Kentucky mental health court celebrates first anniversary

Jan. 04--Nathan Smith was happy to see Fayette District Judge Kim Wilkie.

He had good news.

"I've been 57 days clean today," Smith said as he stood in front of Wilkie in Fayette District Court on a recent Monday.

Wilkie beamed.

"This is about the best I've ever seen you look," Wilkie said. "I thought we were going to lose you, Nathan."

Wilkie pressed play on a stereo perched on top of his bench and the sound of applause erupted from the speakers as Smith grinned and the packed courtroom clapped.

Smith was one of the first people to enter a new Fayette County treatment court for people with a diagnosed mental illness.

Participants agree to a two-year diversion program that focuses on treatment and recovery instead of jail time. The court started as an all-volunteer effort in November 2014. It received a $150,000 start-up grant from Lexington Urban County Government in February to help pay for staff. It is one of four courts in Kentucky that focuses on treatment instead of jail time for people with mental illness.

In its first eight months, 21 people enrolled in the diversion program. Eighteen were still in the program in early December. Others either voluntarily left for various reasons and were required to serve their sentences or were kicked out of the program for non-compliance.

People with misdemeanors and non-violent felonies can be referred to the program by prosecutors, defense attorneys and people in the community. They are then screened for mental illness. The most common diagnosis is bipolar disorder followed by schizophrenia. Other diagnoses include depression, obsessive compulsive disorder and dissociative identity disorder. Eleven either are homeless or have experienced homelessness during their participation in the program, according to data provided by the court.

"It's still in its beginning phases," said Kelly Gunning, who spearheaded efforts to get the program off the ground. "We have learned a lot."

Charlie Lanter, Lexington's director of the Office of Homelessness Prevention and Intervention, said the city is encouraged by the quarterly reports the court sends to his office.

"Thus far, I've been really impressed with the court's work. They have exceeded enrollment goals and have a high retention rate among those who participate," Lanter said. "We've seen a positive impact among several of the individuals most commonly encountered in downtown Lexington, and that relieves some of the pressure experienced by police and downtown churches, business and visitors."

Smith, who was referred to the program after being arrested on wanton endangerment and fourth-degree assault charges, said without the program, "I would be in federal prison, no doubt."

His father, Kenny Smith, agreed.

Smith, 20, suffered a series of concussions when he was younger and has been in and out of therapy most of his life. But like many people with a diagnosed mental condition, he also has a substance abuse problem -- an addiction to alprazolam, an anti-anxiety drug sometimes known by its brand name Xanax.

"People like him do not need to be in jail, they need treatment," said Kenny Smith, after treatment court on Dec. 21. "This is one of the best things that Fayette County has ever done."

Although just a year old, it could become one of the most cost-effective programs the city has funded.

If Smith stays in treatment, out of trouble and out of jail, it could potentially save taxpayers thousands of dollars in future jail and prison costs.

Jail or a prison sentence is supposed to act as a deterrent. But studies show jail time does not work for people struggling with mental health issues. They frequently cycle in and out of county jails and state prisons on misdemeanor and low-level felony charges -- sometimes for decades. A 2006 study by the Bureau of Justice Statistics found more than half of all jail and prison inmates have mental health problems. An estimated 1.25 million suffered from mental illness; that's four times the amount found in a similar study in 1998.

"The traditional criminal justice system model does not work for people with mental illness," said John Landon, a lawyer with the Department of Public Advocacy who wrote the regulations that created the Fayette County treatment court. "Jail is the worst place for them. You are setting them up for a lifetime cycle of arrest, release and re-arrest."

Gunning, who is executive director of NAMI, a nonprofit organization that advocates on behalf of people with mental illness, said early detection and treatment of people with serious mental illness is also critical to stopping the progression of the disease. The goal of treatment court is not just about stopping the cycle of arrest or re-arrest, but saving the lives of people with mental illness.

"We have found with our younger participants -- people in their early 20s -- the program has been very successful," Gunning said. It was Gunning and her husband, Phil Gunning, who spearheaded efforts to start the treatment court after seeing so many people with a serious mental health diagnosis cycle in and out of jail. A group of stakeholders met for more than two years before the court was started in November 2014.

The treatment court team -- which includes social workers, a psychologist from Eastern State Hospital, Wilkie, Kelly Gunning, prosecutors and defense lawyers -- said some people who entered the program have re-offended or were arrested again.

But many of the people who re-offended were arrested on new charges when they were still new to the program, said Heather Matics, a prosecutor with the Fayette County attorney's office who sits on the treatment court team.

The group has also found that the community mental health system is not adequate to meet the needs of treatment court participants. For example, there is limited supportive housing for people with a serious mental illness. Many people aren't sick enough to go to Eastern State but are not well enough to live independently.

Although drug treatment has expanded in Kentucky over the past several years, there are few programs that specialize in treating people with a serious mental illness and a substance abuse problem. Many long-term treatment facilities expect participants to comply with a strict schedule. People with serious mental illness such as schizophrenia aren't able to do that.

"A lot of them will make you call every day if you are on a wait list," Kelly Gunning said. "A lot of people with serious mental illness can't do that."

One of the treatment court's participants did well early in the program. A former college student who was on the dean's list, he had a breakdown in college but eventually was able to get into treatment and on medications. He was able to get a steady job and became a model employee. But he went off his medications earlier this year and eventually became homeless. The treatment court issued an arrest warrant for him and he spent 24 hours in the jail. He appeared recently before Wilkie and agreed to go to Eastern State and get back on his medications and into treatment.

"We've had to put people in jail so they would be safe because we didn't have any other options," Kelly Gunning said.

The program is also voluntary. People have to want treatment.

"I have approached several people who would be eligible for the program but they do not want to do it," Matics said. It's easier to serve a week or two in jail than commit to a two-year program, she said.

In addition to attending court sessions on Mondays, participants in the first phase of the program meet regularly with Jennifer Van Ort, the court administrator, and Jean Lafky, a peer specialist. They are assigned a case plan tailored to their condition and charges. Some are required to attend Alcoholics Anonymous meetings. Others are required to attend peer support classes for people with mental illness in addition to therapy. If they show signs of improvement, they are moved to the next phase, which means they are not required to meet with Van Ort and Lafky as often.

Those with drug problems are tested for drug randomly. But unlike drug court, a diversion program for people in the criminal justice system with substance abuse problems, people who test positive for drugs are not immediately kicked out of treatment court.

Sobriety and recovery is a process that people have to want for it to work, said Lafky. She has a mental illness and is an alcoholic who has been sober for 14 years. Because she has been in the same position as the treatment court participants, "I have a lot of street cred," Lafky said.

But Lafky also holds participants accountable.

"I don't accept excuses," Lafky said.

Wilkie, whose father was a psychiatrist, excels at motivating people, treatment court team members said. Wilkie said he agreed to oversee the court after running into Phil Gunning, who used to be his neighbor, at a local festival a few years ago.

Even the smallest step forward is awarded with praise from Wilkie. Applause is not something that people with serious mental illness hear very much, Kelly Gunning said.

"We have one participant who recently told me he is working hard because he wants to hear Judge Wilkie say, 'I'm proud of you." Van Ort said.

Wilkie was a big factor in Smith's decision to finally get help for his Xanax addiction.

Smith said he originally signed up for the treatment court because he didn't want to serve 10 months in jail -- a sentence he could have received for his wanton endangerment and assault charges. After he entered the treatment court program, he was arrested on new charges. He continued to test positive for drugs during his random drug screenings.

Eventually the court issued a bench warrant for his arrest. He was given a chance to seek long-term drug treatment. At 20, Smith wasn't convinced he had a problem. But Wilkie and the treatment court team thought he did. Smith also realized that he didn't want to be in and out of jail his entire life.

"I just like him," Smith said of Wilkie. "He's always fair. I never have to come to court and worry if he's in a bad mood. And yeah, I wanted him to be proud of me."

Smith's journey to sobriety and treatment shows that recovery and sobriety is not a linear path, Kelly Gunning said. "He's the type of participant that this program was designed to save."

Smith recently got a pass to leave the Hope Center, where he will be in treatment for six months, for a few hours. He went to his father's house to surprise him. It was Kenny Smith's birthday.

"It was the best birthday present ever," Kenny Smith said.

Beth Musgrave: 859-231-3205, @HLCityhall

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