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The Creation of a Family Mental Health Court

Deborah SchumacherDeborah Schumacher, Judge, Second Judicial District Family Court and Reno Mentor Model Court Lead Judge

Summary: The author describes the creation of a family drug court 20 years ago under the Model Court Project of NCJFCJ and gives insight into the needs of parents with dual diagnosis.


The Reno, NV, dependency court had the great good fortune to be in the first wave of dependency model courts created in the mid-1990's by the National Council of Juvenile and Family Court Judges. The Model Court Project encouraged us to be systematically involved in reexamination of our basic practices and to pursue best practices. In this rich context, we created a family drug court that is 22 years old this year. It will be honored at the 2014 National Association of Drug Court Professionals Conference as the nation's first dependency drug court.

Throughout our journey in this court, we questioned whether we were providing adequate and appropriate services to our dual-diagnosis clients and their children. Despite the generally robust positive outcomes for our drug court clients, we grappled with our self-acknowledged poorer outcomes for our clients with co-occurring disorders. We had placed in our drug court parents who were self-medicating for known or suspected mental illness, anticipating outcomes similar to our general drug court population. Our clients were sent for mental health treatment, but the feedback loop was missing and we lacked a coordinated response. We ultimately acknowledged that the fit was poor and began to turn away from drug court clients who had mental health needs we felt drug court would not meet. We were deeply uncomfortable, as a population needing our help the most was falling through the cracks. Our model court authorized a subcommittee to explore the creation of a separate mental health track in dependency court.

Perhaps the most important take-away I can provide to jurisdictions considering establishing a dependency mental health court is that it was implemented with existing resources. It began as a pilot of two families in December 2010, a moment in time when the court and its partner stakeholders were in the thrall of budget cutbacks and fighting to stave off deeper cuts. A design predicated on acquisition of additional public resources would have had no possibility of being implemented.

There is no separate, dedicated funding scheme for our family mental health court. The key is that the families are already clients of each of the institutional entities involved in mental health court—Washoe County Social Services, the district attorney's office (representing social services), the court, the public defender's office (representing parents)—and each is eligible by definition of his or her mental illness to receive services at Northern Nevada Adult Mental Health Services, our public mental health treatment provider. The involved institutions essentially provide in-kind contributions.

The program lasts 15 months from admission for successful participants; it includes 12 months for graduation and 3 months of after care. Potential participants observe at least one court session and receive an extended, one-on-one orientation regarding policies and expectations. Admission is voluntary, based on a serious, current mental health assessment, but exit from the program must be court ordered. Applicants are advised that they are consenting to possible non-compliance sanctions, which may include incarceration. Admission is generally by team consensus, with ultimate authority in the judge's hands.

Mental health court sessions are held every two weeks, as a separate court session from our drug court tracks. Participants are subject to the identical random drug testing scheme that applies to drug court clients. (Specifically, clients call daily to learn if their testing color has been selected. Testing is random. Testing frequency remains random but is reduced during after care.)

The professionals comprising the team for mental health court include a designated social worker and specialty courts supervisor from Washoe County Services, social services' counsel, parents' counsel as well as case managers from Northern Nevada Adult Mental Health, the court and a nonprofit agency called Tru-Vista. Tru-Vista is a small nonprofit that funds peer recovery specialists (our "mentor moms") and foster grandparents for our families, and can assist in providing goods or funds to remove barriers for our families. Examples of Tru-Vista's assistance have been provision of furniture and work attire and clearing a past due power bill that is keeping a family from housing needed for reunification. Tru-Vista is responsible for client orientation and also provides some ongoing service delivery, such as job search assistance and budgeting education.

We also benefit from the management and coordination services of the district-wide specialty court coordinator. Prior to each session, two staffings occur, one with and one without the judge. For each session, the team reviews a written report that includes drug testing results and reports from the treatment provider and social worker, as well as the assigned foster grandparent. Progress, barriers and potential additional court orders are discussed.

Key to the success of family mental health court are the services provided by Northern Nevada Adult Mental Health Services. Outpatient services include psychiatric assessment, medication management, individual and group counseling, targeted case management, co-occurring disorder groups (including trauma informed care), vocational classes and paid training opportunities at an in-house cafe. Critically important and needed housing assistance can be provided, where appropriate.

The current capacity of our family mental health court is 12 clients. The total number of participants since inception is 25, 12 of whom are still participating. To date, the court has had the following outcomes: Six clients have been removed from the program by court order, and one individual was transferred to drug court, as a better fit. Six participants have successfully reunified with their children and the family's CPS case has been closed. One client's CPS case has closed by relinquishment of parental rights. Several clients have participated by family mental health court providing courtesy supervision for our criminal courts. Sometimes a client’s deferred or probationary status is tied to successful completion of a specialty court program. Seventy-two percent of our clients have had prior court-substantiated child protection cases. By any criteria, it is a population with complex needs.

Our family mental health court has quarterly policy meetings, and we consider it very much a work in progress. We have realized that a client may be able to be stabilized and also be in substantial compliance with our program (i.e., through negative drug testing and genuine, consistent participation in treatment) but remain too impaired to safely parent a child. The promise and expectation of the program from the parents' viewpoint is clearly that it is a path to reunification if the parent does what is asked of him or her. We continue to grapple with this issue, but at present do not believe that it is always possible to know whether a client will succeed prior to providing the opportunity. In these cases, the array of services and personalized attention and case planning that has occurred give the judge a firm basis for finding that reasonable efforts toward reunification were provided, even though, sadly, the desired outcome of reunification was not obtained.

We remained excited about our family mental health court project and convinced it is greatly needed. We attempt to communicate to our clients that mental illness is not the individual's fault, but is the individual's responsibility. It is our hope to help our clients obtain the skills and knowledge to successfully parent and manage their mental health, connecting them with community resources to assist beyond their time in our court. 

 

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