In 2013, Lexington, Kentucky, city leadership analyzed the growing challenge of homelessness in their community; they learned that many of the people experiencing homelessness in their city also had serious mental illness (SMI) and also had ongoing interactions with the justice system. Knowing that the “black robe effect”[1] was a powerful motivator, the city partnered with its local National Alliance on Mental Illness (NAMI) Lexington and Fayette County Court to establish a mental health court to divert individuals entering the court system from incarceration and into treatment. The Fayette County Mental Health Court, overseen by Fayette County Judge John Tackett in partnership with a multidisciplinary team from NAMI, is dedicated to reducing recidivism among individuals with a diagnosed mental illness or a co-occurring mental illness and substance use disorder by increasing their wellness, which is facilitated through court-ordered services and treatment.
An Interdisciplinary Peer-Run Team
Unlike many mental health courts, the Fayette County Mental Health Court (FMHC) is run and operated through NAMI, not the court system. Court founders Connie Milligan, LCSW, clinical director, and Kelly Gunning, MA, director of advocacy and policy, work with an interdisciplinary team that includes director Bill Buckman, CSW; peer support specialist Makia Atkins; recovery navigator Annabell Vance, MA; family liaison and advocate Jennifer Giles, MBA; and Judge Tackett.
“What makes this mental health court team really special is that nearly every member of the team has lived experience with mental illness,” says Milligan. “Since over 90 percent of the individuals in our court have a history of trauma, and many also have substance use disorders (SUD), we have built a staff that reflects those experiences and the skills needed to address them.”
Upon referral to the court, an individual’s case is reviewed by the interdisciplinary team. The team works closely with community stakeholders including the state hospital, community health center, public advocates, law enforcement, the Sheriff’s Department, and representatives from parole. The court’s eligibility criteria include a verifiable mental illness, competence to stand trial, and a charge that does not involve a sex offense or certain violent offenses.
Focus on Diversion and Treatment
The FMHC is a diversionary court, focused on providing justice-involved individuals with treatment to address their mental health challenges. Individuals are referred to the court either pretrial as a diversionary method or post-release as a condition of probation. Additionally, individuals may be referred to the mental health court if they are found in contempt of court by a judge, and they would benefit from mental health treatment.
“Using a non-adversarial approach, prosecution and defense counsel promote public safety while protecting participants’ due process rights,” says Judge Tackett. “Having a court that is consumer-run helps people feel comfortable and hopeful.” Adds Atkins: “We have lived through what people are going through. We can relate to them on a level that others normally can’t. It makes them feel more comfortable and willing to work with us.”
The court has an intensive four-phase (3-month increments), one-year requirement, at the end of which participants have their charges dismissed or the probation conditionally discharged.
- Stabilization Phase. Focused on establishing and maintaining mental health treatment and abstinence from substances, and beginning to find housing, along with complying with expectations of the court (e.g., showing up for appointments, refraining from criminal activity, etc.).
- Treatment Phase. Focused on maintaining sobriety and engagement in treatment; housing and stable income; increasing meaningful activities and social supports and relationships; and continuing to comply with court expectations.
- Self-motivation Phase. Focused on continuing to maintain all previous activities.
- Wellness Phase: Focused on participating in aftercare, maintaining sobriety (confirmed via drug tests), and acting as a mentor to new mental health court participants.
“We are focused on getting people from the lowest rung of the hierarchy of need, where they are just surviving, and moving them up to a place where they can thrive,” says Milligan. That may be accomplished through inpatient psychiatric or substance use treatment, establishment of housing, or initiating medication. “Often, we have people with SMI and SUD,” says Buckman. “So, we will work on addressing the co-occurring disorders to help them move forward.” Upon completing the court required activities, many participants join the NAMI Alumni Group to support others on the same journey.
Evidence of Success
The Fayette County Mental Health Court has shown very successful outcomes, including:
- A 97 percent reduction of criminogenic activity in the first 30 days (compared to individuals who do not enter the court).
- 59 percent of participants maintain full sobriety from substances after one year, compared to the national average of 20 percent.
- 31 percent of participants were unhoused upon entry; after one year in the program, 97 percent maintained stable housing.
- Recidivism rates down to 17.7 percent among graduates and 7 percent among individuals who join the Alumni Group.
Finally, the court has saved the jail system and other law enforcement partners hundreds of thousands of dollars per year in costs related to incarceration and police activity. By providing a supportive, consumer-run approach to justice, the Fayette County Mental Health Court not only helps individuals with serious mental illness but also promotes a more compassionate and effective approach to criminal justice in other communities. NAMI Lexington is open to assisting other systems in creating mental health courts in their communities. “We know that we can’t incarcerate people out of mental illness or substance use disorder,” says Milligan. “This court offers us a proven method of addressing SMI, COD, and trauma from a recovery oriented and strength-based perspective to help the community and individuals.”
[1] The Black Robe Effect is a noted phenomenon that individuals with mental illness are motivated to complete treatment when it is ordered by a judge. For instance, see Mark R. Munetz, “Black Robe/White Coat: Mental Health Providers Must Reclaim the Role of Caring Clinician,” Psychiatric Services 71, no. 4 (April 1, 2020): 403–4. https://doi.org/10.1176/appi.ps.201900366.
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