The 8th Judicial District’s Wellness Court
Hope for Individuals with Mental Health Issues
The felony menacing charge was not a surprise, under the circumstances. Carl was in the convenience store insisting that he was an FBI agent and that the clerk was under orders to cooperate with him by first giving him cigarettes and then hiding him from “them.” When the clerk tried to reason with him, Carl pulled a hammer out of his pants and threatened to bash the clerk’s head. Carl was arrested and facing felony charges for what was clearly a mental health crisis as much as it was a crime. Carl was facing up to three years in prison. But he had another option—one that would address his mental health issues and allow him to get treatment, find a job, reunite with his family, and make amends to the clerk whom he had terrified. Carl had the chance to be supervised by Wellness Court, the 8th Judicial District’s mental health problem solving court.1
Carl represents just one of the 34 graduates of Wellness Court, an innovative problem-solving court that provides healing and hope for those who participate. This article discusses the work of Wellness Court.
In 2005, Alternatives to Incarceration for Individuals with Mental Illness (AIIM) started as a heightened probation program for individuals with mental health issues facing misdemeanor charges. The program was overwhelmed with participants, and though an option for low-level offenders, AIIM was asked to add and supervise more high-risk individuals. Because AIIM did not have the resources to handle more individuals, especially those with significant mental health issues and corresponding felony charges, it became clear that something more was needed for offenders with greater needs. Enter Wellness Court.
Wellness Court started in 2014 as a partnership between Larimer County and the 8th Judicial District Court to address the challenges these high-needs individuals face when they enter the criminal justice system. Focused on those individuals charged with felonies or misdemeanors that arise because of mental health issues, Wellness Court applies a proven problem-solving court model to these most challenging cases.
Often, an individual with mental illness who is facing criminal charges enters the “revolving door” of arrest, incarceration, release, probation, revocation of probation, arrest, and further incarceration.2 And because the defendant’s underlying mental health issues have not been addressed, that revolving door continues unabated. The Wellness Court’s services and resources are designed to interrupt this cycle and provide a higher level of probation supervision and oversight that includes medication, therapy, basic needs support (such as help finding housing, employment, and benefits), and a community of professionals and peers who create a supportive web of assistance and inspiration. In the five-plus years that the program has been operating, Wellness Court has reduced jail bed days for our clients by a staggering 20,690 days.3
All that said, demand is not being met. Working together and sharing staff, Wellness Court and AIIM are currently at capacity with a combined 70 clients. We have more people interested in joining the program than we can serve.
The Wellness Court team comprises a presiding judge (myself), a problem-solving court coordinator, a dedicated division clerk, the district attorney, the public defender, representatives and therapists from the local community mental health program, case managers, a psychiatric nurse practitioner, probation officers, and law enforcement representatives from every agency in Larimer County. The team also has the support of a nonprofit program that provides clients essential items such as furniture or baby items, on an as-needed basis.
Screening and Acceptance
Before a client is accepted into the program, the Wellness Court team conducts a thorough criminal history and mental health review. The program is intensive, and clients must choose to participate. Potential clients can be referred by anyone (e.g., family members, defense attorneys, district attorneys, probation officers, or victims). Referred clients sign releases of information and are screened to determine if they meet admission criteria for the program (i.e., they have a severe and persistent mental illness such as bipolar disorder, schizophrenia, schizoaffective disorder, combat-induced post-traumatic stress disorder, or major depression) and that they live in Larimer County and are charged with a felony or misdemeanor there. Some charged offenses, such as crimes of violence or a sex offense where sex offender treatment is required, disqualify the applicant from the program. Almost every applicant has a co-occurring drug or alcohol issue. The mental health professionals review mental health records and interview the Wellness Court applicant, and the team votes on whether to accept the applicant into the program, based on the admission criteria and the client’s desire to participate in the program. Once accepted, the defendant can be sentenced into Wellness Court probation or can enter a guilty plea or a deferred sentence agreement with the prosecution that requires successful completion of Wellness Court as a condition of probation.
Wellness Court has four phases and generally takes about two years to complete. Clients (not “defendants”) gain privileges and autonomy with each phase. It is an intensive program. Clients are expected to come to “café” twice daily, Monday through Friday, and once on Saturday. Unlike regular probation, where a probationer is expected to seek out different providers for mental health and drug treatment, drug testing, medication provision, court-ordered classes, and other probation requirements, café is a “one stop shop.” At café, clients meet with the nurse practitioner for prescribed medications, take medications that have been prescribed, take required drug tests, meet with therapists and their probation officer, talk with their basic needs case manager to address housing or employment issues, and socialize with other clients and staff. Individuals with mental illness often isolate themselves; café provides a place to socialize and an opportunity for staff to observe clients and identify any potential medication interactions or mental health deterioration, or just to check in. Every week, clients come to court and have an opportunity to discuss with me how their week has gone, what challenges they have faced, what successes and celebrations should be noted, and whether an intervention or a sanction is appropriate.
As you can see, Wellness Court demands a lot of the participants. But each client has an individualized plan. We grade on a curve and expect clients to perform according to their unique abilities at a particular point based on their mental health condition and symptoms, their stage of sobriety, and their developmental capacity. We try hard not to give individual clients more than they can handle, while still demanding accountability and expecting compliance with Wellness Court requirements.
As part of the final phase, each client prepares and presents a final project. Those projects are as powerful as they are personal. Clients have shared stories about their decade of homelessness and drug use before Wellness Court. They share the number of days, months, or years they have been sober, and how their lives have changed because of it. They share their booking photos and compare them with current pictures of their new, healthy selves. They have told us of reunions with family members who had previously disowned them. They have presented original music and artwork that depicts the harm they’ve caused with their crimes and how much they’ve grown since being part of Wellness Court. Many participants share that they would have been dead on the street if not for Wellness Court.
When all four phases have been successfully completed, the client graduates from Wellness Court in a community celebration that includes cake, peer comments, and family members. For many Wellness Court graduates, this marks the first time in their lives that anyone has told them they’ve done something well.
Wellness Court sessions are unlike other criminal court sessions and are meant to be encouraging, embracing, and supportive, while still providing consistency and accountability. For instance, when a client enters the program, I greet them with the following message: “Welcome to Wellness Court! We’re glad that you’re here. Please remember that you’ve been hand-picked to be part of this program, and we can’t wait to see you use this opportunity to succeed!”
The courtroom itself is set up to minimize trauma. The public defender and the district attorney sit together, and I step down from the bench to talk with clients and give them rewards (and high-fives, and sometimes pinky-swears). There’s a therapist on hand in court to meet individually with clients if something is triggering. Court opens with soothing classical music and closes with a song selected by a client who has done well the prior week. Clients are called by their first names, and they each spend a few minutes talking with me one-on-one. If things have gone well, the client can “fish”—and draw a reward. Rewards can include snacks, personal hygiene items, a day off of programing, an inspirational quote, or gift cards to restaurants or stores. A powerful reward to a client can be something as simple (but as moving) as a standing ovation, in which every person in the courtroom rises to their feet and applauds the client. There is frequently laughter, sometimes tears, and occasionally dancing. The key component of any problem-solving court generally, and of Wellness Court in particular, is the clients’ interactions with the judge.5 I spend hours meeting with the team members before our court sessions to get updates about each client’s current challenges and successes. The three to five minutes that I spend talking with each of the Wellness Court clients in court is the best and most inspiring part of my week.
While Wellness Court is obviously not a complete solution to the challenge of individuals with mental health issues who are facing criminal liability, it is a beacon of hope for those in the program and to those in the community who are increasingly aware of the need to address mental health issues. Wellness Court can serve as a model for communities that are struggling with individuals with mental health issues who are caught up in that revolving door of incarceration.
I invite you to contact us to learn more about Wellness Court and to come and see Wellness Court in action. I can promise that there will be music, and maybe even dancing.
1. Carl’s name and the facts of his case have been changed to protect his privacy.
2. 17% percent of adults booked into jails (31% of women and 15% of men) have a serious mental illness; 65% of adults in US corrections systems have a substance use disorder; and 72% of adults with serious mental illnesses in jail also had co-occurring substance use disorders. CSG Justice Center et al., “Judges’ Guide to Mental Illnesses in the Courtroom,” https://csgjusticecenter.org/wp-content/uploads/2020/02/judges-guide-to-mental-illnesses-in-the-courtroom.pdf. The incidence of serious mental illness in jail is high when compared to the incidence of mental health and serious mental health challenges in the general population: 19.1% of US adults experienced mental illness in 2018 (47.6 million people); 4.6% of US adults experienced serious mental illness in 2018 (11.4 million people); and 3.7% of US adults experienced a co-occurring substance use disorder and mental illness in 2018 (9.2 million people). National Alliance on Mental Illness, Mental Health by the Numbers, https://www.nami.org/Learn-More/Mental-Health-By-the-Numbers. See also CSG Justice Center and American Psychiatric Association Foundation, “On the Over-Valuation of Risk for People with Mental Illnesses” (Fall 2015), https://csgjusticecenter.org/mental-health/publications/on-the-over-valuation-of-risk-for-people-with-mental-illnesses (noting that an “estimated two million people with serious mental illnesses are booked into jail each year, making prevalence rates for people with serious mental illnesses in jails three to six times higher than for the general population. Almost three-quarters of these adults have co-occurring substance use disorders. Once incarcerated, they tend to stay longer in jail and are at a higher risk of recidivism upon release than individuals without these disorders.”).
3. As of 2018, Colorado had 76 problem-solving courts. But because helping individuals who need to address mental health issues can require more oversight over clients than what is required of a typical drug- or DUI-court participant, there are only seven mental health problem-solving courts in Colorado. See Colorado Judicial Branch, Problem Solving Courts, https://www.courts.state.co.us/Administration/Unit.cfm?Unit=prbsolcrt.
4. The “LSI-R” (Level of Supervision Inventory-Revised) is an actuarial assessment tool designed to identify the offenders’ risks and needs with regard to recidivism. The LSI-R is a scale of 0 to 54 that seeks to classify an offender’s risk of re-offending and identify their individual criminogenic needs.
5. Problem-solving courts work because they incorporate key components that have proven to be effective, including:
- integration of drug and alcohol treatment, mental health treatment, case management, intensive supervision, and judicial oversight;
- early identification of eligible participants and prompt placement in the court program/intervention;
- judicial interaction with each participant on a frequent and regular basis;
- a nonadversarial, coordinated team approach to communication, case planning, and responses to participant compliance;
- use of sanctions and incentives as a coordinated strategy of contingency management;
- access to the appropriate level of evidence-based treatment and case management services;
- monitored abstinence measured by frequent and random drug and alcohol screens;
- development of partnerships with all participating service organizations and written agreements where appropriate;
- process and outcomes evaluations used to measure the achievement of program goals and gauge effectiveness; and
- continuing interdisciplinary education to promote effective court planning, implementation, and operations.
Colorado Judicial Branch, Colorado Problem Solving Courts Best Practice Manual (Feb. 2014), https://www.courts.state.co.us/Administration/Custom.cfm?Unit=prbsolcrt&Page_ID=804.
Wellness Court: Statistics Through 2019
|Total number of clients served||155|
|Number of graduates||34|
|Number of referrals processed||581|
|Jail bed days used year before entry into Wellness Court||24,163|
|Jail bed days used after entry into Wellness Court||3,473|
|Jail bed days reduced by||20,690 days|
|Average incoming LSI-R score4||35|
|Average end LSI-R for graduates||24|