Not all mental health courts have been as successful as the court in Pittsburgh or the courts in San Francisco and Broward County, where studies have also pointed to lower recidivism rates. Different courts use different treatment facilities. They also apply different sanctions. Some judges see jail time as fair punishment for breaking treatment; others say jail is counterproductive. A number of courts will take felony cases, while others restrict participation to those accused of misdemeanors. "What's unclear is for whom and under what circumstances mental health courts work," says Henry Steadman, the director of Policy Research Associates, who is running the first national study of mental health courts. (Even in Pittsburgh, of the 481 people who have enrolled in the court, 47 have been thrown out or left.)
The courts have sparked criticism by some mental health experts. First, they worry that the courts criminalize the mentally ill because most force defendants to plead guilty in order to receive treatment. (A few will erase charges altogether if treatment is successful.) Second, critics are concerned that the courts divert limited treatment resources from the general community to those with criminal records. "Nobody talks about the trade-offs," says Joseph De Raismes, vice president for public policy for Mental Health America, an advocacy group. "Nobody talks about whether three or four needy people didn't get into treatment."
Addiction. The choices inside court aren't always easy either. During a recent session, Zottola heard the difficult case of Jeffrey Woods, who at age 48 had spent more of his life inside the criminal justice system than outside it. He was raised by a single mother as one of 13 children. Arrested at 17 for stealing from a jewelry store, Woods says he fell into drug dealing for most of his 20s and soon became his own best client. The addiction was heightened by his untreated mental illness: schizoaffective disorder, which had led to a number of suicide attempts. In 1992, he was sent to prison for a decade.
Released in 2003, Woods tried to turn his life around. He fell in love and began to reacquaint himself with his teenage son. But soon, he says, "my urge and needs came back." In 2004 he was arrested again for stealing, but this time, he was offered a way to avoid jail: the mental health court.
Since joining the program, Woods has been charged with four new offenses, including felony theft charges. After his arrest last fall for stealing a $400 watch, he stopped checking in with his probation officer and his therapist. Prosecutor Heather Kelly wanted him thrown out of the program.
Woods, aware that he was on thin ice, had made a pre-emptive strike by sending the judge a Christmas card. He had also begun showing up for therapy and arrived at court early, clean, and sober. It wasn't perfect, but it was progress. Zottola warned Woods that he was getting close to jail time again. "You have to try to straighten some of this stuff out," the judge said. "I'm ready," Woods assured him, announcing his efforts to enroll in culinary school.
The judge ordered Woods to report for weekly drug tests and to check in regularly with his probation officers. "I have a lot of faith in you," he told the defendant, while reminding him that jail still loomed.
After the hearing, Woods said he feared returning to jail largely because it would cost him his fiancée . But he believes the mental health court has made a difference. "It helps me realize you do have choices in life," he says. Yet he says he's never quite sure what the next moment will hold. When he's off medication, he says, trouble lurks. Last winter he walked out of mental health court, only to be arrested hours later for shoplifting a pair of gloves.
Still, Woods counts himself lucky. He's nearly 50—an age, he says, that his father never reached.