Mental health court seen as example for state


 Jaclyn O’Malley


Reno Gazette-Journal



The court

A look at the Washoe County Mental Health Court, which was established in 2001:

The Team: A judge, private contract defense attorney, two pre-trial services officers, state mental health liaison and probation officer.

The Defendants: Those with misdemeanor or low-level felony charges who have a diagnosis of schizophrenia, schizoaffective disorder, bipolar disorder, major depression or other mental illness. The idea is that mental illness caused them to commit the crime. Upon completion of the program, about a year, the charge will be dropped.

Its role: The court is considered "therapeutic" and is similar to drug court, where the focus is on determining the root of the person's problem and getting them psychological or drug treatment, life skills and holding them accountable for their actions. If they do not follow the program they face jail.


An example: The court is a national model being studied by the Bureau of Justice for the next two years.

Fiscal 2005-06


·  Of 304 active defendants, 51 percent are ongoing, 49 percent are new, 80 people graduated from the program, while 16 percent of the defendants were unsuccessful.

·  86 percent of defendants were white with the number of men and women equal. The average age was 35, and ranged from 18 to 67.

·  54 percent were charged with felonies, 36 percent were with crimes against property and 28 percent with crimes against a person.

·  Most referrals come from police and defense lawyers. The leading mental illness is bi-polar disorder with schizophrenic and schizoaffective disorder trailing.

·  About 85 percent of defendants had a high incidence of substance abuse.


·  The 2007 housing budget for mental health court is $781,728 while there is nearly $2.5 million slated for non-court defendants, which includes group homes.

·  A 2004 Nevada Divison of Mental Health and Development Services survey showed 42 percent of the 55,000 Nevadans identified as severely mentally ill were not receiving services, while 30 percent of the 5,616 identified in Washoe County were not receiving services

If you're severely mentally ill, the best way to receive immediate housing help and intensive treatment in Washoe County is to commit a crime, a state lawmaker said.

That's because you could be diverted to the nationally acclaimed Washoe County Mental Health Court, which has more than 300 clients, Assemblywoman Sheila Leslie said. Its recidivism rate is less than 20 percent, she said.

Success of the mental health court underscores the need to improve the state's overall mental-health system, officials said.

"It makes good sense to target those in jail and use those resources to reduce prison time and stop the cycle of criminal behavior," said Leslie, D-Reno, the county's coordinator overseeing mental health and drug courts.

"But I wish we could be more proactive and help people before they commit a crime," she said.

Defendants in mental health court participate in a yearlong program in which the state pays for rent, therapy and medication until they are deemed capable of living outside the court's supervision. Fewer than 20 percent are arrested again.

Getting arrested might have been the best thing that could have happened to Kenneth Wiley.

He has a serious mental illnesses that had gone unnoticed and untreated before his arrest last year that sent him to the mental health court, where he received support, therapy, housing, medications and motivation. After a year, he is scheduled to graduate and have his criminal charge dismissed. It will then be up to him to take charge of his mental illness and have the best quality of life possible.

"I found support from the court," said Wiley, 43, who suffers from schizoaffective disorder, struggles with hallucinations and hears voices in his head. "And I noticed that support has impacted my change. They want to see me grow and develop and pat me on the shoulder when I do good.

"We all need that."

Mental Health Court Judge Archie Blake said when he first presided over Wiley's case, he was skeptical whether the program could really help him.

"I am a true believer," Blake said of the program's effectiveness. "The resources spent give you a real return to society not only in financial, but social terms. It's a real-deal government program that has tremendous success because of the cooperation and partnerships with local resources."

A low grade

That the mental health court is deemed the most effective conduit for treatment of mental disease is a testament to a failing state system, observers say.

The National Alliance on Mental Illness this year gave Nevada a D-minus when it graded the country's health care system for serious mental illness.

Nationwide, the 2006 average grade was a D. The year before, Nevada received a failing grade.

In Nevada this year, the group cited overflowing Las Vegas emergency rooms, a lack of community treatment programs and a lack of housing options, particularly in rural Nevada, as its main shortcomings.

A 2004 state survey said 42 percent of the 55,000 Nevadans identified as severely mentally ill were not receiving services, while 30 percent of the 5,616 identified in Washoe County were not receiving services, said Carlos Brandenburg, head of the Nevada Division of Mental Health and Developmental Services.

The reason those people were not getting help, Brandenburg said, is a lack of resources and "a stigma that is alive and well."

"People can recover if they are given the opportunities and the resources -- housing, medications, therapy and support," he said. "People do recover."

How bad is it?

A state report found that in 2003, the patient to psychiatrist ratio in the state was 700:1, as opposed to the target of 345:1.

According to a 2006 study by the Nevada Divison of Mental Health and Social Services in December 2005 it was estimated that nearly 1,600 people in the state waited an average of 85 hours in emergency rooms to access a public mental health hospital.

Brandenburg said that in 1991, when the state fell into a recession, the budget for human services was cut -- mostly for mental illness assistance. He said his department has never fully recovered.

But, with the support of bipartisan legislators and Gov. Kenny Guinn, Brandenburg's budget has increased about 50 percent. The 2006-07 fiscal year budget was more than $500 million. Leslie sponsored allocations of more than $19.5 million. Last year the department was awarded $100 million for new services.

Housing an issue

In Washoe County, where the average apartment rent is $800, home prices average $325,000 and low-income downtown hotels are the only accessible places to live, housing options are hard to find. Brandenburg said resources in rural areas are even worse.

When Brandenburg and Leslie approached the Legislature to obtain funding for mental health court, they showed that the most expensive service is a bed in a psychiatric hospital, which runs roughly $429 a day. In contrast in costs about $83.50 a day to house an inmate at the Washoe County Jail. It costs about $73 a day to house and provide services to a mental health court defendant.

"I can put someone in housing, allowing them to live in the community for $600 a month," Brandenburg said. "If we provide the resources, it's very cost effective."

The first year the court existed, it received no state funding. The second year, it did, and it had money available to provide housing.

"Unless we provide consumers with a roof over their heads, the cost is that they will be living by the river or in back alleys or by bridges," he said.

Dearth of alternatives

But, if a mentally ill person was a law-abiding citizen, therefore ineligible to participate in mental health court, their chances for obtaining housing on their own is slim.

"If we don't have housing, how can we have a place to take our medications?" said Joe Tyler, who has been diagnosed as a schizophrenic, who works as a consumer assistant at Reno's Northern Nevada Adult Mental Health Services. "It seems like it'd be an advantage to be a criminal, I hate to say."

Tyler, also the Nevada president of the National Alliance on Mental Illness, said some of the noncriminal patients at Northern Nevada Adult Mental Health Services are released from the hospital with medications they throw in the garbage.

"When someone needs everything at once -- medications, a job, a roof over their heads -- they need it now," Tyler said. "If they don't get it, they fall through the cracks. They then ditch any efforts, stop taking their medications and become homeless."

Tyler thought it was odd that a psychiatric hospital could charge several hundred dollars a day to hospitalize a person to then direct them to a homeless shelter upon their release.

"Money is spent on the front end, but not spent to help them," he said.

More community programs needed

Assemblywoman Leslie said no one wants to return to locking the mentally ill away in institutions and that more community-based programs are needed. She said having those programs, like clubhouses, employment opportunities and intensive out-patient community programs, will increase Nevada's D-minus grade.

Leslie said that a lot of progress has been made in recent years "but when you start at the bottom, it takes time to get out of the last quartile."

"Mental health court is a permanent solution that works, unlike the endless cycle of arrest and incarceration, which usually ends with the person on the street again without housing or medication," Leslie said. "Everyone in our system can easily predict what happens next."