Partnering to Create the Wayne County Mental Health Court

Mental illness among men and women arrested for crimes—from misdemeanors to felonies—is a significant challenge for the justice system. Individuals with serious mental illness often find themselves cycling repeatedly through the system, going through the steps of arrest, court, incarceration, and return to community without ever addressing the root cause of the unlawful behavior.

In Wayne County, which includes the City of Detroit, community leaders in the criminal justice system and the social services sector recognized that the courts were overburdened with persons with mental illness. They began working together to create a specialty court that provides solutions for jail overcrowding, costs, and treatment for some of the county's most vulnerable citizens.

Sheryl Kubiak's expertise is contributing to a collaborative community effort that offers an alternative to mainstream solutions in the state's busiest local court system.

When Kubiak joined the faculty at Michigan State University in 2006 she already had lengthy experience with social services in Detroit and Wayne County. As a licensed practical nurse, and then as a licensed social worker, Kubiak gained experience with patient care, legislative issues, advocacy, and local and state policies.

Dr. Kubiak focused her academic interests on interventions at the intersections of mental health and substance abuse treatment in the criminal justice arena. She has done research on the residential substance abuse treatment program in the Wayne County Jail and Michigan prisons, the impact of welfare reform legislation on women with drug offenses, and gender-specific and trauma-informed interventions for women.

This work led to an invitation to join the Wayne County Behavioral Health/Criminal Justice Committee, a multidisciplinary group of administrators representing the courts, the jail, and mental health treatment programs. Their goal was to find new methods of collaboration that improve outcomes for individuals and to enhance public safety. Similar to drug offenses, crimes that involve psychiatric symptoms require specific treatment protocols to address, minimize, and/or stop the revolving door of incarceration.

Kubiak worked with Timothy Kenny, Chief Judge of the Third Judicial Circuit, and Risa Coleman, Clinical Services Director for the Detroit-Wayne County Community Mental Health Authority, to transform that committee into the Wayne County Mental Health Court Committee.

"The Wayne County Mental Health Court is among the strongest, most viable specialty courts in the state of Michigan, thanks in large part to the investment we've made in evaluation. Dr. Kubiak is an integral part of our court's development, growth, and success," said Judge Kenny.

Establishing a Mental Health Court

In 2002, the Detroit-Wayne County Community Mental Health Agency and the Wayne County Prosecutor's Office established the Expedited Plea Program. It was designed to offer expedited plea agreements early in the criminal process, and inmates were given psychiatric assessments in jail so that recommendations prepared by jail staff could be made available to the court before sentencing. The recommendations then became part of the inmate's probation plan.

One of the most significant aspects of the Wayne County program was the collaboration and cooperation between the Wayne County Prosecutor's Office, Detroit-Wayne County Community Mental Health Agency, Wayne County Circuit Court, Wayne County Jail, Wayne County Child and Family Services, Michigan Department of Corrections, and numerous community service providers.

The Expedited Plea Program led to an even more specific approach for supervising and treating offenders with mental illness.

In 2006 Judge Kenny and Elaine Thomas, now retired from the Detroit-Wayne County Community Mental Health Authority, visited a mental health court in Chicago to learn more about alternatives to traditional criminal court processing. They determined that a similar program could work in Wayne County, although the program would be most successful if there was widespread support. Initial leadership for the Mental Health Court Task Force was established in 2006 and was led by William L. Cahalan, a retired Wayne County Circuit Court Judge. Judge Cahalan passed away in 2007 and Judge Kenny assumed leadership of the task force.

Judge Kenny, Elaine Thomas, and Dr. Kubiak worked together to develop, implement and evaluate the Mental Health Court for Wayne County, with the following objectives:

• Refer mentally ill defendants for treatment instead of incarceration, with a goal of reducing jail overcrowding.
• Assess, treat, and stabilize individuals with mental illness involved in the criminal/legal system and reduce the short-term risks of illegal behavior.
• Reduce the risk of long-term recidivism.
• Reduce "revolving-door" jails for those with mental illness, thereby reducing the overall costs to society.

Court operation began in 2009, with Judge Kenny presiding.

While other programs have focused on misdemeanor offenses, the Wayne County Mental Health Court accepts felony offenders, who have previous failures such as probation violations.

Creating a Common Culture

During the formation of the mental health court committee, Kubiak provided cross-training exercises for stakeholders to help achieve a common understanding of what duties would be performed by the Mental Health Court, and how it would be operated within the existing Wayne County infrastructure.

"With so many stakeholders involved it was essential to understand everyone's language and culture. Once that was addressed, we could work on obstacles, challenges and common goals," said Kubiak.

Those conversations made it easier to work out solutions for the problems that mental health courts in other areas had experienced. Now, each time Kubiak and her colleagues identify an issue, such as lack of housing or access to medication or childcare/family concerns, they bring in new resources or invite more community participants into the group.

Kubiak and her team still attend monthly committee meetings where they document problem-solving processes, interactions, and changes to group membership.

"Listen, interpret, facilitate, contribute. That's my role," said Kubiak.

Kubiak's experiences gave her insight about the importance of facilitating communication, interpreting and translating the missions and boundaries of various agencies and departments, and creating an evaluation roadmap that would generate empirical evidence and critical analysis for data-driven decisions.

Evaluation, Results, and Outcomes

Kubiak designs and leads comprehensive outcome evaluation of the collaboration. She provides data about recidivism, cost/benefit analyses, and measurement of project progress.

Among her contributions was the introduction of K6, a brief screening instrument for assessing mental illness that had been validated in epidemiologic studies worldwide, but never within a jail. Kubiak, along with MSU colleagues, doctoral students, and research assistants, designed the survey instrument for assessing the prevalence of serious mental illnesses for offenders in the Wayne County Jail.

Research conducted by Kubiak, in collaboration with community partners, indicates that serious mental illness affects between 18 percent of men and 36 percent of women in the Wayne County Jail. It is further estimated that jail affects men and women who are mentally ill by worsening or intensifying their symptoms or condition.

The Wayne County Mental Health Court partnership is designed to incorporate longitudinal evaluation strategies to calculate costs, benefits, and other impacts associated with the program. The research, funded by the National Institute of Justice, Detroit/Wayne County Community Mental Health and State Court Administrators Office, is led by Kubiak and provides essential information for stakeholders to make better informed, data-driven decisions about the operation of the Wayne County Mental Health Court.

The Flinn Foundation of Michigan funded a 2011 grant to assess outcomes of the Urban Mental Health Court, and a 2013 grant to study long-term outcomes and a cost-benefit analysis.

During 2011-2012 the Michigan Department of Community Health asked Dr. Kubiak to lead a statewide evaluation of eight mental health courts. The research findings have been utilized by state legislators for policy discussions regarding mental health courts statewide.

In March 2014 Kubiak introduced a year 5 report that focuses on outcomes of discharged offenders two years after participation with the Wayne County Mental Health Court, long-term outcomes, and cost savings of the program. The findings conclude that the program to date has yielded a total savings of $1.4 million, with a cost savings of $22,865 per successful participant. Recidivism for offenders in Mental Health Court is down to 12% charged with a new offense in the year after participation. The average number of days in jail has decreased from 50 days prior to participation to 11 days in the year after participation.

Along the way Kubiak has formed a strong working partnership with those involved with the Wayne County Mental Health Court. She has navigated the complex landscape associated with bureaucracies and political boundaries, criminal justice, mental health, community-defined needs, engaged scholarship, and societal impacts.

According to Dr. Kubiak, "I'm honored to be invited into the community's efforts, and view my role as a guest who is respectful and sensitive to everyone. My approach is to offer a piece of the puzzle, and provide as much knowledge and scholarship as possible to help improve these complicated situations."