The Seattle Mental Health Court Model
Reprinted from "Concurrent Disorders" issue of Visions Journal, 2004, 2 (1), p. 39
Like many cities, Seattle, Washington, has a significant group of people who are either homeless, mentally ill, substance abusers – or a combination of some or all of these things – who are repeat offenders of low-level offenses that formerly consumed expensive court and hospital services, with no improvement in their condition or to public order. Seattle officials say that prior to 1999, too many people were inappropriately getting caught in the justice system who should have been diverted out, due to a lack of quick entry routes to proper care. In June 1999, a task force recommended that the city integrate publicly-funded services for mentally ill and drug/alcohol offenders into a single administrative and service delivery authority.
The first point of entry into this system for many patients is either the Mental Health Court (MHC) or the Crisis Triage Unit (CTU) at Seattle’s Harborview Medical Center, which link up and implement treatment, housing and case management solutions for the clients they see. Feedback from police, hospitals and court personnel is that these mechanisms have significantly cut down on the time people spend in jails, courts and hospitals. The results are diminished costs, decreased escalation of behaviour due to lack of early intervention, and strengthened linkages for ongoing care and stabilization for the patients seen.
Key Elements of the Model: What Seattle’s MHC and CTU Have Learned
Systems of mental health and substance abuse care need to be integrated. The five ingredients to integration are shared information, shared planning, shared clients, shared resources and shared responsibility. The most difficult to share for the agencies concerned was planning, but their experience was that if only four out of the five ingredients to integration are present, it won’t work.
Agency linkage and case management is critical. Database access to re-link a client with his or her case manager and treatment provider when he or she falls off the plan is critical to keeping the client out of detention in hospital or jail, and out of trouble in the community. Having clients who fall off the treatment plan is to be expected.
For a treatment plan to work it needs the three ingredients of housing, treatment and case management. If any one element is missing, it won’t work.
All housing is not equal Housing for people without case management and supervision will not work. Housing without appropriate support will end up being a haven for drugs, weapons and crime in short order. As a transition to stable and secure housing, the county has contracted with several shelters to provide ‘respite beds’ for the homeless. These are designated beds visited by a community health nurse who gives out medications and treats low-level health complaints and injuries for individuals who don’t require hospitalization, but do require some level of extended follow up and care.
For a MHC to work, it needs a good clincian for diagnosis and a good case manager to intergrate systems. The court team must be dedicated, trusting, stable and willing to meet on an ongoing basis to develop a knowledge of the clients, as well as expertise in mental health, substance abuse and criminal law issues.
A phase one evaluation has been conducted on the King County MHC program by the University of Washington, describing the results from the first two years of operation. The study compared clients who opted-in versus those that opted-out of the MHC route and indicated that:
MHC was more successful in linking opt-in defendants to treatment services and increasing the amount of treatment received
MHC was more successful in establishing engagement with treatment regimen
MHC opt-in patients experienced significant improvements in adaptive functioning
MHC resulted in fewer problems with the criminal justice system for defendants seen
MHC opt-in defendants, on average, spent fewer days in detention
MHC opt-in participants had a significantly lower rate of new bookings after contact as opposed to the rate for those who chose not to participate.
King County believes it is spending less on dealing with mentally ill clients, and getting better results than it was before it set up the Mental Health Court, if all costs including police, court, jail, hospital, community-based treatment and housing are taken into consideration.
The following is excerpted from the proceedings of Vancouver City Hall, and are part of a report prepared by Councillor Jennifer Clarke in October 2001