New Laws Make Changes at the Intersection of Criminal Justice and Health Care

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 new resources for courts and our partner stakeholders. Going forward each Behavioral Health Alerts will revisit a Task Force recommendation and an accompanying resource.

Finding: Key Questions All Courts Must Ask – Data and Information Sharing Information sharing within and across systems utilized by courts and behavioral health agencies is inadequate, undermining opportunities to identify issues, target resources, and improve system responses.

Recommendation: Courts should lead and support the identification of appropriate data, as well as data collection and information-sharing opportunities across the community, behavioral health, and justice systems as a critical part of developing a comprehensive and collaborative continuum of behavioral health services.

Courts should review data about the prevalence of people in the United States living with serious mental illness (SMI) and substance use disorders (SUD) and ensure that comparable state and local prevalence data is being compiled. Courts should also collect data specified in the Behavioral Health Data Guides and other Task Force resources. Courts should assess the current state of data sharing between the court, jails, other justice partners, and community providers to identify gaps in needed data and assess whether there is a place to capture these data in the current court case management systems.

Task Force Recommendations Implementation – Resources and News

New laws make changes at the intersection of criminal justice and health care Vermont S.91 makes several changes in the procedures around court-ordered competency evaluations. Specifically, it separates the process for competency hearings from the process related to seeking a defense based on insanity, and directs the Department of Mental Health and the Department of Aging and Independent Living, or DAIL, to report on a framework for competency restoration by November 15. In addition, S.91 also clarifies that a court may order subsequent evaluations after an initial one, but only if there is clinical evidence that a person’s competency may have changed. It also allows an arrest warrant to be issued for a defendant who fails to appear for a competency evaluation. Finally, the law allows the Department of Mental Health to contract with doctoral-level psychologists trained in forensic psychology to conduct competency evaluations for one year, while the Joint Legislative Justice Oversight Committee considers whether this change should become permanent. Currently, Vermont is one of just a few states that requires evaluations be performed only by psychiatrists, but the department was recently held in contempt of court in part because of an ongoing backlog of evaluations.

Fall 2023 dates announced for visits to engage with the Miami Model In the past 15 months almost 300 individuals on teams from jurisdictions in 27 states have attended structured tours of the Miami Center for Mental Health and Recovery, and facilitated discussions about “what works” across the Sequential Intercept Model, as operationalized in Miami. These visits have served as the catalyst for dozens of new initiatives in those jurisdictions. To support and encourage even broader change, the National Center for State Courts will continue to coordinate these visits this fall. The visits are two full days, and are scheduled for October 26-27, November 8-9, and December 14-15. For registration information and to reserve a spot for you and your team please contact Rick Schwermer at

Research and Resources

Leveraging the Strengths of the Behavioral HealthChoices Program to Support Integrated Care in Pennsylvania To inform efforts to improve access to integrated care in Pennsylvania, this Center for Health Care Strategies report explores the national behavioral health integration landscape, reviews key characteristics of Pennsylvania’s Behavioral HealthChoices Program, and highlights innovative county-based programs across the state. It draws from state and national lessons to outline six broad opportunities to build on strengths of the HealthChoices system, leverage new federal flexibilities, and pursue policies to better facilitate integration. While focused on Pennsylvania, this resource offers relevant insights for stakeholders nationally.

Fixing the Competence Restoration Process Over the past decade, both the frequency of referrals and the rates of findings of incompetency have skyrocketed across the United States. As described in the article “Standing Tall: A New Stage for Incompetency Cases,” in the June 2022 Monitor, the reasons for this surge are complex and thought to be the result of the shuttering of long-term civil mental health beds and the ensuing cascade of events, including insufficient community treatment services to address the increase in demand. Jails have evolved as the de facto mental health hospitals for pretrial detainees.

TAC Research Weekly: Reasons for arrest among people with severe mental illness Every year, up to two million people with severe mental illness end up in jail. In order to solve the overrepresentation of people with severe mental illness in the criminal legal system, it is necessary to understand the most common charges against people with severe mental illness. In a recent study from “Psychiatric Services,” researchers compared the reasons for arrest among people with and without severe mental illness to determine if there are differences in reasons for arrest. Findings suggest that people with severe mental illness were less likely to be arrested for violent crimes and more likely to be arrested for offenses like theft and trespassing than people without severe mental illness.

TAC Research Weekly: Longer hospital stays for Asian Americans and Pacific Islanders According to data from the Substance Abuse and Mental Health Administration’s 2021 National Survey of Drug Use and Health, serious mental illness was more common among people who identified as Native Hawaiian or Other Pacific Islander (6.3%) than in the general population (5.5%). The prevalence of co-morbid substance use disorders were also higher, with 4.1% of people who identified as Native Hawaiian or Other Pacific Islander having both a serious mental illness and a substance use disorder, compared to 2.5% of Americans overall.

2022 Painting the Current Picture: A National Report on Treatment Courts in the United States NADCP is thrilled to share the 2022 Painting the Current Picture publication! The report shines a light on a wide variety of treatment court types and their participants, the growth and evolution of the treatment court model, federal funding, state legislation and appropriations, progress on issues such as equity and inclusion, and more.

Free Webinar on Traumatic Brain Injury NADCP's Justice For Vets is offering a free webinar on traumatic brain injury (TBI). This webinar will provide attendees with a brief overview of what brain injury is and why it is important for treatment court staff to be knowledgeable on this topic.

Behavioral Change, Progress, & Technology: Take Two Behavioral change is a difficult process, especially for individuals dealing with substance use disorder (SUD). In this webinar, Judge Bull will explore how justice staff can help in this process and the role technology can play. Drawing on her experience and research, she will discuss programming programs can use to facilitate behavioral change, the ways technology can assist in the process, and provide practical examples for attendees to utilize in their programs.

States Consider Forced Treatment for Homelessness and Mental Illness In Oregon, some politicians, including Portland Mayor Ted Wheeler, have proposed changing the civil commitment law so doctors have more leeway in compelling treatment for patients too sick to know they need care. Without such changes, they argue, people with untreated addictions or mental illnesses are stuck cycling between the streets, county jails, and state psychiatric hospitals. Last year, California legislators approved a new approach to mental health care — called CARE Court — that allows judges to issue treatment plans for people with certain diagnoses. That program begins on a pilot basis this fall in seven counties, including San Diego and San Francisco counties, with the rest of the state expected to join next year. This year, a bill moving through the legislature would expand who qualifies for a conservatorship or involuntary psychiatric hold.

The Deflection Conversation Framework: A Community Engagement Tool for First Responders This free online training seeks to provide a comprehensive understanding of effective communication strategies for law enforcement and first responder deflection over the course of three interactive educational modules. These modules will examine the science of addiction, treatment, and recovery and offer practical approaches for building strong community partnerships and effectively engaging individuals struggling with substance use disorders. By implementing deflection initiatives, first responders can serve as a referral source to allow for individuals to get the services they want and/or need and improve public health and public safety in our communities.

“The Right Kind of Crazy”: How Patrol Officers Police the Boundaries of Mental Illness through Hybridized Strategies The Los Angeles Police Department (LAPD) has, like many departments, adopted specialized strategies designed to improve these encounters by tasking officers with both care and control responsibilities. This article draws from fieldwork with the LAPD to analyze how patrol officers construct the category of “mental illness” and deploy hybridized strategies. The analysis focuses on the inflection points that shape how a subject is categorized and the call’s disposal to understand how policing from the “murky middle” of state governance unfolds on the ground. Findings show how officers strategically invoke the pressure of time and the power of place to construct this category and deploy specialized resources when resolving trouble case, or “5149 and a half,” calls.

HHS Launches New Website to Help People Find Support for Issues with Mental Health, Drugs, or Alcohol The U.S. Department of Health and Human Services (HHS) today launched, a new user-friendly website, designed for the general public, to help people identify available resources, explore unbiased information about various treatment options, and learn how to reach out to get the support they need for issues related to mental health, drugs, or alcohol.

In the News

America should fund rehab for schizophrenia — not jail and ER People with serious mental illness are shuttled among prisons, encampments and hospitals for crisis care that costs the nation billions. Society has failed to ensure that people with serious mental illness, especially those of color, get the care that could help them recover. They might receive medication in jail or the hospital. They might get emergency services. But less than 5 percent of the 14 million Americans with serious mental illness receive the kind of rehabilitative services that could have helped Neely. These services include peer support, family education and supportive housing. This is equally true of the clubhouse model, developed by and for people with serious mental illness.

Mental health task force discusses court diversion project, crisis intervention training for law enforcement A legislative task force continued work this month on a plan to keep more people with mental illnesses out of the criminal justice system in Wyoming. “We’re working … to divert people who find themselves in legal affairs (who) also have mental illness,” Representative Larsen said at the beginning of the discussion. “How do we divert them away from the judicial system and get them the help that they need?” The judicial diversion plan for those struggling with mental illness should help “unclog the courts” while also easing the demand for competency evaluations at the Wyoming State Hospital and reducing jail populations, state court administrator Elisa Butler explained. But Larsen reiterated that the “ultimate goal” of the project is to “get (people) the help they need … rather than punishing people through the court system.”

L.A. criminal court program diverts mentally ill offenders from prosecution Rapid diversion aims to identify candidates for mental health diversion as early as possible after they’ve been arrested so they can be shifted into community care without long stays in jail that would likely lead to further mental deterioration. Among the thousands of defendants passing through daily, many stand out to public defenders as offenders whose crimes arose from untreated mental illness. In the past, their only option was to request a court-ordered psychiatric exam, a drawn-out process requiring a psychiatrist to be scheduled. “That takes upwards of two months or more,” Stewart-Oaten said. “Someone sitting in custody might be decompensating that whole time.” Rapid diversion places clinical staff inside the court to provide that evaluation.

Competency hearing dispute lands mental health commissioner in contempt of court Vermont Superior Court judge in Chittenden County found the commissioner of the state’s Department of Mental Health in contempt of court on Friday, concluding that the department willfully violated a court order by not scheduling an updated competency evaluation for a criminal defendant. The order is the latest sign of frustration within the criminal justice system over lengthy periods of inaction while awaiting completion of competency evaluations, which in some cases have delayed the resolution of criminal cases for a year or more. The contempt order, in response to the court’s own motion for a finding in January, characterized the department’s unwillingness to schedule a second evaluation of defendant Tek Karki as its “continued obstruction of the criminal justice process.”

Michigan Courts Are Addressing Mental Health on Multiple Fronts During Mental Health Awareness Month, the Michigan Supreme Court is spotlighting the many ways that mental health issues are being prioritized and addressed throughout Michigan’s judiciary and the criminal justice system. Michigan Judicial Council Work Group Addressing Behavioral Health Improvements – Appropriately addressing behavioral health issues will provide more effective problem solving and may improve the public’s collective experience in our courts. To that end, the Michigan Judicial Council created the Behavioral Health Improvements Work Group under its Strategic Objective of “Public’s Experience & Effective Problem Resolution.” Chaired by Calhoun County Judge Michael Jaconette, the Work Group is made up of MJC members and judicial system stakeholders who are studying the justice system’s response to behavioral health issues with an eye toward developing recommendations for improving the judiciary

Real leadership, transparency required to address mental health crisis I am the Montgomery County Probate Judge and privileged to serve. In Ohio, the probate judge oversees involuntarily commitments of mentally ill persons who may be a danger to themselves or others. I also care deeply about the safety of my community as well as the rights of patients on my docket. I believe our system is overwhelmed and unequipped. Serious change is needed, but there is hope when leaders choose to lead by collaborating, innovating and holding leaders and their agencies accountable.

Mental health and the role it plays in the court system For Mental Health Awareness Month, host Heather Abraham is talking with Michael Harper, the Behavioral Health Administrator of PA Courts. They are discussing mental health and the role it plays in the court system.

Judge gives state 12-months to end ER boarding of psych patients New Hampshire has a 12-month deadline to end the controversial practice of boarding people having a psychiatric crisis in hospital emergency rooms, a federal judge has ruled. By next May 17, the state will be required to accept someone into a psychiatric hospital six hours after a doctor authorizes involuntary admission, U.S. District Court Judge Landya McCafferty wrote in an order issued last Wednesday. The ruling comes after years of lawsuits and judicial rulings to address the practice of boarding people in hospital emergency rooms while they wait for an open bed at the New Hampshire State Hospital.

Baptist Hospital and Lakeview Center will operate centralized Baker Act [involuntary civil commitment] facilities The new strategic plan recommends a road map for improving mental health care in the area by having organizations work together to create more public awareness about available services, expanding services, creating peer-led support centers, improving the training and recruitment of behavioral healthcare workers, increasing affordable housing availability that also has access to mental health care services and expanding the diversion court program to create a mental health treatment court.


Building mindful courts can promote well-being, reduce stress While courts are making strides to effectively respond to the needs of court-involved individuals with serious mental illness, it’s also important to focus on the well-being of judges and staff. Mindfulness can help. Last year, NCSC offered an eight-week mindfulness education program to help promote well-being and resilience for judges, court professionals, and others who work with courts. For those who missed out on last year’s offering, visit Mindful Courts to find the summary report, webinar recordings and mindfulness FAQs.

Judge on Michigan’s top court returning after mental-health care A Michigan Supreme Court justice said he’s returning to in-person work after a month away to seek treatment for depression. “It is my sincere hope that by talking about these issues in the open, free from any needless stigma, we can move closer to a day when anyone struggling can avail themselves of the same quality care I was blessed to receive,” Justice Bernstein, 48, said in a statement.


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