Download PowerPoint Presentation - National Mental Health Court Summit

Getting from A to Z, Even with
Multiple Detours
Mental Health Court vs. Traditional Court
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Governmental Mechanisms of Dispute
Resolution.
Resolving Disputes Between the Government
and Individual Concerning Allegations of
Criminal Wrongdoing.
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Now, new kinds of problems, many of which
are social and psychological in nature, have
appeared before the courts.
Problem Solving Courts:
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Not only resolve disputed issues of fact, but also
Attempt to solve a variety of human problems that
are responsible for bringing the case to court.
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Traditional courts limit their attention to
resolving the narrow dispute in controversy.
PSC’s attempt to understand and address the
underlying problem that is responsible for the
immediate dispute:
Help the individuals involved in the court
system to effectively deal with the problem in
ways that will prevent recurring court
involvement.
In general, problem-solving courts share some
common elements:
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Focus on Outcomes. Problem-solving courts are designed to provide positive case
outcomes for victims, society and the offender (e.g., reducing recidivism or
creating safer communities).
System Change. Problem-solving courts promote reform in how the government
responds to problems such as drug addiction and mental illness.
Judicial Involvement. Judges take a more hands-on approach to addressing
problems and changing behaviors of defendants.
Collaboration. Problem-solving courts work with external parties to achieve certain
goals (e.g., developing partnerships with mental health providers).
Non-traditional Roles. These courts and their personnel take on roles or processes
not common in traditional courts. For example, some problem-solving courts are
less adversarial than traditional criminal justice processing.
Screening and Assessment. Use of screening and assessment tools to identify
appropriate candidates for the court is required.
Standard
Docket
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Short-term View
Address the Symptoms, not the
Problem.
What is the “Message” to:
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Offender
Others in the System
Public
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Sentencing Considerations
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State v. Toohill Factors:
The four objectives of criminal
punishment: (1) protection of
society, (2) deterrence of the
individual and the public
generally, (3) possibility of
rehabilitation, and (4)
punishment or retribution for
wrongdoing.
State v. Toohill, 103 Idaho 565, 568, 650 P.2d 707, 710 (Ct. App.
1982)
Rehabilitation is a goal with probation, BUT not
the main focus of sentencing, which is protection
of society and generally a punitive measure.
Defendant’s must pay for their crime.
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Not Merely Processing/Resolving the Court Case.
Achieving a Tangible Outcome Associated with
Avoiding Reoccurrence of the Problem.
Actively and Holistically Resolve, not just the case,
but the problem that created it.
See the law as an instrument for helping people,
particularly those with a variety of psychological
and emotional problems.
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Screening Process – Guidelines
Mental Illness Related to Charge; OR
Mental Health Treatment in a court supervised setting can foster
recovery and reduce recidivism.
Evaluate for criminogenic risks and needs with the LSI-R prior to
final acceptance and should give preference to medium to high
criminogenic risk offenders.
Participants should not be excluded from admission solely
because of prior treatment failures or a current lack of motivation
for treatment.
Mental health courts should implement motivational
enhancement strategies to engage participants and keep them in
treatment.
The Treatment Model for mental health courts is Assertive
Community Treatment (ACT) delivered by the Department of
Health & Welfare. . . .
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Sanctions or enticements from family,
employment settings, and/or the criminal
justice system can significantly increase
treatment entry, retention rates, and the
ultimate success of drug treatment
interventions.
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Element 4—Terms of Participation: Terms of
participation are clear, promote public safety, facilitate
the defendant’s engagement in treatment, are
individualized to correspond to the level of risk that
the defendant presents to the community, and provide
for positive legal outcomes for those individuals who
successfully complete the program.
Element 9—Monitoring Adherence to Court
Requirements: Criminal justice and mental health staff
collaboratively monitor participants’ adherence to
court conditions, offer individualized graduated
incentives and sanctions, and modify treatment as
necessary to promote public safety and participants’
recovery.
Mental health courts in Idaho . . . that closely
supervise and monitor mentally ill . . . offenders
and oversee their treatment will:
 Address the mental health needs of offenders;
 Reduce recidivism;
 Provide community protection;
 Ease the caseload of the courts; and
 Alleviate the problem of increasing prison, jail
and detention populations.
Idaho Code 19-5602
What is Recovery?
“A process of change through which individuals
improve their health and wellness, live a selfdirected life, and strive to reach their full
potential.”
SAMHSA 2011
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Procedural Justice Must Exist in Problem
Solving Courts as Well as in “Regular” Courts:
Mental Health Court is COURT.
Mental Health Court requires accountability.
The method of achieving change is focused on recovery of the
whole person and the changes that hopefully bode well for longterm success.
Getting from A to Z
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How do we achieve the goals of MHC with
participants who present with very diverse
mental illnesses, functional abilities, and
criminal behaviors?
Diversity in Presentation.
Diversity of Treatment Approaches
Motivation
Can Incentives/Sanctions be Motivational?
What Will Achieve Results?
We must understand:
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Although we can assist people to solve their
problems, we cannot solve them.
The individual must confront and solve her own
problem and assume the primary responsibility for
doing so.
We must help the individual realize this, and, as a team,
help the individual to identify and build upon her own
strengths and use them effectively in the collaborative effort
of solving the problem.
Where one has learned to behave helplessly, failing to
respond even though there are opportunities for the
person to help him or herself by avoiding unpleasant
circumstances or by gaining positive rewards.
Clinical depression and related mental illnesses may
result from a perceived absence of control over the
outcome of a situation.
Learned helplessness can also be a motivational
problem. Individuals who have failed at tasks in the
past conclude erroneously that they are incapable of
improving their performance.
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Poor Social Boundaries
Antisocial Thinking
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Motivational Interviewing
Facilitating and engaging intrinsic motivation within
the client in order to change behavior.
Project acceptance, rather than censure, freeing the
person to change.
Empower the individual to improve their motivation to
change.
Stages of change: Pre-contemplation, Contemplation,
Preparation, Action, Maintenance, Termination.
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Incentives/Rewards must be designed to keep
participants engaged in treatment.
The longer a participant stays in treatment, the
better they do; thus, directed motivational
sanctions must be designed to keep
participants in treatment longer.
Our Goal: Catch them doing something right –
while redirecting undesired behavior.
Changing Behavior is the Goal
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Rewards and sanctions are most likely to
change behavior when they:
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are certain to follow the targeted behavior;
follow swiftly; and
are perceived as fair.
Use of incentives to reward compliance with
court mandates.
Rehabilitation emphasis modeled on principles
of restorative justice and therapeutic
jurisprudence models.
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Cognition (CBT, CSC, MRT)
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Beliefs drive emotions and thinking. Emotions and thinking drive
behavior.
Behavioral modification (operant conditioning)
Reinforcement is any event that strengthens or increases the
behavior it follows. There are two kinds of reinforcers:
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Positive reinforcers are favorable events or outcomes that are presented
after the behavior. In situations that reflect positive reinforcement, a
response or behavior is strengthened by the addition of something, such as
praise or a direct reward.
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Negative reinforcers involve the removal of an unfavorable event or
outcomes after the display of a behavior. In these situations, a response is
strengthened by the removal of something considered unpleasant, e.g.,
decreasing time in a phase, time off court.
In both of these cases of reinforcement, the behavior improves.
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Punishment, on the other hand, is the presentation of
an adverse event or outcome that causes a decrease in
the behavior it follows. There are two kinds of
punishment:
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Positive punishment, sometimes referred to as punishment by
application, involves the presentation of an unfavorable event
or outcome in order to weaken the response it follows, e.g.
community service or jail.
Negative punishment, also known as punishment by removal,
occurs when a favorable event or outcome is removed after a
behavior occurs, e.g., removal of a privilege.
In both of these cases of punishment, the goal is that
the unwanted behavior decreases.
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Responses must be keyed to target behavior.
 What is a target behavior in the first 30-60 days?
 Don’t reward with something they are intrinsically
motivated to do.
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Most-valuable reward: immediate and
consistent praise that is deserved.
Timing is Everything.
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Speed Supports Recovery.
Delay Supports Addiction/Disease.
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Rewarding positive behavior is more effective
in producing long-term positive change than
punishing negative behavior.
Punishment alone is an ineffective public
health and safety intervention for offenders
whose crime is directly related to drug use
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Nonmonetary rewards such as social recognition
can be as effective as monetary ones.
A graduated range of rewards given for meeting
predetermined goals can be an effective strategy.
Contingency management strategies.
Bus tokens, to reinforce abstinence (measured by negative
drug tests); or
 to shape progress toward other treatment goals, such as
program session attendance or compliance with
medication regimens.
 Most-effective when it closely follows the behavior being
monitored.
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Less punitive responses for early and less
serious noncompliance and increasingly severe
sanctions for more serious or continuing
problems
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Insure accountability.
Must be:
 Consistent
 Predictable
 Clear
 Perceived as fair
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A behavioral contract is an explicit agreement
between the participant and the treatment
provider or criminal justice monitor (or among
all three) that specifies proscribed behaviors
and associated sanctions, as well as positive
goals and rewards for success.
Behavioral contracting can instill a sense of
procedural justice because both the necessary
steps toward progress and the sanctions for
violating the contract are specified and
understood in advance.
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Maintain participant accountability through
engagement with a dynamic and
individualized process;
Focus the need for the participant’s change of
attitude and behavior through programing
solutions; and
Praise. “I recognize how hard you’re
working.” “Thanks for showing up today.”
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Incarceration is NOT the worst punishment
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Jail is about us because we’re mad.
Jail works for the period of time I have my foot on their throat.
Punishment works best on those who have something to lose
by incarceration.
Punishment is only temporary – real change comes with
rewards.
Pygmalion Effect-Golem Effect
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Reality can be influenced by the expectations of others. This
influence can be beneficial as well as detrimental depending on
which label an individual is assigned.
"Whether you think you can or whether you think you can't,
you're right." Henry Ford
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Difficult clients
“Nice” clients
Burnout
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Undesirable behavior must be reliably
detected.
Cannot Sanction or Reward based on rumor.
While we’re “allies,” we must understand our
roles.
Make sure the Judge gets it right.
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Engagement
Co-occurring disorders
Different risks and needs mean different
responses.
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Engage
Encourage
Instill HOPE
This is very difficult work for them.
 As
long as they are not
harming the public or
program integrity, keep
them in the court.
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Why do we do this work?
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No great hopes of getting wealthy.
Hope that I have made a difference, even for just a
few.
Big Picture
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Eventually they will be our neighbors
This is a long term effort.