The Judges’ Guide to Mental Health Diversion

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: All too often, the criminal system is a path of first instead of last resort to access care. A continuum of behavioral health programs, services, and alternatives must be available in the community to prevent individuals with mental illness from entering the criminal justice system, and when appropriate, if criminal justice involvement occurs, deflect and divert to treatment and care as soon as possible.

Recommendation: This continuum of care in communities must include a robust set of services and deflection and diversion opportunities that meet the needs of individuals with behavioral health disorders whether through the behavioral health system, the behavioral health crisis system, pre-arrest deflection and diversion, pre-adjudication diversion, or post-adjudication diversion. All judges should exercise leadership to expand and improve responses to individuals with mental illness across the continuum of behavioral health diversion. The Judges’ Guide to Mental Health Diversion provides a roadmap for judges.

Chief Justice Highlights Courts’ Accomplishments in State of Judiciary Task Force member Chief Justice Loretta Rush discussed the Indiana judiciary’s efforts regarding mental health and the courts. The issue has taxed the criminal justice system “beyond its abilities,” Rush said. “We know that our communities have come to rely on county jails to serve as de facto mental health treatment centers… this was never planned and is not sustainable,” Rush said. “When we ask sheriffs to take on this never-intended duty, we prevent them from carrying out their core mission to provide public safety.”

Casey Excellence for Children Awards - Judge Kathleen Quigley Task Force member Judge Quigley is a recipient of a 2023 Leadership Award. Judge Quigley learned of Casey Family Programs’ work to establish Indian Child Welfare Act (ICWA) courts and worked in partnership on the creation of an ICWA Court in Pima County. The team focuses on placing out-of-home children with family or tribal families, building cultural awareness, ensuring ICWA is followed and establishing relationships with tribes. Much of Judge Quigley’s work nationally and in Arizona has been centered on keeping families together and improving the system.

SJI Grantee Spotlights the National Judicial Task Force to Examine State Courts’ Response to Mental Illness Led by an Executive Committee, joined by 40 additional judges, court, and behavioral health experts, and funded by the State Justice Institute, the Task Force has engaged in research, developed tools and resources, delivered training, education, and technical assistance, and developed best practice and policy recommendations for courts and communities.

Research and Resources

SAMHSA’s GAINS Center Announces Criminal Justice Learning Collaboratives AMHSA’s GAINS Center for Behavioral Health and Justice Transformation, operated by Policy Research Associates, Inc. (PRA), is continuing to provide direct training and technical assistance to jurisdictions across the nation to better support people with behavioral health needs who are involved in the criminal justice system. The GAINS Center is currently soliciting applications from jurisdictions interested in collaborating with subject-matter experts through Criminal Justice Learning Collaboratives (LCs) designed to explore four topics:

  • Trauma-Informed Treatment Courts
  • Peer Integration in Treatment Courts
  • Data-Driven Strategies for Reducing Frequent Systems Engagement
  • Addressing the Housing Needs of People with Behavioral Health Conditions Who Are Justice-Involved

How Communities Can Improve Responses to Behavioral Health Emergencies The Pew Charitable Trusts has identified key questions local decision-makers can consider when prioritizing areas of focus. Those questions are centered on three overarching goals Pew identified by collecting the opinions and perspectives of a range of public officials and national experts, along with an informal review of publicly available resources.

Unjust Punishment: The Impact of Incarceration on Mental Health Sadly, a defining feature of our nation is its legacy of punishing rather than humanely caring for people with mental illness. Yet, the solutions needed to break this legacy already exist. It is well past time to pledge ourselves to implementing these solutions so we can meaningfully care for rather than punish people with mental illness. Our nation’s overreliance on arrest and incarceration, combined with the failure to provide meaningful treatment options for people with mental illness, has resulted in far too many people with mental illness being ensnared in our criminal legal system.

Report Shows Cost of Unmet MH Needs Among Minority Groups If minority populations had access to quality mental health care, nearly 117,000 lives and over $278 billion could have been saved between 2016 and 2020, according to a report from the Satcher Health Leadership Institute. The report points to numerous policy recommendations that can help address the need.

SAMHSA Announces National Survey on Drug Use and Health (NSDUH) Results Detailing Mental Illness and Substance Use Levels in 2021 Among the findings:

  • 5 percent of young adults aged 18 to 25 had both a substance use disorder and any mental illness in the past year.
  • Nearly 1 in 3 adults had either a substance use disorder or any mental illness in the past year, and 46 percent of young adults 18-25 had either a substance use disorder or any mental illness.
  • The percentage of adults aged 18 or older who met criteria for both a mental illness and a substance use disorder in the past year was higher among Multiracial adults than among White, Black, Hispanic or Latino, or Asian adults. Asian adults were less likely to have had both AMI and a substance use disorder in the past year compared with adults in most other racial or ethnic groups.

All In 101: An Overview of the New Federal Strategic Plan to Prevent and End Homelessness To prevent and end homelessness, we must be all in on solving it. We need each and every one of you. Thank you for everything that you do to build a future when no one experiences the tragedy and indignity of homelessness—and everyone has a safe, stable, accessible, and affordable home.

State-by-State Legislative Analysis of Funding for 988 Last year the National Association of State Mental Health Program Directors (NASMHPD) released a paper, State’s Experiences in Legislating 988 and Crisis Services Systems (2021), which provided an overview of legislation developed throughout the nation to strengthen behavioral health crisis response and crisis systems of care. This year NASMHPD is releasing a sequel, State-by-State Legislative Analysis of Funding for 988 Suicide and Crisis Lifeline, which provides a summary of legislative approaches taken during January 2022 to November 2022 to finance 988 Suicide and Crisis Lifelines throughout the country.

TAC Research Weekly: Psychosocial Interventions for Schizophrenia The authors identified several forms of treatment for which there was evidence of their positive impact on people with schizophrenia. One of these was assertive community treatment. ACT is an intervention in which a team of psychiatric care providers, nurses, employment specialists and peer specialists work together to assist a person with serious mental illness with living successfully in the community. This study found that people with schizophrenia in assertive community treatment had better outcomes than people with schizophrenia who were in a reference treatment. Specifically, they were more likely to be living independently, less likely to be homeless, more likely to be employed and had less severe symptoms.

Veteran Intercepts in the Criminal Justice System Webinar Series: Intercepts 0-1 Develop a better understanding of the Veteran Sequential Intercept Model (V-SIM) and the intervention strategies and resources available at intercepts 0-1 with this upcoming webinar. This webinar is part two of NIC’s four-part series on veteran intercepts in the criminal justice system highlighting deflection, diversion, reentry, and desistance alternatives for justice-involved veterans.

Top 10 Learning Points from the 2022 Texas JCMH Summit This year’s Summit Learning Points come directly from the speakers themselves, and include links to the presentations:

  1. Violence is not a mental illness.
  2. Trauma’s effect is real, but relationships can heal.
  3. You don’t have to wait for crisis.
  4. Assisted Outpatient Treatment (AOT) Courts can save lives.
  5. Tailor the case plan for the client
  6. Language matters
  7. Diversion ideas exist for every budget.
  8. Think different.
  9. Start small.
  10. Take care of yourselves and each other

CSG Justice Briefing New Justice and Mental Health Collaboration Program website offers resources for justice and health partners; New Hampshire’s Justice Reinvestment Initiative addresses behavioral health needs; and more.

CSG Justice Briefing 2022 highlights and what’s ahead for Justice Counts; join a national program for Criminal Justice and Mental Health Learning Sites; the New Hampshire Governor’s Commission on Mental Illness and the Correction System reviews jail data analysis; and more.

SMI Advocate Newsletter Includes a rundown of state legislation enacted inn 2022 regarding civil commitment, IMD exclusions, and new initiatives to address untreated SMI.

Our printable guide for helping someone in a mental health crisis When you see someone experiencing a mental health crisis, you may need to act fast. You’ve got to find the right resources, and in some cases, you may need to call in professionals and talk with dispatchers about what’s going on. But how do you know which numbers to call? And how do you know if the situation is, in fact, a crisis?

In the News

Judge rules new limits on stays at Oregon State Hospital will remain in place New requirements aimed at speeding up admissions and reducing the amount of time patients charged with crimes can stay at the Oregon State Hospital will remain in place, a federal judge in Oregon ruled Tuesday. Multnomah County Circuit Court Judge Nan Waller, who oversees specialty courts that focus on mental health, said Mosman’s ruling means state court judges will continue to balance public safety and the mental health needs of defendants. “The public and elected leaders will see the impact, consider whether they are desirable or acceptable, and help determine the path forward,” Waller said in a statement. “The decision puts a spotlight on the need for additional community mental health resources. The legislature is paying attention to that need and the challenge remains to develop that capacity.”

Arizona State Hospital remains a pain point; solutions seem limited despite issues The Arizona State Hospital, which provides psychiatric care for those with serious mental illness, continues to be a pain point for the state. Some say it needs to be extricated from the Arizona Department of Health Services, which both runs and regulates it. The state hospital has frequently been in the news due to patient deaths, complaints and resident on resident attacks. The council made additional recommendations including whether the hospital should be operated by an independent board.

Los Angeles County Accelerates CARE Court Implementation to Support Californians with Untreated Severe Mental Illness Los Angeles County today moved to accelerate its implementation of CARE Court, the state’s new framework to deliver mental health and substance use disorder services to Californians suffering from severe mental health disorders. The County is working to implement the CARE Act by December 1, 2023, one year ahead of schedule. Los Angeles County, the state’s most populous, will join the original seven counties committed to implementing CARE Court in 2023: the counties of Glenn, San Diego, San Francisco, Tuolumne, Stanislaus, Orange and Riverside.

Tulsa donation aims to change how the state's criminal-justice system interacts with mental health issues Funded programs will include Street Outreach and Rapid Response, dispatching teams to help homeless individuals in need of immediate help, and the Special Services Docket, which connects case managers with people facing misdemeanor charges that are often related to homelessness. The Hardesty grant will also help support the Mental Health Association’s Bridge Program, which tries to reduce the use of law enforcement and jail time in response to mental-health crises, as well as the Criminal Justice and Mental Health Training Center, which offers training for criminal-justice officials.

The Downward Spiral: Trapped Between Mental Health and Criminal Justice Systems, Omaha Families Struggle Short staffed, underfunded and mired by legal obstacles, Omaha’s mental health system often leaves many with the most serious, persistent mental health issues cycling in and out of local courts and the Douglas County jail, which by default has become the area’s largest mental health facility, costing taxpayers money and leaving many families running in circles.

Stop Processing Mentally Ill People Through the Justice System The record shows that we have been more inclined to punish people with mental illness than to care for them. Imagine if society were to incarcerate people suffering from dementia or Parkinson’s disease. How long would it take Congress to pass reform legislation? American scientists took less than a decade to accomplish Kennedy’s challenge to land a man on the moon. It should not take decades longer for society to achieve his other goal of replacing the “cold mercy of custodial isolation” with compassionate community care. Every minute of delay is a minute too long.

OCFMH congratulates Larimer County’s competency docket and seeks to fund dockets in more communities This competency docket was the first of its kind in Colorado and was formed in partnership with the Colorado Department of Human Services (CDHS) and Larimer County in May 2021. Because competency matters account for less than 2% of all criminal cases, attorneys, judges, and other stakeholders rarely have the opportunity to become fluent in the issue of competency. This type of docket seeks to combine and consolidate competency-related cases to one division and/or one judge. The dedicated docket team has an understanding of competency statutes and processes, and reviews individual cases to get to the right outcomes sooner. The Larimer County docket has resulted in 159 clients receiving competency evaluations in the community, meaning individuals don’t have to wait in jail for this service. The team meets weekly to discuss each case individually to address specific obstacles to competency restoration for each client.

New Orleans Mental Health System Is Broken, but There Is a Solution The time is long past, not only to provide mental health services to people arrested, but also to help our children, families, friends, co-workers, neighbors, veterans and the homeless. The mayor, sheriff, federal monitors, judges, district attorney, public defender, coroner, EMS, NOPD, Health Department, mental health, housing advocates, and the medical community must come together to create a comprehensive sustainable mental health plan for the city.


The Relentless Mental Toll of Public Defense - And what could make it better Public defenders represent clients facing devastating, potentially life-destroying punishments; they witness the effects of criminalizing mental health needs, substance use, and poverty. A 2020 study of public defenders, jointly conducted by faculty of Rutgers University–Newark and Drexel University, concluded that public defenders suffered from the “stress of injustice” or the “demands of working in a punitive system with laws and practices that target and punish those who are the most disadvantaged.”

7 Domains of Wellness The seven domains of wellness are: physical, social, occupational, emotional, intellectual, environmental, and spiritual. These domains can be used to assess the state of your own health or the population at large. When one domain is suffering, the others will also be affected. Read on to learn more about each domain.


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