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Mental Health Court Offers an Alternate Path

A special court aims to help people with mental health problems who get caught in the criminal justice system to escape the revolving door.

By Taylor Sisk

“I’m not a jail kind of guy,” said Kurt O’Briant. ”I’m really not. I can’t take jail.”

But in the early 2000s, O’Briant, 57, of Carrboro, found himself in the Hillsborough jail. Alcohol had bested him once again.

Kurt O'Briant, a Community Resource Court graduate, stands outside his home at Club Nova Apartments in Carrboro.

Kurt O’Briant, a Community Resource Court graduate, stands outside his home at Club Nova Apartments in Carrboro. Photo credit: Taylor Sisk

“I was up there in Hillsborough,” he said, “and I wasn’t at Hog Day.”

There in the Hillsborough jail, O’Briant faced his moment of reckoning.

“My mind was spinning: ‘How am I going to get out of this?’”

The answer, though, wasn’t immediately forthcoming. O’Briant wasn’t quite ready for the straight and narrow. He backslid a bit, and staggered.

It took a little shove, and some intestinal fortitude, to take that first step in the right direction. The Community Resource Court (CRC) was his portal.

“If I’d have gotten time, I’d have probably wound up trying to kill myself. Those bars scare me to death,” O’Briant said.

Today, though, O’Briant sits in the front row of the courthouse in Chapel Hill, a guest of the Community Resource Court, his days in the hoosegow long behind him.

‘The perfect intervention’

Launched in April 2000 as a collaborative effort of the OPC Area Program – the agency that provided mental health services in Orange, Person and Chatham counties at the time – and the court system, the CRC is designed to address the needs of people living with mental health problems who’ve gotten into trouble with the law. The court offers treatment as an alternative to jail – that might mean psychiatric services, one-on-one or group mental health therapy, substance-abuse therapy, medication management, case management or some combination of these.

“From my perspective, as a mental heath social worker,” said Caroline Ginley, one two case managers for the CRC from the UNC Center for Excellence in Community Health. “I feel like this is the perfect intervention because we’re all at the same table.

“The criminal-justice folks can now better understand what these people are dealing with on a day-to-day basis.”

“Our interest is less in seeing that the person receives a traditional judicial punishment and more on that they get the help they need so that they don’t repeat the behavior,” said Assistant District Attorney Jeffrey Nieman.

About 50 percent of those who enter the program successfully meet their obligations and graduate from the CRC. A study by researchers at NC State University found  those who complete mental health court programs are much less likely to recommit crimes than those who don’t.

“Even people who wash out, the fact that they were engaged with treatment, some of them for the first time, that they’ve had some sobriety, it’s a stepping stone,” said Marie Lamoureaux, CRC’s court administrator.

Make or break

Judge Joe Buckner, now chief district court judge for Orange and Chatham counties, was the catalyst behind CRC’s launch. At that time, Buckner said, the DA, the public defender and the district judges made a collaborative decision.

“We said, ‘We’re seeing these people anyway; they’re coming in multiple times. Is there a better way to manage this court population?’” It didn’t require any new funding for the courts. “It was just a court-scheduling piece.”

The treatment is funded by a line item in the state Department of Health and Human Services budget, first introduced by Rep. Verla Insko (D- Chapel Hill), and is now managed by the UNC Center for Excellence.

“We made a choice, operationally, to address this population, which we were seeing every day,” Buckner said. “It’s not more work, it’s the same work done differently.”

“Judge Buckner has been terrific,” said Gary Cuddeback, an assistant professor in the UNC School of Social Work who has done extensive research on ways to keep people with mental illness from cycling through the criminal-justice system. “He’s a real advocate and very compassionate toward people with severe mental illness.”

“The reality is that judges can make or break these courts,” Cuddeback said. “If you get a judge who doesn’t buy into the model, it doesn’t work.”

“All the [district] judges have different styles, but they all support the mission,” Ginley said. “They all engage … just with a little bit different styles.”

Practical sense

Cuddeback says that for all intents and purposes the courts are woven into the fabric of the community mental health system.

Thirty years ago, he says, people with severe mental illness were generally kept in state hospitals. Now they’ve been returned to their communities, but with few available services.

They very often end up in homeless shelters – or the criminal-justice system.

These individuals have more in common than a severe mental health diagnosis. Most – probably 75 percent to 80 percent, Ginley said – have a dual diagnosis of mental illness and substance abuse, and have a limited social-support network.

“I would say they all have extreme life stressors,” she said, “whether that be extreme poverty, possibly homelessness, or unstable housing. … The life stressors are almost always what pushed them into the criminal activity.”

Buckner echoed that, saying, “They’ve committed criminal offenses, but their motivations are not as criminals.” When they stand before him in court, he acknowledges the criminal act as a misdirected detour, and encourages them along their paths to recovery.

“Without some kind of intervention, they’re right back out on the street, they’re re-offending and probably costing more in police contact time and everything than even in jail,” Lamoureaux said.

“So unless we’re doing some intervention along the way, it’s more money spent.”

Moreover, Buckner said, jails don’t have the space. “Putting aside the ‘do-the-right-thing’ aspect, if you said let’s just lock them all up, we physically don’t have room.”

A 2010 study published by the National Sheriffs’ Association and the Treatment Advocacy Center reported 8,617 inmates in North Carolina’s jails and prisons with a serious mental illness, as compared with 2,443 patients in all state and private psychiatric hospitals, and psychiatric units in general hospitals – a 3.5 to 1 ratio.
Conversations

Buckner jokes with some who come through the court that they’re doing their undergraduate, graduate, post-graduate and fellowship work, before eventually, hopefully, graduating. But it’s not for everyone.

Even for Kurt Bryant, it didn’t take the first time. “I played poker with the man,” he said of Buckner. “I thought he was bluffing. So I went on and did exactly what I was used to doing.”

He came back though, to rehab and the CRC, and graduated in 2005. And today he returns to the court each month, having only missed twice in more than seven years. He does it for two reasons.

The second reason is to let those coming before the CRC know that the court is a gift they should take advantage of.

“But the first reason is for myself. Nothing keeps it more real than right here. I’ll go home and I’ll think about this throughout the month, every day. Everything I do comes back to right here.”

The memory of those bars still chills him.

“Every time I step out the door, I think of this court. Because without it, I never would have been able to step out the door.”

“We’re not curing anybody,” Buckner said, “but we’re having conversations with people. At least we try.”

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2 Comments

  1. Bebe SmithDec 6, 2012 at 1:20 pm

    Thanks for writing about the great work being done by the Orange County Community Resource Court! Caroline Ginley, Jim White, and Robin Siska do great work. When we’ve lost so much in the mental health community over the past few years, it is great to hear about a program that is working well.

  2. State Roundup: Fla. Judge Rules Legislature Must Decide On Prison Care Privatization | Health CareDec 6, 2012 at 3:43 pm

    […] North Carolina Health News: Mental Health Court Offers An Alternative Path “I’m not a jail kind of guy,” said Kurt O’Briant. “I’m really not. I can’t take jail.” … It took a little shove, and some intestinal fortitude, to take that first step in the right direction. The Community Resource Court (CRC) was his portal. … Launched in April 2000 as a collaborative effort of the OPC Area Program – the agency that provided mental health services in Orange, Person and Chatham counties at the time – and the court system, the CRC is designed to address the needs of people living with mental health problems who’ve gotten into trouble with the law. The court offers treatment as an alternative to jail – that might mean psychiatric services, one-on-one or group mental health therapy, substance-abuse therapy, medication management, case management or some combination of these (Sisk, 12/6). […]

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