What is a Treatment & Accountability Court (T.A.C.)?

A treatment and accountability court, sometimes called a mental health court, is not a separate court. Rather, it is a specialized court docket, or calendar, in which participants seek treatment for their mental illness while being closely monitored by local mental health providers and the court.

It is a collaborative program involving representatives from the court, mental health providers, prosecutors, public defenders, and community advocates all working towards providing treatment rather than punishment.

It targets non-violent offenders whose crime would not have occurred had it not been for their mental illness.

It links participants not only to mental health services such as counseling and treatment but also link them to needed social services – social security, housing, jobs, etc.

It may accept referrals from a variety of sources including the police, jail, mental health providers, family and the individuals themselves.

Unlike traditional substance abuse treatment in drug court where a standard model is available, mental health court is not a one-size-fits-all approach but instead is tailored around the individual’s specific needs.

What’s happening nationally in the judicial system for those with mental illness?

The US Department of Justice reports, however, that about 16 percent of the population in prison or jail has a mental illness compared to only 5% of the general population.

The Los Angeles County Jail, the Cook County Jail (Chicago) and Riker's Island (New York City) each hold more people with mental illness on any given day than any hospital in the United States.

Inmates with mental illness in state prison were 2.5 times as likely to have been homeless in the year preceding their arrest than inmates without a mental illness.

Nearly three-quarters of inmates with mental illness have a co-occurring substance abuse problem.

Nearly half the inmates in prison with a mental illness were incarcerated for committing a nonviolent crime.

On average, inmates with mental illness serve a longer portion of their sentence than inmates without mental illness –often at least twice as long.

The majority of people with mental illness who are arrested continue to be re-arrested – mostly for minor, non-violent crimes (drunkenness, disorderly conduct, trespassing, etc.).

What’s happening in Georgia with courts that offer mental health treatment?

There are about 10 mental health courts in the state at various levels in the court system compared to almost 50 drug courts. For example, there are mental health court programs in Atlanta (Fulton), Decatur (DeKalb), Gainesville (Hall), Columbus (Muscogee), Savannah (Chatham), and Macon (Bibb).

Most are new within the last 2-3 years and several are still in various stages of planning or early development.

Albany, Georgia in Dougherty County is a national learning site.

What’s happening locally in Athens-Clarke County?

The Athens-Clarke County jail currently has more than 450 inmates. National estimates are that more than 16% of inmates have a mental illness, which means there are at least 70 people in need of treatment in the Athens-Clarke County jail.

At the last county homeless count, over 120 or 25% of the 475 homeless had severe mental illness and nearly all of these had some interaction with the judicial process.

Fewer and fewer services are available locally each year further disconnecting those who need services with the services. A downward spiral often occurs which will land them in the judicial system.

What makes the Athens-Clarke County “Treatment & Accountability Court” unique?

Integrated with the civil commitment process, it provides several options for addressing those with mental illness who need treatment.

Since the courts and judges in Athens-Clarke County are in regular communication, the mental health court can pull in cases from any of our courts (which is unique in the state).

Focuses on incentives to encourage participation and treatment. While sanctions, including time in jail, are sometimes needed, mental health court participants are more likely to be successful when praised rather than punished.

What is the target population of the Treatment & Accountability Court?

Homeless with Mental Illness
The data for 2008 reveals that 46% deal with chronic substance abuse, 23% are considered chronically homeless, and 36% are considered severely mentally ill. Additional local data on homelessness from 2007 indicates that 16% of individuals (or 146 of 891) who utilized local homeless shelters throughout 2005 accounted for 7,865 days in jail resulting in nearly $370,000 in jail costs.

Chronically Incarcerated
As an example, one such individual was recently identified who meets the eligibility criteria for participation in TAC. From 2000 to 2008, this individual spent an average of 223 days per year in the Clarke County Jail at a cost of approximately $10,000 per year (nearly $80,000 total) and while in jail only received basic medical care.

Co-Occurring Substance Abuse
A recent snapshot of the Felony Drug Court indicates that as many as 40% of the participants have a diagnosable mental health condition, though most are not receiving treatment for their mental illness. Further estimates from the National GAINS Center note that as many as 72% of those diagnosed with mental illness also have a co-occurring substance abuse disorder.

Civil Commitment and Mental Incompetency Individuals
Changes in state law in Georgia effective July 2007 now allow the state to release individuals referred to state hospitals for reasons of mental incompetency provided they meet minimal levels of stabilization. The referring “court” is held responsible for monitoring such individuals in community-based treatment.

Who is excluded from participating?

Each participant will be reviewed on a case-by-case basis. However, offenders with the following current or past offenses may be excluded: Murder, Armed Robbery, Aggravated Child Molestation, Aggravated Sexual Battery, Kidnapping, Rape, Voluntary Manslaughter, Child Molestation, Child Exploitation, Possession of Child Pornography, Sexual Battery of a Minor, Statutory Rape.

How many participants do you expect?

Potentially, there may be well over a 100 people eligible at any given time. Currently, the court only has resources to support about 15-25 participants depending on the level of assistance and case management they require.

Why does a Treatment & Accountability Court make sense?

Reduces the number of jail days for those with mental illness (they often serve twice as longer and sometimes much longer).

Reduces the local costs for those individuals using emergency rooms, jail medical facilities, and other clinics by focusing on long-term treatment rather than short-term crises.

Focuses on long-term treatment to break the cycle of crime and substance abuse. It may often takes months of treatment and medicine before a person can stabilize to a point where they truly comprehend they are now in a better place.

How is a T.A.C. different from a drug court?

Both provide treatment. However, a mental health court is much more individualized. What treatment, medication and counseling that works for one person may not for another. Treatment plans will be set up around the specific mental need and the wrap-around support services required.

Incentives and sanctions will also be focused on the individual needs of each participant. While incarceration in jail is still an ultimate sanction, intermediate sanctions such as changes in frequency or type of treatment will be used more frequently.

How is the T.A.C. funded?

Athens-Clarke County has provided funding for a part-time Case Manager.

Most participants will be eligible for Medicaid, Social Security Insurance (SSI) or Social Security Disability Insurance (SSDI) as well as other means of public assistance.

The Case Manager will work with each participant to link them to Medicaid, SSI/SSDI, public assistance, and job opportunities to ensure a continuous income stream.

Who will provide treatment?

Most services will come from direct treatment provided through the state’s contract with Advantage Behavioral Health Systems, our local mental health community service board.

Additional local mental health providers may volunteer to assist one or several clients from the program. The program may also seek assistance from other local providers for educational or learning opportunities.

What did we do with the 2007-2008 planning grant funding?

• Collaborated with UGA’s School of Social Work to set up a referral and assessment process and to set up a system to track each participant’s progress.
  
• Collaborated with UGA’s Law School to finalize the various court procedures and ensure that each participant’s rights are protected.
  
• Collaborated with local mental health providers and social services groups to identify available resources to support participants in the community – housing, jobs, treatment, etc.
  
• Provided funding for staff to visit other mental courts and conferences to learn what works.
  

What will we do with 2008-2010 implementation grant funding?

• Provides funding for up to two-years of operation to implement and expand services.
  
• Provides funds for direct service delivery (treatment/counseling, temporary housing, medication, vocational/job/skills training, etc).
  
• Creates a full-time case manager allowing for a potential capacity of up to 75 participants.
  
• Continues Community Outreach project with Athens Justice Project.
  
• Establishes an assistantship at the UGA School of Social Work dedicated to the mental health court.
  
• Provides funding for ongoing training and community education.
  

Why do we need local community help?

• Donate rewards and incentives – gift certificates, movie passes, etc.
  
• Provide meaningful jobs and job training.
  
• Develop healthier attitudes and understanding towards those with mental illness.
  

What lessons did we learn from the Virginia Tech incident?

In December of 2005, Cho Seung-Hui was declared mentally ill by a special judge and sent to a mental institution. Instead of involuntary admission into a mental hospital, the judge ruled that outpatient treatment was allowable. Upon return to the community, there was little or no supervision and follow-up. Neither the mental health system nor the judicial system was designed to ensure that he continued in treatment after his release. In a post-incident report to the President, officials noted that timely access to treatment – meaningful treatment – is imperative and that such approaches must include long-term family and community support for the individual rather than a “catch and release” approach.

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