Policy Today magazine cover
July 5, 2006

In the midst of California's prison crisis, San Francisco's Behavioral Health Court is working to keep mentally ill people out of jail—by giving them the kind of treatment they need most.

Judge Mary Morgan finishes speaking, and the defendants exit the courtroom to the sound of applause.

One by one, the members of the courtroom audience make their way to the lectern and speak in calm, collegial voices with Judge Morgan.

"I've been going to all of my groups," explains one man in a blue flannel shirt. "I'm doing lots better." Morgan's face beams as she encourages the man to continue his hard work. "I'd like you to focus on drinking less and doing fewer drugs," she says before asking for another round of applause. The man nods and smiles broadly as the ovation carries him down the aisle and out of the room.

This is the San Francisco Behavioral Health Court, a special program designed to address one of the most glaring problems in the criminal justice system: the overrepresentation of the mentally ill. In the United States, there are three times more mentally ill people in prisons than in mental health hospitals, accounting for about 16% of all inmates in state prisons across the country.

Filling a void

"The criminal justice system is designed to handle mentally ill individuals in only two different contexts," explains Deputy Public Defender Jennifer Johnson. "One is 'not guilty by reason of insanity,' and the other is 'unfit to stand trial.' The problem is that the majority of mentally ill people don't fall into either of those categories."

That's where the Behavioral Health Court comes in. The 3-year-old program is an attempt to shore up this structural defect in our legal system by pulling mentally ill people out of the criminal justice arena and into the mental health system. There are different ways for offenders to arrive in behavioral health court, but the most common is via referral from jail psychiatric services. Most participants in the program have moderate to severe psychological problems, and about 90% have concurrent substance abuse issues. All of them are closely monitored and cared for throughout the process. Early statistics suggest that the approach works, with recidivism rates for court graduates steady around 12%. That's about 58% better than average.

"I think that one of the reasons our recidivism rate is so good is because when people graduate from the program, we are convinced that they are well rooted in the community mental health system, so if something goes wrong, they have an established support network," explains Johnson. "They're receiving the kind of treatment that, perhaps, they've never had before."

Modest means to great ends

The project isn't without its challenges, however. "The biggest problem is the availability of services in the community to meet the needs of our clients coming out of the criminal justice system," notes Tanya Weisheit of Jail Psychiatric Services. "We need more beds, more programs and longer lasting programs for our clients to reintegrate into the community."

To say that the Behavioral Health Court is run on a shoestring would be an understatement. The program has no budget and zero funding outside of a handful of grant dollars, but it continues to thrive regardless of its modest means. According to Johnson, the project was motivated by the compassion of one particular judge, and made reality with cooperation from the sheriff's department, community mental health providers, pretrial diversion services and a smattering of other interested parties.

"We are probably one of the only behavioral health courts in the country that was not driven by a district attorney or a city official," says Weisheit. In essence, the program evolved from the bottom up, driven by individuals who saw a pressing need and pulled together to address it. Free from the politics and bureaucracy that come with a city council mandate, the program has been allowed to adapt and grow organically. "On the one hand, it's difficult because there is no blueprint," says Johnson. "On the other, we're allowed to be very innovative and creative."

An example for others

That kind of innovation could be just what's needed to help change the course of California's criminal justice system. Conditions have gotten so bad in the state that Governor Schwarzenegger recently ordered a special legislative session to address the issue. At the heart of his request is a plan to build two new prisons. Few, however, believe that the state can build its way out of the crisis.

By addressing a real and pressing need in the criminal justice system itself, the San Francisco Behavioral Health Court and others like it are helping many individuals stay out of the overcrowded prisons that would otherwise be their ultimate destination. And although participants in the program may spend longer in custody as they wait for an available bed and appropriate treatment plan, it is a small price to pay. "What it really comes down to is immediate freedom vs. long-term freedom," says Weisheit.

About Frank Holland

Frank Holland is Policy Today's managing editor.