires From the Bench Miami-Dade County Judge Steve Leifman has just stepped down from the bench after 30 years, effective December 31st. He’s internationally known for developing major reforms of how the criminal justice system deals with people who have mental illnesses; he’s even been honored by Pope Francis.
Research and Resources
How U.S. Jurisdictions Address Competence Evaluation and Restoration for Defendants Facing Only Misdemeanor or Low-Level Charges One potential strategy to address competence crisis—and perhaps the needs of some people with serious mental illness—may be laws and policies that address competence differently for defendants facing only misdemeanor charges. All state statutes that describe competence services were reviewed to consider whether and how states approach competence matters differently for those charged only with misdemeanors or lower-level offenses. It was found that most states (n = 29) have some distinct procedures for defendants facing only lower-level offenses, although the nature of these procedures, and which offenses qualify for the procedures, varies greatly. Among jurisdictions with distinct procedures, statutes typically alter competence evaluation procedures, timing of court proceedings, or restoration setting. Some jurisdictions allow for the dismissal of misdemeanor charges in certain circumstances. Overall, it appears that many jurisdictions are aware that misdemeanor offenses may warrant special approaches to competence services. However, given the gravity of the competency crisis—and the limits of competence restoration as a general psychiatric treatment strategy—even greater changes may be appropriate.
Community Integration of People With Disabilities A Quarter Century After Olmstead v. L.C. Olmstead established the principle that people with disabilities must receive state-funded supports in the “most integrated settings” — that is, within the communities where they live. Indirectly related to Olmstead, but highly relevant to its implementation, during the Spring 2024 Term, the Court issued opinions in Loper Bright Enterprises v. Raimondo affecting the role of agency regulations interpreting federal statutes and in City of Grants Pass v. Johnson upholding the criminalization of unhoused people, many of whom have disabilities. This short blog essay reflects on the convergence of these cases and their implications for the as-yet-to-be realized right of Americans with disabilities to live in the community.
Narrowing the "Medicaid Inmate Exclusion Policy" to Improve Continuity of Care for the Reentry Population Upon reentry to their communities, many individuals are left unsupported in vulnerable positions without health insurance or transitional medical care. The consequences for those with acute medical needs and mental health disorders—particularly those with substance use disorders—can be severe. Though countless policies, practices, and dynamics underlie this concerning status quo, this Article focuses on one in particular: the “Medicaid Inmate Exclusion Policy” (MIEP). This Article surveys these various MIEP-related legislative and regulatory efforts and analyzes their potential to narrow the scope of the MIEP to improve quality of health care for incarcerated people and continuity of care upon reentry. Ultimately, this Article recommends leveraging state regulatory law to improve continuity of care as a potential stepping stone to repealing or amending the MIEP.
2025 Practitioner Training Coordinators, Judges, and Defense Attorneys Registration is open and filling up for practitioner training from All Rise's Treatment Court Institute! Don't miss your opportunity to attend these four-day, in-person trainings held in Oklahoma City and facilitated by national experts. Research confirms that individualized training and role-specific education improves treatment court outcomes.
Reference Guide for Treatment Court Defense Attorneys This quick-reference guide is designed for defense attorneys to support effective representation of treatment court participants. The guide consists of three sections: communication, legal considerations, and treatment. Each section highlights current best practices and legal requirements while offering questions and recommendations designed to promote arguments or mitigation in the most common areas of contention. Each section of the guide is followed by references that provide more in-depth information on that topic.
Judicial Bench Card: How to Address Adolescent Substance Use From the Bench Many youth and families are affected by substance use disorders. According to the National Survey on Drug Use and Health, in 2023, 48.5 million people aged 12 or older in the United States met the criteria for a substance use disorder (SUD). Not surprisingly, the justice system encounters those suffering from SUD and must be ready to respond in a way that promotes public safety and offers effective solutions. This judicial bench card highlights ways a judge can identify adolescents needing treatment services, make referrals to qualified clinicians, engage individuals and families in a trauma-informed way, and provide motivation for successful treatment completion.
Emerging Trends in Research on Assisted Outpatient Treatment in the United States: A Narrative Review In this review, the authors used a narrative methodology and performed an interpretive synthesis of existing U.S.-based literature (2008–2023) on AOT implementation and outcomes. The search yielded 21 peer-reviewed articles published between 2009 and 2022 that assessed various aspects and outcomes of AOT. Although many of these studies generally supported the use of AOT, most used a limited data set (i.e., AOT program data from New York or Ohio between 1999 and 2007). Much of the latest research on AOT did not include attention to possible mechanisms to explain observed outcomes. The emerging literature suggests that increased outreach and less coercive tactics may lead to better outpatient treatment outcomes. However, more research, especially from the point of view of individuals enrolled in AOT programs, is needed.
Evaluating Assisted Outpatient Treatment Programs: Getting Started – AOT Evaluators The AOT evaluator is a key member of the AOT team who can help determine AOT’s impact on participants, ensure the program’s sustainability, and optimize service delivery for AOT participants. This paper is a guide for assisted outpatient treatment (AOT) evaluators written by Treatment Advocacy Center (TAC) in collaboration with several experienced AOT evaluators across the United States. The paper covers several essential topics for AOT evaluation including identifying data sources, collaborating with key stakeholders, and process evaluations.
Healing Over Handcuffs: Advancing Deflection Strategies What role does deflection play in substance use disorder (SUD) treatment? How are innovative deflection programs transforming the justice system? Find out during a new Wellbeing Wednesdays episode with Jac Charlier, MPA, Executive Director of TASC’s (Treatment Alternatives for Safer Communities) Center for Health and Justice and CEO of PTACC (Police, Treatment and Community Collaborative). Joined by National Council Vice President, Substance Use Continuum, Philip Rutherford, Charlier will share his experiences and provide insight into:
- The crucial role of deflection programs in reducing incarceration.
- The scope of SUD among justice-involved individuals and the barriers to treatment.
- The global impact of deflection on recidivism and recovery.
- The ongoing battle against stigma in SUD treatment.
National HSPA Webinar on Emerging Findings to Strengthen Housing, Health, and Social Care Partnerships The U.S. Departments of Health and Human Services (HHS) and Housing and Urban Development (HUD) will host a national webinar through the Housing and Services Resource Center (HSRC) to share the achievements states experienced throughout the 2024 Housing and Services Partnership Accelerator (HSPA) 12-month opportunity. Participants will learn about the growing array of HSPA and related HSRC resources to support state and local efforts to align housing, health, and social care. This webinar will discuss how cross-sector collaboration can improve the coordination of housing assistance and wrap-around services and supports as a cost-effective approach to assisting people with disabilities and older adults to transition from homelessness, exit or avoid institutional settings, and live stably in the community.
Innovative Guardianship Improvements: Electronic Systems to Better Support Court Monitoring (Webinar) Guardianship cases present unique challenges for courts, particularly due to the ongoing oversight required long after the date of deposition. Many courts have found it difficult to use their electronic systems to assist with this oversight. Join NCSC for our January webinar, where we will spotlight four courts that are building or improving their guardianship monitoring systems. Learn new strategies and system enhancements designed to support judges, court staff, and clerks in managing these complex cases more effectively.
Pretrial, Prosecution, Defense Counsel, and Courts Mentoring Initiative Mentor Site Application Deadline Extended The Bureau of Justice Assistance (BJA) and RTI International are seeking mentor sites to share their best practices and expertise with diverting justice-involved persons with substance use disorders to community-based treatment or connecting individuals to treatment and support services during the pretrial and court adjudication phases of justice processing. This program is part of the training and technical assistance (TTA) resources available to jurisdictions through BJA’s Comprehensive Opioid, Stimulant, and Substance Use Program (COSSUP).
CSG Justice Briefing Salt Lake City expands emergency response; Improving juvenile justice; 5 ways to improve behavioral health crisis response; and more.
In the News
Maryland Health Department Sued for Leaving Mentally Ill Criminal Defendants ‘Languishing in Jails’ A disability rights group is suing Maryland’s health secretary and health department in federal court for leaving mentally ill people accused of crimes to languish in jail rather than admitting them to psychiatric hospitals as required by state law. Maryland law requires the health department to admit defendants deemed incompetent to stand trial to state hospitals within 10 days of a judge’s order. In reality, that rarely happens. “More than 200 individuals charged by the State of Maryland with a criminal offense but determined to be incompetent to stand trial (IST) and a potential danger to themselves or others due to their mental health have been detained and are currently languishing in jails — some for weeks to months at a time,” the complaint says. “Notwithstanding its unambiguously clear statutory obligation to do so, the Maryland Department of Health has continuously failed to commit these individuals to an appropriate health care facility for purposes of treatment, as ordered by Maryland courts.” It takes the health department an average of 53 business days to transfer defendants deemed incompetent to stand trial from county jails to one of the five mental health facilities statewide.
A New Mississippi Law Aims to Limit Jailings of People Awaiting Mental Health Treatment. Is It Working? Officials say a new law to decrease the number of people being jailed solely because they need mental health treatment has led to fewer people with serious mental illness detained in jails – but the data is contradictory and incomplete. The new law went into effect in July 2024. Now, local community mental health center staffers screen people who are reported to be a potential danger to themself or others before they are taken into state custody and must note why a less restrictive treatment is not an option. A person cannot be held in jail unless all other options for care have been exhausted, they are “actively violent,” and never for more than 48 hours. Over 500 people were diverted to a less restrictive treatment than civil commitment, and 1,330 screenings for commitment by mental health professionals were conducted statewide during the first three months after the new law took effect, according to community mental health center reports.
Disability Watchdog Group Seeks Order to Find Oregon in Contempt of Court Disability Rights Oregon wants a federal judge to hold the state in contempt of court for failing to move people from jails into Oregon State Hospital for mental health care within a court-ordered deadline of seven days. Instead, they wait weeks to enter the Salem-based psychiatric hospital as their health deteriorates. In the past three years, at least two people died after extended waits in jail to enter the hospital and start mental health treatment.
Psychiatric Bed Shortage Is a Public Health Emergency Arizona is overflowing with private psychiatric hospitals for “voluntary” patients needing short-term stays. Alternatively, Arizona has a severe shortage of beds for dangerous and disabled SMI individuals who require months or years to stabilize on antipsychotic and mood stabilizing medications. However, the biggest problem masking Arizona’s extreme bed shortage is the thousands of SMI individuals incarcerated because of untreated illness. Failure to provide sustained competent SMI treatment and support is causing tragic outcomes, with mothers, law enforcement, and taxpayers paying a heavy price.
Chief Justice Debra Hembree Lambert Outlines Priorities for Kentucky’s Judicial Branch In 2025, Kentucky Supreme Court Chief Justice Debra Hembree Lambert is stepping into her new role as Kentucky’s first female chief justice. In an interview with The Bottom Line, she shared her priorities, her journey from attorney to becoming the state’s top judicial leader, and more. An issue of particular focus for Justice Lambert has been mental health. In 2022, the Kentucky Supreme Court launched the Kentucky Judicial Commission on Mental Health, comprised of leaders and stakeholders from various government, judicial, business, and nonprofit organizations. Though she is stepping down as chair of the commission, Justice Lambert will continue to participate and looks forward to the progress that will be made.
New York Lawmakers Gear Up for Mental Health Budget Battle Mental health and legal groups want New York lawmakers to think twice before backing Gov. Kathy Hochul's proposal to expand criteria for involuntary commitment or forcing someone with a mental health issue to be hospitalized for treatment. Hochul wants to strengthen Kendra's Law, which allows courts to order outpatient treatment for mental illness if a person is deemed a threat to themselves or others. The governor wants to improve the process for a court to order a person to participate in assisted outpatient treatment on the heels of brutal attacks in New York City by people with a history of mental illness. But nearly 20 advocacy groups wrote a letter to Hochul in opposition to the proposal, and they're hoping lawmakers follow suit. “Our folks are being targeted... and to round them up and force them into hospitals and outpatient commitment programs which have been proven not to work, we're looking to defeat those bills,” Alliance for Rights and Recovery CEO Harvey Rosenthal said.
Wellbeing
The Myth of the High-Functioning Lawyer Addict It is a myth that an individual seemingly functioning well at work could not also be suffering from addiction and severe emotional trauma. Maintaining a life of active addiction while working in a high-pressure field, such as law, frequently translates to leading a double life. Prevention efforts and treatment approaches for addictions are generally as successful as those for other chronic diseases. The good news is that by following these recommendations, lawyers with addiction do achieve better outcomes than the general population.
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