POLICIES AND PROCEDURES
HARRIS COUNTY FELONY MENTAL HEALTH COURT
INTRODUCTION In September 2011, Harris County established the Felony Mental Health Court (FMHC) in an effort to address the increasing number of defendants cycling through the courts and jail who were diagnosed with a mental illness. The Court, originally funded by a grant from the Bureau of Justice Assistance, was implemented after extensive planning by representatives from the criminal justice system, mental health community as well as treatment providers and advocates. Judge Jan Krocker, the Presiding Judge of the 184th District Court served as the Founding Judge. As the Court entered its second year, Judge David Mendoza, the Presiding Judge of the 178th District Court, and Judge Brock Thomas, Presiding Judge of the 338th District Court, assumed leadership over the Felony Mental Health Court.
MISSION STATEMENT The mission of the Harris County Felony Mental Health Court is to divert defendants living with mental illness from incarceration and instead facilitating linkage to appropriate treatment and community resources.
GOALS The primary goals of the Felony Mental Health Court are to:
Improve public safety Minimize recidivism Increase access to and continued utilization of community resources Enhance collaboration between criminal justice agencies and community service providers to better serve all defendants Improve the quality of life for defendants living with a mental illness
MODEL AND STRUCTURE The FMHC is based on the national problem-solving court model. It is a collaborative partnership between the criminal justice system, a network of community-based providers and the participant. The FMHC program is recovery-based and designed to accommodate a full range of identified needs while providing structure and guidelines to help participants reach their goals. At the beginning of the program, more intensive supervision and treatment opportunities are expected. As a Client progresses through the FMHC program and demonstrates to the Judge that s/he is successfully managing treatment and the requirements of the Community Supervision and Corrections Department, the Judge will consider reducing the frequency and intensity of Court contact. Defendants who are accepted into the FMHC receive deferred adjudication or community supervision. The FMHC program length, which is determined by the Client’s progress, is at least 18 months. Some Clients may require a longer and more structured experience to help them fully benefit from the program. February 2016
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Others may demonstrate early and continued adherence to Court requirements and may be considered for early termination once the minimum 18 months of successful participation in the Court has elapsed. On some occasions, a Client may complete the FMHC program but still remain under the supervision of a Community Supervision Officer until the terms of Community Supervision are complete or the Judge early terminates the supervision period.
ELIGIBLITY FOR THE FELONY MENTAL HEALTH COURT The FMHC is designed for defendants who have been charged with a felony offense and have a diagnosis of a severe and persistent mental illness. Inclusion Criteria Pending felony case Primary diagnosis of Major Depressive Disorder; Bipolar Disorder or Schizophrenia/Schizoaffective Disorder (may also have a secondary Substance Use Disorder) Competent Willing to plead guilty Voluntary Willing to undergo a clinical evaluation and risk needs assessment Willing to adhere to an individualized Re-Entry Plan Willing and able to comply with terms of Community Supervision Willing and able to participate in frequent Court appearances Exclusion Criteria Past or current charge of a sex offense More than one (1) previous DWI offense Primary diagnosis of a substance use disorder No established link between the mental illness and current offense Assaultive offenses will be considered on a case-by-case basis Currently on Parole
REFERRALS TO THE FELONY MENTAL HEALTH COURT Clients are referred to the FMHC through a variety of sources including the following: Defense Attorney/Assistant Public Defender Assistant District Attorney Judge Community Supervision and Corrections Department Perspective Client Family Community Treatment or Service Provider February 2016
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The four page FMHC Referral Packet, which is available on line and in all of the District Courts, must be completed and submitted with the required documentation to the home court Prosecutor who delivers it to the Mental Health Division of the District Attorney’s Office. (See Appendix 1). Once the Referral Packet has been received by the Mental Health Division, the defendant’s past and current criminal history are reviewed. Both non-violent and violent offenses are eligible. Assaultive offenses are considered on a case by case basis. Defendants charged with murder, or who have a past or current charge of a sex offense or have more than one (1) previous DWI offense are ineligible for the FMHC. If the District Attorney’s Office determines that the perspective Client is not legally eligible for the Court, the referring attorney and home court are notified and the case is disposed of in the Home Court. If the District Attorney’s Office determines that the perspective Client is legally eligible for the Court, the FMHC Referral Packet is delivered to the FMHC Court Coordinator who enters the referral information into the Management Information System (MIS) as well as the FMHC database. The Coordinator then delivers the packet to the Clinical Supervisor who reviews the clinical documents to ensure the Client meets the preliminary clinical requirements of the Court and then provides the packet to the Court Clinician to schedule the evaluation. Clients can be evaluated while in custody or out on bond. The Mental Health Court Liaison Officer (CLO) is also notified of the pending referral in order to schedule a TRAS (risk needs assessment) which is completed by CSCD prior to staffing the referral with the FMHC Team. Participation in the FMHC is voluntary and the defendant must be willing to plead guilty. FMHC clients agree to a minimum of a three (3) year deferred adjudication sentence though the seriousness of the offense may result in a longer deferred adjudication period or standard probation. Prior to the plea proceedings, all clients meet with a member of the FMHC Clinical Team for an orientation to the Court during which the FMHC Handbook (See Appendix 2) and FMHC Phases are reviewed (See Appendix 3) and the proposed individualized Re-Entry Plan is presented. Clients are encouraged to ask questions and raise any concerns they have about participating in the FMHC. Upon completion of the orientation, prospective clients meet with their attorney to review and sign plea papers as well as the Harris County Specialty Court Waivers and Consents (see Appendix 4) Acceptance into the FMHC must be agreed upon by the perspective Client’s Defense Attorney, the Home Court Judge and Prosecutor and the entire FMHC Team which includes the Judge, Assistant District Attorney, Assistant Public Defender, FMHC Community Supervision Officer, FMHC Court Liaison Officer and FMHC Clinical Team. FMHC candidates must agree to adhere to an individualized Re-Entry Plan, comply with terms of Community Supervision and participate in frequent Court appearances
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Participation in the FMHC necessitates that a Client actively engages in mental health treatment and substance use treatment (when indicated). Once pleaded into the court, an FMHC Client must be willing to sign a release of information with each treatment or service provider for details pertaining to his/her past and current mental health treatment, past and current substance use and substance use treatment and past and current medical issues and treatment. Once a defendant has plead into the FMHC, they are ineligible to opt out of FMHC participation. The only reasons that a client will be unsuccessfully discharged from the FMHC are: New law violations resulting in adjudication Non-adherence to FMHC requirements resulting in transfer to a standard Community Supervision caseload
PHASES The FMHC Program requires a minimum of 18 months of participation and is comprised of 4 distinctive phases which culminate in a graduation ceremony (See Appendix 3). The length of each of phase depends upon a Client’s progress as well as their individual strengths and needs. Movement through the phases is completely individual and will not be based solely upon the length of time a Client has participated in a phase. The four phases are as follows: Phase 1: ENGAGEMENT Phase 2: ACTIVE TREATMENT Phase 3: STABILIZATION Phase 4: REINTEGRATION The FMHC Team regularly staffs each Client and determines when a Client is ready to be promoted to the next phase. A Client may also request consideration for phase promotion. Clients who are being considered for phase promotion are directed to complete a Phase Promotion Worksheet (See Appendix 5) which is reviewed by the Team prior to the Client’s next court appearance. If the Team agrees that the Client is ready to be promoted, the Client reads and signs a Phase Contract (See Appendix 6). Upon successful completion of the FMHC Phases, Clients may be eligible to graduate from the Court program.
COMPLETION OF THE FMHC All prospective graduates must complete and submit a Graduation Application (see Appendix 7), Personal Crisis Plan (See Appendix 8) and a Wellness Action Plan (See Appendix 9) at least 2 (two) months prior to Graduation. The Team reviews the Graduation Application packet and determines if the Client is ready for graduation. Upon graduation from the FMHC, Clients may be considered for early termination from Community Supervision. However, based upon a Client’s original sentence and participation in the Court, it may be February 2016
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determined that while the Client is eligible to graduate, they would benefit from continued monitoring by the Community Supervision and Corrections Department. Under these circumstances, the Judge will reevaluate the possibility of early termination from Community Supervision every six (6) months
THE TEAM Judge The FMHC Judge heads the collaborative Court Team. In this capacity, the Judge regularly reviews reports from the Community Supervision and Correction Department and treatment updates detailing each Client’s compliance with the Re-Entry Plan. During Court appearances, the Judge addresses each client individually at the Bench – asking them for their perspective on treatment, adherence and life in general. Based upon how the Client is doing, the Judge administers graduated incentives and sanctions to increase each Client’s accountability and to enhance the likelihood of long-term behavior change. Program Director The Program Director is the key liaison with the FMHC Judges, FMHC Team, internal and external stakeholders. This position provides administrative, fiscal and clinical supervision over programmatic functions of the Court. The Program Director establishes operational guidelines and manages all aspects of the budget including the procurement of supplemental funds; facilitates weekly staffings for each docket; develops and implements innovative community-based treatment options for FMHC participants; cultivates and strengthens collaborative relationships with community stakeholders. Assistant District Attorney The role of the Assistant District Attorney in the FMHC differs from their role in a traditional adjudication process. In the FMHC, all parties and counsel share the common goal of helping participants successfully comply with treatment in a community setting, and as such, the Assistant District Attorney assumes a non-adversarial approach. The Prosecutor reviews new cases concerning eligibility pursuant to the guidelines previously stated. The eligibility assessment includes a review of the defendant’s criminal history, consultation with the victims, legal eligibility, and appropriate dispositions upon the defendant’s entry into the FMHC. Assistant Public Defender/Defense Counsel The Assistant Public Defender/Defense Counsel represents and advises the Client in all Court proceedings and is mindful of the Client’s constitutional rights as a criminal defendant. The Assistant Public Defender/Defense Counsel uses a non-adversarial approach with a focus on protecting defendants’ constitutional rights and their success in treatment. The Assistant Public Defender/Defense Counsel seeks to find treatment solutions for the defendant that minimize the defendant’s exposure to incarceration, reduce the risk of re-arrest or new charges and mitigate the consequence of a criminal conviction. Community Supervision Officer/Court Liaison Officer The specialized Community Supervision Officers and Court Liaison Officer oversee a caseload of exclusively FMHC participants. Each Officer works closely with participants and provides updates to the February 2016
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Team regarding compliance with Conditions of Supervision. The Officer focuses on community involvement including meetings with participants in the field and office, interacting with communitybased organizations, overseeing probation fees and restitution and assisting participants with strategies that promote adherence to Conditions of Supervision and compliance with treatment. Clinical Supervisor The Clinical Supervisor oversees the Clinical Team’s role in the evaluation, development and implementation of treatment recommendations. In addition to providing supervision to the FMHC Team and clinical recommendations to the FMHC Community Supervision Officers, the Clinical Supervisor delivers direct clinical interventions to FMHC Clients and support systems when indicated including the management of psychiatric crises. Additional responsibilities include obtaining and relaying treatment updates to the Program Director and the Court Team; providing weekly individual and group supervision for the Clinical Team, and serving as a Field Instructor for graduate and undergraduate students. Court Clinician The Court Clinician conducts initial and on-going assessments to determine FMHC Court eligibility as well as identify biopsychosocial needs. The Court Clinician obtains weekly clinical updates from each treatment provider and routinely delivers direct clinical interventions to FMHC participants and support systems. Additional responsibilities include on-going assessment of emerging participant needs, recommendation of subsequent modifications to participant Re-Entry Plans, and triage and management of psychiatric crises. Case Manager The FMHC Case Manager assesses the nature and degree of FMHC participant service needs and subsequently develops, implements and monitors the efficacy of the Court Re-Entry Plan. The Case Manager identifies current and emerging participant needs and links participants with appropriate rehabilitative services including mental health and substance abuse treatment, housing, food and other community resources. In addition, the Case Manager serves as a liaison with the FMHC Client, community service providers and the Court. Peer Support Specialist The Peer Support Specialist is an individual in recovery who has been trained to use their recovery story to help other individuals in their recovery journey. The FMHC Peer Support Specialist engages one-onone with FMHC Clients offering recovery goal setting through the use of self-management recovery tools. The FMHC Peer Support Specialist assists Clients with the development of their Wellness Action Plan and serves as a model for personal recovery.
SCREENING PROCESS With the consent of the Home Court Judge, Home Court Chief Prosecutor, Defense Attorney and Defendant, the Mental Health Division of the Harris County District Attorney’s Office screens the defendant to ensure they meet legal criteria for the Court. If the defendant does not meet legal criteria, then the Home Court is notified that the defendant is ineligible based on past or current criminal history. February 2016
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If the defendant is found to be appropriate for the FMHC from a legal standpoint, then the defendant’s referral packet is sent to the FMHC Court Coordinator who enters the defendant’s demographic information into the Harris County District Court Administration’s Management Information System (MIS) and alerts the FMHC Court Clinician that there is a new referral ready to be evaluated. The evaluation includes review of the following sources of information: Incident Reports Criminal History Available psychiatric records from Harris County Jail Available psychiatric records from the community TRAS if completed prior to the FMHC evaluation Clinical Interview with the defendant The Clinical Interview includes review of the following categories of information: Reason for Referral Past and current living situation Past and current psychiatric history Past and current substance use history Past and current medical history Social Supports Attitudes and criminal thought patterns Client identified strengths and goals for FMHC Service needs Clinical impression Recommendations Following the FMHC Evaluation, the Court Clinician: Completes a written psychosocial evaluation May request additional medical records if indicated Reviews case with the FMHC Clinical Team to determine next steps, including Recommend acceptance to full FMHC Team Request additional work-up (e.g. evaluation by Community Services and Corrections Department for consider of entrance into their Dual Diagnosis Residential Program) Deny case for FMHC If the Client is legally and clinically eligible for the Court, the Defense Attorney is notified and is requested to attend the next FMHC Staffing during which defendant’s case will be reviewed by the entire FMHC Team for acceptance into the FMHC Program. If the Judge and all parties of the Team agree that this is a suitable case for the Court, a plea date is set for the next available Court date. If the Client is not clinically eligible for the Court, the FMHC Court Clinician generates a denial letter indicating the reason for the denial and recommendations when possible. The FMHC Court Coordinator then verbally informs the Defense Attorney of the denial and emails the Defense Attorney, the Mental February 2016
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Health Division of the District Attorney’s Office and the Home Court Coordinator a copy of the denial letter. If denied from the FMHC, the Client’s case will remain in the Home Court.
PROGRAM REQUIREMENTS General program requirements include the following: Follow all FMHC recommendations Adhere to Conditions of Supervision Abstain from drugs and alcohol Submit random drug and alcohol samples Actively participate in mental health treatment Actively participate in substance abuse treatment and support groups (if indicated) Demonstrate adherence to psychotropic medication Attend all FMHC Court appearances Remain law-abiding
DECISION MAKING Prior to each weekly docket, the FMHC engages in a staffing with the full FMHC Team during which advancements and barriers of each of the Clients on the docket that day are discussed. During the staffing, the Community Supervision Officer and members of the FMHC Clinical Team provide updates from interactions with clients and families as well as information obtained from treatment, service and housing providers. Both the Defense Attorneys and Prosecutors have the opportunity share any information or recommendations they have regarding clients. The general approach is non-adversarial. Recommendations are elicited from all who are involved in the case and are offered to the Judge. Based upon all of the information and recommendations presented, the Judge makes the final decision regarding any incentives or sanctions that will be applied. The staffing is also used to review new referrals being considered for acceptance into the Court and to assess the status of complex Clients not on the docket for which current treatment and supervision do not appear to be effective.
CONFIDENTIALITY The FMHC Program is governed by the laws of confidentiality. Disclosure of information received in the course of participation in the Court to non-authorized parties is strictly prohibited. FMHC Clients must authorize the disclosure to the Court of information regarding their diagnosis, attendance, scope of treatment, treatment progress, and quality of participation in treatment and termination or completion of February 2016
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treatment. All parties attending staffing that are not affiliated with the FMHC must sign a pledge to maintain confidentiality of all client information and discussion around such information. The FMHC Clinical Team maintains paper and electronic files on each FMHC participant. Both paper and electronic files are secure and only accessible to FMHC staff and FMHC interns.
COURT APPEARANCES Court appearances are a central feature of the FMHC. In the initial phase of the Court Program, participants appear weekly before the Judge who reviews their individual progress. During their court appearance, Clients interact directly with the Judge. The Judge asks how they are doing and if there is anything they’d like to discuss. Clients are expected to provide proof of treatment compliance (such as attendance at groups) and notify the Court of any changes to their treatment plan.
RE-ENTRY PLANS Re-Entry Plans are developed by the FMHC Clinical Team prior to the Client pleading into the Court. While similar to a treatment plan, a Re-Entry Plan is designed to address domains that are central to a client’s successful re-entry from jail back into the community and their continued success throughout and long after their involvement in the FMHC. Upon a thorough psychosocial evaluation, the Clinical Team identifies the strengths and needs of prospective FMHC clients and, if accepted into the Court, links them to appropriate services. Re-entry plans are flexible and continuously re-adjusted based a client’s individual needs and goals. The FMHC Re-Entry Plan addresses the following 5 categories: mental health treatment; substance abuse treatment; housing; medication adherence; and support (which include financial support and social support).
TREATMENT PROVIDERS The FMHC works with a variety of behavioral health treatment providers. The local Mental Health Authority, Mental Health Mental Retardation of Harris County, provides the majority of mental health services to FMHC clients. In addition to MHMRA, Clients may receive services through Harris Health, a Federally Qualified Health Center (FQHC) or a private provider. Clients are encouraged to attend National Alliance on Mental Illness (NAMI) or Depression Bipolar Support Alliance (DBSA) groups. FMHC Clients in need of substance abuse treatment are linked to providers that offer the appropriate level of care. Clients may be referred for acute detox services; secure and non-secure residential treatment facilities; Intensive Out Patient; Supportive Out Patient and Out Patient treatment. Clients are often directed to attend 12 Step meetings during and after their treatment is complete.
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Clients who are interested in additional support are encouraged to consider participating in a Psychosocial Clubhouse or work with a Recovery Coach and/or with the FMHC Peer Support Specialist.
TRANSPORTATION Clients in need of transportation assistance may request bus passes in the form of Metro Money from the FMHC Team. Court personnel instruct Clients that transportation assistance is provided only for Court and treatment related activities. Court personnel determine the amount of Metro Money based on Client reported activities scheduled between court dates. Metro Money is approved and documented by the FMHC Clinical Team. Clients who become employed may have their transportation assistance request reduced or denied depending on the Client’s income and need.
HOUSING If a client is or becomes homeless during their participation in the Court, the FMHC Clinical Team will link the Client to the most appropriate available housing. Additionally, if a Client appears to be in need of a more structured living environment during any point in their participation in the Court, The FMHC Team may recommend to the Judge that the client be considered for transitional and/or sober housing. If the Judge is in agreement, The FMHC Clinical Team will work closely with the Client and their treatment providers to determine the best option(s) for the Client. Clients who are referred to transitional and/or sober housing may be eligible for time-limited financial assistance through the FMHC or another funding source. If a Client is in need of such assistance, the FMHC Clinical Team will coordinate with one of the facilities with which the FMHC Program or other funding source has a contract.
INCENTIVES AND SANCTIONS Graduated incentives and sanctions are a fundamental element of the FMHC program. Incentives and sanctions are used by the Court to motivate Client adherence with the recommendations of the Court and Treatment Provider. Designed to encourage positive behavior change, client adherence with their treatment plan, Conditions of Supervision and program compliance are rewarded with incentives while non-compliance and negative behaviors are addressed with sanctions. (See Appendix 10).
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Incentives The Judge determines incentives based upon recommendations from the entire FMHC Team. The type of incentive will vary depending on the behavior that the Team hopes to reinforce and the rewards that motivate the individual. Incentives include but are not limited to: Praise from the Judge All Star Reduced frequency of Court appearances Decreased intensity of supervision (e.g. fewer meetings with Community Supervision Officer) Decreased drug testing Applause Granting of privileges (e.g. travel permit) Phase advancement Graduation Early termination of probation
Sanctions Non-compliant and undesirable behaviors are addressed immediately through the application of sanctions. The Judge applies the principle of graduated and least restrictive sanctions based both on current and previous behavior. The Judge imposes sanctions after listening to the Client, and hearing recommendations from Counsel, the CSO, the Clinical Team and the Peer Specialist. Similar to the concept of incentives, the type of sanction that the Judge selects varies depending on the behavior that needs to be addressed and the consequences that motivate the individual. (See Appendix 11). Sanctions for non-compliance with FMHC program rules may include but are not limited to: Judicial reprimand Increased frequency in Court appearances Rotated to the bottom of the docket Behavior contract Delay in phase advancement or regression to a prior phase Written assignment Increased intensity of supervision (e.g. more frequent meetings with Community Supervision Officer Increased drug testing Loss of privileges (travel permit denied) Community service hours Jail remand Termination from the FMHC program/sentencing
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JAIL REMAND The Court may decide to remand a Client currently living in the community for a brief incarceration at the Harris County Jail when the Court believes that it is in the Client’s and/or community’s best interest to do so. Jail remand is a decision made by the Judge in consultation with the FMHC Team. Is it an action taken by the Court as a “last resort.” No FMHC Client is ever remanded as a first resort or for the purpose of “teaching the Client a lesson.” Remand occurs as a result of the Court’s reaction to reports regarding substance use, program compliance and community behavior. Jail remand differs from termination from the FMHC in that it does not necessarily imply unsuccessful discharge from the FMHC. The FMHC Team will continue to work with the Client during and after the remand to address the issues that initiated the remand order.
CLINICAL INTERVENTIONS If warranted, clinical interventions may be applied in addition to or in place of a sanction. Clinical interventions include but are not limited to:
New level of care (e.g. the addition of individual therapy or Recovery Coach) Increased level of care (e.g. residential or in-patient admission) Increased and documented attendance in support groups
TERMINATION When a client engages in negative behaviors that result in a new arrest, the FMHC Team reviews the Treatment Plan, the Re-Entry Plan and the Conditions of Supervision to identify possible areas to be modified. Depending upon the severity of the new law violation the client may be terminated from the FMHC. A client may also be terminated from the FMHC for acute or prolonged non-compliance with their Conditions of Supervision.
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APPENDICIES 1. FMHC Referral Packet 2. FMHC Handbook 3. FMHC Phases 4. Harris County Specialty Courts Waivers and Consents 5. FMHC Phase Promotion Worksheet 6. FMHC Phase Contract 7. FMHC Graduation Application 8. FMHC Personal Crisis Plan 9. FMHC Wellness Action Plan 10. FMHC Incentives and Sanctions 11. FMHC Graduations of Sanctions
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