"Jane" had been struggling with mental illness for years. When she was on her medication, everything was fine. But when she went off it, which happened often, she had a tendency to physically attack her father, with whom she lived. Though he didn't want to, he had to call the police to protect himself. The police had no alternative but to take her to jail each time. Before long, she had a lengthy criminal record. The scenario is one that Jason Schwarz, a public defender headquartered in Everett, has encountered all too often: people struggling with mental illness who wind up in jail because they pose a threat to others when off their meds, who use illegal drugs to self-medicate, or who repeatedly trespass due to homelessness.

"It's safe to say that the biggest mental health facility in this city is the jail. They see more people with mental health issues than the hospitals," he said.

In King County, the court system has discovered a solution to this seemingly unending cycle. It's called mental health court.

Unlike traditional courts, which mete out punishment in the form of fines or prison time, mental health courts focus on providing highly supervised treatment options, social services and ongoing monitoring to offenders whose crimes were precipitated by mental illness.

Starting with a handful of courts in the 1990s, there are currently more than 150 mental health courts across the U.S., according to the Bureau of Justice Assistance, which administers the Mental Health Courts Program. 

King County has operated one for nearly 13 years. Judge Anne Harper served on the task force that vetted the program during its inception, and last month wrapped up a two-year stint as the court's presiding judge.

"No one chooses to be schizophrenic," said Harper. "People have this image that people that are mentally ill are violent. That's not true. If they are going to be violent, they're violent toward themselves."

She got her first taste of the complex challenges faced by mentally ill defendants during her tenure as a public defender in Snohomish County. She found dealing with someone with long-term chemical dependency to be easier than trying to get help for a person with untreated mental illness. Often the only alternative to releasing them from jail was involuntary commitment.

"I represented a lot of people who were sent to Western State Hospital on insanity cases," she said. 

In 1999, the King County District Court launched its mental health court. Initially it only dealt with misdemeanor cases. Today it also handles felonies that have been downgraded to misdemeanors.

An individual typically becomes involved with mental health court after being arrested and booked into jail, where they are screened for mental illness. Once the public defender is notified, they can be referred to mental health court — but only if they agree to participate.

Unlike standard criminal courts, where a suspect must stand trial whether they want to or not, mental health court is a voluntary court. The individual who has been charged with a crime has the right to refuse to participate, and can instead be tried in a regular court of law. If they agree to participate in mental health court, however, they are released from custody and provided with "wrap-around services" for a two-year period. This can include housing, mental health treatment, medical care, and counseling for chemical dependency. 

During their two years in mental health court, they are monitored by a case manager, the prosecuting attorney, their own lawyer and a probation officer. And, unlike the average criminal court, "One of the things that mental health court provides is intensive monitoring and involvement by the judge," said Harper.

The defendants are required to come to court on a regular basis to check in with the judge, report on their progress in therapy or treatment programs, and let the court know about any problems they are having. For some, this check-in takes place every week. For those who are becoming more stable, it can happen every two or three months.

The program isn't a "get out of jail free card." Those who don't follow the orders of the judge or who fail to show up in court can be dropped from the program. They then must face the charges for their original crime, and may go to prison.

If the case manager discovers that the defendant is beginning to have problems, they contact the probation officer, who comes to court. As a team, the lawyers, case manager, probation officer and judge try to come up with a plan to help the person. They don't simply yank the parole and send the person to prison. But there are consequences.

Two days in jail is a common punishment, or being sentenced to serve on a work crew picking up trash. For a first offense, many are made to attend mental health court as observers, in order to gain perspective on how other people enrolled in the court are behaving and what the judge's response is.

"They are actually part of the solution creation process. We tell them when they come in, 'You need to tell us what you need to be healthy,'" said Harper. "You really get to know the person. The person trusts you. You respond in a very parental way, actually."

Inside the courtroom

When King County's mental health court was created, it handled just 25 to 30 cases. Today, it has 200, with a capacity of up to 285 cases, according to Betsy Bosch, regional mental health court manager. Until December 2011, Harper was responsible for all 200 cases in mental health court, along with a morning docket of regular court cases. To prevent burn out, judges serve two-year rotations.

"We're running four afternoons a week and five every other week," Harper said. "It can be pretty exhausting."

Starting this month, the court's presiding judge is Michael Finkle. As Harper was winding down her tenure on Nov. 22, she held a session of court with 15 cases on the docket. For many of the defendants seen that day, it was more than a regular check-in. It was also goodbye.

One of these was "Mr. Sanchez," who recently completed an inpatient treatment program at Sea Mar Community Health Center's Behavioral Health Department.

"Bravo!" Harper said spontaneously. "I'm very, very pleased that you went to inpatient treatment and that you're doing well. I want you to keep your head up and be proud."

Sanchez then addressed the court. "I just want to say, I'm doing my program and I feel good. It's way better for me, working this way, than the other way [without medication]. I need to do good things and get good results."

Another man, "Mr. Kroto," had recently aroused concern that his symptoms were worsening and that he was not responding to treatment. He had told an official that he stopped taking his medication because he didn't like the side effects. "I'm glad that you're here," said Harper. She assigned him a 4 p.m. check-in every day, in order to provide him with more intense monitoring. "Think about what else would help, and then tell us," she concluded.

"I think one of the big values of the mental health court is it openly brings a sense of compassion into the criminal justice system," Harper explained. "The system as a whole tends to become incrementally more compassionate by modeling on the mental health court. ... It demystifies mental illness."

The court is not a secretive operation, and is open to the public. Harper feels that its existence demonstrates that something can be done, even in seemingly hopeless cases, by providing a resource other than the less-desirable options of jail or commitment to a mental hospital.

Some people even graduate from the program early. "It's a balance of public safety with meeting their therapeutic needs," said Harper.

Seeking help in Snohomish County

It's no surprise that mental health advocates want to open a mental health court in Snohomish County. One of the driving forces behind the effort to establish a pilot program is Public Defender Jason Schwarz. The Snohomish County Public Defenders Association handles all indigent cases for the county. Though Snohomish County has a drug treatment court, which offers supervision, rehab and treatment to nonviolent defendants, the county is less adept at handling mental illness, according to Schwarz.

"Probation officers are experts at drug and alcohol issues. What you do with mental health issues is outside our expertise," he said.

As a social worker employed by the Snohomish County Office of Public Defense, it's Eric Johnson's job to assess mentally ill clients and provides case management during the pretrial and the sentencing phases. He has seen numerous people slip through the cracks.

"Most of the chronically mentally ill who wind up in jail don't have a strong family support system and aren't connected to resources. ... Typically, my clients lack even basic needs — food, shelter, clothing," said Johnson. "Some of them are definitely offenders that I see come through here again and again. ... A lot of them have co-occurring disorders, which means they also use or abuse chemical substances."

"These are the most expensive people to treat in jail," said Judge Douglas Fair of Edmonds Municipal Court. "If we're not putting them in jail, we're saving $65 a day, plus medicals."

This is because, once diagnosed, the jail has to provide medication, therapy and medical treatment, Fair explained. However, "Once you get out of jail, the treatment stops," he said.

Though there is range of help for the mentally ill available in Snohomish County, the biggest issue with repeat offenders is an inability or an unwillingness to take advantage of this assistance.

"There are a lot of barriers to treatment in the first place," Johnson said. "The process of accessing treatment can be complex for the average person, let alone a person with mental illness." He feels that one of the most daunting tasks is simply applying for Medicaid; something those who are deemed indigent must do in order to pay for treatment. The application process requires a great deal of paperwork, multiple visits to the Department of Social and Health Services, and considerable personal follow-through.

In 2011, a crisis triage center opened in Snohomish County as an alternative to incarcerating mentally ill individuals whose behavior is out of control. "The triage center has been helpful for a lot of folks," Johnson said, explaining that a trip to an emergency room is another option for treatment. In both cases, "They're able to temporarily stabilize people, but it's not a long-term solution," he said.

When a hospital emergency room or the triage center aren't able to stabilize the person adequately, a mentally ill person can wind up in the involuntary commitment system, also referred to as ITA (Involuntary Treatment Act). They must pose a danger to themselves or others, or be gravely disabled in order to be committed. If a county-designated mental health specialist makes such an assessment, the individual can be detained for 72 hours against his or her will.

"That system is independent of the criminal justice system, but there is some overlap," said Johnson. "If the person is not an imminent threat to themselves or others, then the chances for commitment are pretty low."

Release into the community then becomes the only option.

Harper feels that it's unfortunate that a person has to be arrested in order to get the kind of help that mental health court provides. "There are a lot of poor, hungry, homeless, mentally ill people out there, and those are the ones we want to reach," she said. "We have a gross need throughout King County and Snohomish County."

A long road ahead

Mental health court is not a cure-all, and those intimately involved with the system are the first to admit it.

"One of the downsides of mental health court is, as a judge, you become personally involved with the clients," said Harper. "You care about them, but as a judge, you [must] pull back and say, 'What is the court for, and what did they do to get here?'" In order to keep her mind on the last question, "Every fourth or fifth hearing, I go back and re-read the police reports."

During the Nov. 22 session of King County's mental health court, three scheduled defendants simply didn't show up. The judge issued a $10,000 warrant for one of them. Another, she ruled in contempt of court. The third had a history of poor attendance and was believed to have left for Oregon for Thanksgiving without permission. No warrant was issued. Not yet.

Meanwhile up north, progress was being made in establishing a mental health court pilot program for Snohomish County.

The planning process, which began in January 2010, culminated in October 2011, when the Chemical Dependency & Mental Health Program Advisory Board unanimously voted to recommend that the Snohomish County Council approve the Mental Health Court Taskforce's request for $100,000 in funding.

On Nov. 21, during the public testimony segment of the Snohomish County Council's 2012 budget meeting, Judge Fair expressed his support for the pilot project, as well as that of the task force, which included Schwarz, Johnson, several local judges, attorneys, social workers and representatives from the mental health treatment community.

"It is our firm belief that the study will end up demonstrating that the county will save money overall," he said. "This project does not cost additional tax dollars — no new taxes need to be raised. The money to fund this project already exists. It's in the 'one-tenth of one percent' fund."

Fair was joined by Jim Bloss, representing the National Alliance on Mental Illness of Snohomish County. "The existence of a mental health court, with its emphasis on prevention, intervention and diversion, over time has the effect of helping to change the mindset and public understanding of mental illness. In a way, it's actually a destigmatizing action, reminding those, who may not already be aware, that those living with a mental illness do not belong in the law and justice system," he said.

The Snohomish County Council voted unanimously to authorize the requested funding to establish a pilot program. Now it's up to the key players to create it.

Schwarz anticipates that 15 to 20 people will be enrolled in the pilot program. The candidates will be carefully screened, to make sure only those who genuinely want to enroll and who have the ability to be successful are accepted. The committee also wants to develop a way to measure the success of the program. "It's all good to say this works, but you need the numbers to prove it. Anecdotal evidence is good, but it doesn't prove anything," said Fair.

Though he acknowledges that there's a lot still to be done, Schwarz is optimistic about the pilot program.

"I can't imagine how it's not going to work," he said.

For others, the mood is hopeful but cautious.

"They're setting it up in probably the most adverse financial circumstances in 60 years," Judge Harper said. "The government budget frankly has massive cuts in the realm of social service. You can have all the mental health court in the world, but if you don't have treatment to back it up, you might as well not have mental health court."

Fair agrees that mental health court alone is no panacea. In addition to agreeing to participate, the defendants must have the means to pay for the treatment they receive throughout the two-year program. Payment typically comes from private insurance, out of their own pockets or from a program like Medicaid. However, if the defendant is a member of the uninsured working-class poor, odds are they won't be able to participate in mental health court. Though the task force hopes to obtain funding to cover those who would be ineligible solely due to an inability to pay, "There's a lot of hurdles," Fair said.

On Nov. 22, the day after Snohomish County's pilot program was approved, a graduation from King County's mental health court was held in Judge Harper's courtroom. It was for "Mr. Haywood," who entered the court in May 2010. He had been in full compliance since being admitted to the program. Though he wasn't due to leave the court system until May 2012, an early graduation was recommended, thanks to the progress he had made.

Harper agreed.

"You came in here on a drug charge, and you have been a star," she said. "You seem to have a very nice point of joy about you. Even if things were tough ... you had a level of optimism." She presented him with a graduation certificate, along with a golden coin meant to serve as a reminder that he could access the court in the future if he ever needed help.

Upon receiving his certificate, Haywood said, "I didn't know what I had until I got in trouble. ... Thank you very much."