1 SLIP SLIDIN' AWAY? WILL OUR NATION'S MENTAL HEALTH COURT EXPERIMENT DIMINISH THE RIGHTS OF THE MENTALLY ILL? By Stacey M Faraci* INTRODUCTION The Drug Treatment Court ("DTC") has received wide approval from the medical, mental health, and legal communities. Presently, there are eight experimental Mental Health Courts' ("MHC") that are modeled after the DTC. These courts have received similar, almost unanimous, support. The result has been a call for the implementation of the MHC around the nation. 2 If the MHC system is expanded from its original four locations at the same rate at which the DTC was expanded, our nation will operate more 3 than 400 MHCs in just a few years. This break-neck pace will have been adopted without careful consideration of potential problems raised by the implementation of the * Ms. Faraci is presently an Associate at Carter, Ledyard & Milburn LLP, in New York City, New York. Ms. Faraci drafted this Article while a student at the Georgetown University Law Center. She earned her J.D. degree from the Georgetown University Law Center in 2002, and her B.A. in Psychology and English from Fairfield University in JOHN S. GOLDKAMP & CHERYL IRONS-GUYNN, BUREAU OF JUSTICE ASSISTANCE, U.S. DEP'T OF JUSTICE, EMERGING JUDICIAL STRATEGIES FOR THE MENTALLY ILL IN THE CRIMINAL CASELOAD: MENTAL HEALTH COURTS IN FORT LAUDERDALE, SEATTLE, SAN BERNARDINO, AND ANCHORAGE iii-iv (APR. 2000), available at (last visited Apr. 10, 2004) (The courts are located in Broward County, Florida, Kings County, Washington, Anchorage, Alaska, Marion County, Indiana, Brooklyn, New York, Hamilton County, Ohio, and San Bernardino and Santa Barbara counties, California.); see also Mental Health: Frequently Asked Questions, at MenHeaFAQ.pdf (last visited May 7, 2004). This Article focuses upon the first four MHCs in existence, i.e., those in Broward County, Kings County, Anchorage, and San Bernardino county, because the remaining MHCs had not yet been created. 2. America's Law Enforcement and Mental Health Project, S. 1865, 106th Cong. (1999) (The legislation was written by Senator Mike DeWine (R-OH) and would authorize a maximum of $10 million through 2004 to set up 100 additional mental health court programs.).
2 QLR [Vol. 22:811 MHC system. In preparation for the popularity of the MHC, certain problems should be addressed which will be unique to the MHC, as well as those shared with the DTC. Before diving headlong into the creation of an entire network of MHCs, we must first ask some crucial questions. This paper seeks to set out a number of these relevant considerations, and presents a call for research and careful exploration of potentially fatal flaws in the MHC legal, philosophical and practical implications. The MHC is similar to the DTC in structure and philosophy. Therefore, many of the problems existing in the DTC likely will carry over to the MHC. Furthermore, additional problems unique to the MHC will arise because of the inherent nature of mental illness. Therefore, the problems facing the DTC, as well as the special issues plaguing the mentally ill, will be present in the MHC. Thus, it is important to identify problems that exist in the DTC because the MHC will face the very same issues. Moreover, a careful exploration of the unique characteristics of the mentally ill population must be undertaken because such problems will exist in the MHC, in addition to those already present in the DTCs. The DTC, after which the MHC is modeled, has been in place for more than ten years, and, thus, a more substantial amount of literature exists about it. Therefore, this paper will describe the DTC in relative detail in order to set up a framework against which to analyze the MHC. Until an extensive amount of literature on the MHC is amassed, a great portion of the analysis in this paper must be based on drawing analogies from the information we do have on the DTC. Part I of this paper traces the historical developments that led to the implementation of the DTC, which, in turn, contributed to the development of the MHC. This section describes the United States' war on drugs, and its role as a catalyst to the establishment of the first DTC. Part I goes on to describe the structure of the DTC, as well as the theoretical basis for the court: therapeutic jurisprudence. This section will delve into the philosophy of therapeutic jurisprudence. A quick definition here will help to orient the reader. According to Bruce J. Winnick, therapeutic jurisprudence is "a field of interdisciplinary scholarship with a law reform agenda that focuses attention on the consequences of law for the psychological functioning and emotional well-being of the people affected. ' A 4. Bruce J. Winnick, Redefining the Role of the Criminal Defense Lawyer at Plea Bargaining and Sentencing: A Therapeutic Jurisprudence/Preventive Law Model, 56 PSYCHOL. PUB. POL'Y & L., 321, 321 (1999).
3 2004] SLIP SLIDIN' AWAY? Part II of this paper relates the perceived "causes" of the genesis of the MHC including, inter alia, the perceived success of the DTC and the large numbers of mentally ill in our criminal justice system. Part III of this paper describes the MHC system itself. This section lays out the structure of the court, the basis for participation, its voluntariness requirement, its shift in theoretical orientation from the traditional criminal justice system, and the new roles the judge, prosecuting attorney, and defense attorney adopt as players in this new system. Part IV conducts an analysis of the MHC and raises pertinent questions and considerations. The first part of this section identifies and discusses problems that the DTC presently faces, that the MHC will soon face, including: (1) the inherent tension between the two competing elements in the DTC and MHC: the punitive and therapeutic justice aspects; (2) sanctions for treatment noncompliance; (3) the nonadversarial element of the DTC and MHC; (4) that, while participation in the DTC and MHC is voluntary, it is nonetheless coercive; (5) whether the defendant feels he has been justly treated; and (6) that the DTC and the MHC will fail if community resources are insufficient. The second part of this section identifies problems unique to the MHC, including: (1) expansion of the qualifications for being considered mentally ill (known as net-widening); (2) that there is a perceived need to identify potential participants as soon as possible which may compromise the thoroughness of an evaluation; (3) the difficulty in determining when treatment objectives have been successfully met; and (4) that the most dangerous of the mentally ill in the criminal justice system-those who are violent-will not receive treatment through the MHC. I. THE DRUG TREATMENT COURT A. Precursor to the Drug Treatment Court In the 1980s, the United States launched its war on drugs by enacting legislation that expanded existing drug laws and imposed stricter punishments for drug-related offenses. 5 This legislative expansion re- 5. See Anti-Drug Abuse Act of 1988, Pub. L. No , 102 Stat (1988) (codified in scattered sections of the U.S.C.); Anti-Drug Abuse Act of 1986, Pub. L. No , 100 Stat (1986) (codified in scattered sections of the United States Code); Comprehensive Crime Control Act of 1984, Pub. L. No , 98 Stat (1984)
4 QLR [Vol. 22:811 suited in a proliferation of drug-related cases being heard in court. 6 Additionally, in the 1980s, our country experienced an influx of cocaine in pure forms, as well as in derivative "crack" form. 7 The new drug flooded the market, and was readily available and inexpensive. Therefore, because the drug was so simple to get and so addictive, drug usage and addiction expanded during this time. 8 These new federal laws, as well as state laws promulgated in the same spirit, coupled with an increase in drug use and abuse, resulted in an explosion of drug cases in our criminal court system. 9 The congestion caused by the innumerable drug cases threatened the functionality of our criminal court system. Adding to the deluge of cases was the fact that the rates of recidivism among drug offenders skyrocketed during this period because of increased use, as well as more aggressive and more strict anti-drug policies. While the courts strived to sift through the crushing caseload, the war on drugs failed miserably. Upon release from prison, drug-users reoffended and ended up in exactly the same place: caught in our criminal justice system. 1 This revolving-door pattern continued throughout the 1980s. Finally, judges, attorneys and legislatures, acknowledging that the reason for such high rates of recidivism was that the root of the problem was being systematically ignored, pushed for change. It was clear that, in order to break the cycle of offense, incarceration, release, re-offense, the system would need to address the defendant's addiction itself. 12 Thus, the DTC was born. In 1989, Broward County, Florida developed the first treatment court dedicated to eradicating defendants' addictions in order to break the revolving-door syndrome. The pilot (codified in scattered sections of the United States Code). 6. The Honorable Peggy Fulton Hora et al., Therapeutic Jurisprudence and the Drug Treatment Court Movement: Revolutionizing the Criminal Justice System's Response to DrugAbuse and Crime in America, 74 NoTRE DAME L. REV. 439, 457 (1999). 7. Id. 8. Id. 9. Id. at 459 (National drug arrest rates increased 134% from , but only 37% of the total number of arrests increased during the same time frame. In 1985, 647,411 individuals were arrested for drug-related offenses. By 1991, more than one million people were arrested for drug-related offenses. This figure represents a 56% increase from From 1985 to 1994 arrests for drug-related offenses increased from 6.8% to 9.2%). 10. Hora et al., supra note 6, at 460 (51% of all parolees who abuse drugs, regardless of the offense for which they were arrested will wind up back in prison) (internal citations omitted). 11. Id. at Id. at 449.
5 2004] SLIP SLIDIN' AWAY? program was spearheaded by the nation's future Attorney General, Janet Reno. The idea was simple: help the defendant become addiction-free and he would be less likely to re-offend. The hope was that, in dealing with the underlying problem of addiction, the overall court system would enjoy less congestion. Further, it was hoped monetary resources would be less strained, and scant jail space would be reserved for the 3 most dangerous lawbreakers.' The theory behind the DTC was that merely incarcerating drug offenders did little to break the cycle of drug abuse and crime, and the link between them, because treatment, not punishment, is what they need to become addiction-free. 14 One of the immediate concerns was to stop the imminent malfunction of the criminal justice system that was already shaking under the weight of drug-related offenses. The DTC attempts not only to alleviate the congestion of the criminal court but also to "attack the real foundation of the drug offender's problem-drug addiction."' 15 B. Therapeutic Justice and the Drug Treatment Court The therapeutic jurisprudence theory was first mentioned in 1987 when Professor David Wexler delivered a paper to the National Institute of Mental Health.' 6 The concept was co-founded by Professor Bruce Winnick on the notion that "the field of mental health law had developed based on a constitutional foundation that emphasized protection of the personal rights of mental health patients,"' 17 but that this foundation was beginning to crumble. The tenets of the discipline require an acknowledgment that our nation's legal system has legal, as well as social and psychological, implications for individuals involved. Therapeutic justice is a theory that identifies the law and the way in which it is applied by various legal actors, including lawyers, as having inevitable consequences for psychological well-being that should be studied with the tools of the behavioral sciences. It suggests that these consequences should be taken into account in reforming law, when consistent with other important normative values, in the direction of making it less antitherapeutic and more therapeutic. It is a mental health ap- 13. Id. 14. Hora et al., supra note 6, at Id. at Id. at 442 n Id.
6 QLR [Vol. 22:811 proach to law and the way it is applied, and suggests the need for lawmakers and those that apply the law to be sensitive to the law's impact on psychological health, and to perform their roles with an awareness of some basic principles of psychology.1 8 As applied, the theory envisions that the lawyer with a therapeutic orientation is cognizant of the emotional well-being of his client and recognizes that his participation in the attorney-client relationship can impact the client emotionally and psychologically. 1 9 The idea is that, once it is recognized that the legal system does have a psychological and emotional effect on those who come in contact with it, the courts should seize the opportunity to begin making improvements on the defendant's lifestyle the moment an individual is brought into the system. Supporters of the DTC believe that, because drug addiction is a "public health problem with deep roots in society," and not merely a law enforcement problem, the legal system alone is ill-equipped to address the problem. 20 DTC proponents believe that drug treatment professionals must become involved in a collaborative effort with the court system in order to effect change. 21 If addiction is a biopsychosocial problem, then it will persist even in the face of punishment, and thus "no amount of jail time, probation, fines, or other types of traditional criminal justice sanctions will prevent the addict from repeating drug use behavior., 22 Thus, a drug addict will not be any closer to recovery after being incarcerated because the addiction itself has not been addressed. In applying the therapeutic justice philosophy to the DTC, the court system turns away from the traditional goals of the criminal justice system, including punishment, retribution and deterrence. Instead, the DTC goal, as based on therapeutic justice, is to provide treatment in lieu of punishment. In this way, the DTC acknowledges that the drug offender does not react to punishment as a deterrent. Rather, he is dictated by his addiction. It is not a question of whether a drug offender will follow the rules, but a question of how to get him free from addiction so that he will not violate the rules again. Both the DTC and the MHC employ a philosophy of therapeutic justice instead of punishment, deterrence and retribution. This is one 18. See generally Richard C. Boldt, Rehabilitative Punishment and the Drug Treatment Court Movement, 76 WASH. U. L.Q. 1205, 1239 (1998). 19. See generally id. 20. Hora et al., supra note 6, at Id. 22. Id. at 467.
7 2004] SLIP SLIDIN' AWAY? reason the MHC will share the problems that exist in the DTC. This point will be discussed further infra. The DTC operates on fundamentally different assumptions about the motivations of offenders. The DTC views addiction not as a complete failure of morals and free will on the part of the defendant, as the traditional criminal justice perspective would hold. Instead, this new model believes that a defendant suffers from a condition requiring medical and therapeutic attention. Deviant behavior that, traditionally, had been viewed solely as an act of the defendant's will was now viewed, in this paradigmatic shift, as a problem with not only moral, but biological, psychological and social dimensions as well. This shift of philosophy represents the embodiment of the therapeutic justice theory. The fact that the DTC seeks to eradicate the drug addiction itself is a large departure from the traditional concept of retributive justice. Throughout the early 1990s, communities around the United States followed Florida's lead and began implementing treatment courts to address the special needs of the addicted defendant. Today, there are more than 400 courts of its kind around the nation. Supporters, of which there are many, believe the system is working. These courts are said to more effectively manage their caseloads, reduce rates of recidivism, and reduce overall costs. 24 C. Structure and Procedures of the Drug Treatment Court While the hundreds of DTCs around the nation differ in many ways, they all have the following in common: (1) intervention is immediate; (2) the adjudication process is non-adversarial in nature; (3) the judge takes a hands-on approach to the defendant's treatment program; (4) the treatment program contains clearly defined rules and structured goals for the participants; and (5) the concept of the DTC teamcomprised of the judge, prosecutor, defense counsel, treatment provider, and corrections personnel-is important. 2 5 The DTC manages its own docket, separate from the criminal court, and hears only drug-related cases. Instead of handing out prison sentences, the DTC devises individual treatment plans designed to assist 23. Id. at Hora et al., supra note 6, at 456 (for instance, less than three percent were rearrested in the year following their completion of the court-mandated treatment as compared to thirty percent of those cycled through the traditional court system). 25. Id. at 453.
8 QLR [Vol. 22:811 the defendant in becoming addiction-free. If the defendant fails to comply with the program's requirements, including producing clean urine samples and participation in therapy, treatment, and educational programs, the DTC judge may impose sanctions. Such sanctions could include loss of privileges, extension of the treatment sentence, and, where deemed necessary, a short jail sentence to set the defendant back on track. 26 This use of jail time as sanction for non-compliance presents concerns about the coercive nature of the DTC and MHC. 1. Target DTC Population Each jurisdiction has its own criteria for who may participate in the DTC, but most courts "focus on the inability of the individual to stop abusing and/or using illicit drugs without the criminal justice system's involvement." 27 For instance, some courts define an addict as "an individual whose compulsive use of drugs continues despite the physical, psychological, and/or social harm which the user encounters through continued drug use." 28 Additionally, participation in the DTC is limited to non-violent misdemeanants who voluntarily "opt in" to the program. 2. Candidate Referral to the Drug Treatment Court The way potential DTC participants are identified differs interjurisdictionally as well, 29 but many follow the procedure adopted by the state of Maryland. In Baltimore, for instance, a potential participant may be routed to the DTC by any of four ways: "(1) Pretrial Detainee Referral Process, (2) Pretrial Non-Detainee Referral Process, (3) Courtroom Population Referral Process, or (4) Violation of Probation Referral Process. 3 In the first instance, the State's Attorney's Office Quality Case Review Team screens detainees held in the Baltimore City Detention Center within two days of their confinement to determine their eligibility in the DTC. Within five days of their confinement, the State's Attorney's Office ("SAO") and Office of the Public Defender ("OPD") meet to discuss those identified as possible candidates. Then, the OPD approaches 26. Id. at Id. 28. Hora et al., supra note 6, at Note that sometimes a defendant starts out in the criminal courts and is transferred to the DTC if he meets that jurisdiction's requirements. 30. Hora et al., supra note 6, at 487.
9 20041 SLIP SLIDIN' AWAY? 819 the detainee and presents the option of participating in the program and explains the ramifications. Next, the OPD informs the SAO of who has accepted or rejected the offers. The SAO then enters the acceptances with the DTC to be placed on the DTC docket. 3. Determining Drug Treatment Court Qualification Within six days of the initial detainment, the Assessment Unit uses the Addiction Severity Index ("ASI") to determine the existence and severity of the candidate's addiction, and the Psychopathy Checklist Revised ("PCR") "to determine the individual's motivation for treatment and behavioral patterns associated with criminality.' 4. The Status of a Drug Treatment Court Participant's Criminal Charges Though it varies by jurisdiction, typically the criminal charges are placed on hold and are then expunged from the defendant's record if they satisfactorily complete the treatment program prescribed for them. For instance, in Kalamazoo, Michigan, a DTC defendant will have her suspended charges dismissed if she completes all treatment and educational elements of the program, and remains free of drugs and arrests for one year after completing the program. 32 D. Effects of the Drug Treatment Court 1. Results of the Drug Treatment Court The American University's Office of Justice Programs Drug Court Clearinghouse (the "Clearinghouse") estimates that approximately 45,000 drug-addicted individuals have opted into the DTC systems. Approximately 31,500 of these individuals have graduated from the program or are currently enrolled. 33 The Clearinghouse interprets these figures to mean that the DTC system's participation and retention rate is about seventy percent nationwide. 34 Additionally, the DTC apparently saves a significant amount of money when compared to the cost of sus- 31. Id. 32. Id. at Id. at Hora et al., supra note 6, at 502.
10 QLR [Vol. 22:811 taining incarcerated individuals. "[I]n Washington D.C., a year of drug court cost[s] $1,800 to $4,400 per participant. This compares to at least $20,000 per year to jail the defendant." 3 In fact, almost every DTC claims to produce significant rates of improvement in costs and recidivism rates. However, there is a question as to how such data was collected and analyzed. The MHC is based largely on the purported and perceived successes of the DTC, so it is important to ascertain the true effect of the DTC on recidivism and overall costs. The legitimacy of the results of these data will be considered in Part IV. 2. How the Drug Treatment Court Led to the Advent of the Mental Health Court DTC proponents believe that the system has so successfully accomplished its goals that therapeutic jurisprudence should be applied to other troubled populations in our criminal justice system. Therefore, treatment courts have sprung up around the United States dedicated to, inter alia, domestic violence, and, most recently, mental health. The perceived success of the DTC has spurred advocates to establish the MHC as a mirror of the DTC, and hopefully capture the same perceived successes. Whether the DTC and MHC have resulted in success will be discussed in Part IV. If the DTC does achieve its objectives, and these objectives are morally, legally, and practically sound, there is a strong argument that the MHC will still fail, though it is so similar to the DTC, because there is something inherently different about the mentally ill individual that makes applying therapeutic justice, and the DTC model, inappropriate. If the DTC does not achieve its ends, or these ends are not justifiable, then there is an even stronger argument that the MHC will fail because not only will the MHC be unable to address the inherently different needs of the mentally ill, but because it will also result in the same problems faced by the DTC. This paper seeks to show that the reality is somewhere in the middle. That is, there are some things in the DTC that do work, and these positives may be transferred to the MHC. However, there are many aspects of the DTC that are undesirable. These problems will carry over to the MHC because the two systems are structured so similarly and are 35. Id. at 503 (Oakland, California conservatively claims that $3,000,000 was saved by the implementation of the F.I.R.S.T. Diversion Program).
11 2004] SLIP SLIDIN' AWAY? based on the same principles. Further, unique problems adhere in the mentally ill population which make the application of the DTC model to the mentally ill undesirable. II. GENESIS OF THE MENTAL HEALTH COURT There was such a perceived level of success with the DTC that the therapeutic justice model applied to the DTC was adapted to meet the special needs of the mentally ill defendant. Thus, the MHC was born. The first MHC was established on June 16, 1997, in Broward County, Florida. The court was devised in an effort to relieve the over-crowded prison system, and to treat the mentally ill population more effectively without any public safety implications. The Broward County model has been adapted for use in three other experimental locations: King County (Seattle), Washington, Anchorage, Alaska, and San Bernardino, California. A. Precursors to the Mental Health Court While the structure of the MHC is similar to that of the DTC, the antecedents of the former are different. The idea was that the criminal justice system was just not working in terms of reducing recidivism for the mentally ill. A variety of factors contributed to the creation of the MHC including the following: (1) the DTC system and its application of therapeutic justice; (2) the effects of the deinstitutionalization of the mentally ill; (3) our nation's epidemic drug problem; (4) the immense overcrowding of jails; (5) the exponential increase in the homeless population in the last twenty years; and (6) "the relatively common cooccurrence of mental illness among... the criminal justice population.,36 The disproportionately large numbers of mentally ill individuals in 36. GOLDKAMP & IRONs-GuYNN, supra note 1, at vii. The relatively recent deinstitutionalization of the mentally ill was undertaken on the hope that local communities would pick up the slack to provide sufficient treatment options for those recently displaced. Regrettably, this plan never materialized. Communities failed to set up adequate treatment plans and the mentally ill soon comprised a huge percentage of our homeless population. Without adequate treatment and basic needs met, the mentally ill have found themselves increasingly involved in the criminal justice system, most frequently for non-violent misdemeanor convictions. The result of our failure to establish adequate community-based resources for the mentally ill is that we released the mentally ill from hospitals only to incarcerate them in jails.
12 QLR [Vol. 22:811 our criminal justice system is one of the most frequently cited justifications for, and precursors to, the establishment of the MHC. This factor is of great interest in this paper and will be further addressed infra. 1. The Mentally Ill and Our Criminal Justice System As a consequence of the deinstitutionalization of the mentally ill, this population has found itself entangled in our nation's criminal justice system in record numbers. Our jails and prisons are overcrowded and the mentally ill account for an increasingly large percentage of incarcerated persons. It seems that the mentally ill are ending up in jails and prisons "with increasing frequency due to issues related more to their illness and less to the crimes they may have committed. 3 7 The Surgeon General's Report on Mental Health found that "there are millions of Americans with treatable mental illness who are receiving no treatment. 38 The mentally ill are a heavily stigmatized segment of the general population, and, as such, they are frequently incarcerated for misdemeanors including "trespass, disorderly conduct, and vagrancy. 9 The revolving-door patients are granted the highest proportion of available mental health treatment. "[T]en percent of persons with mental illness consume seventy-nine percent of the direct costs of all mental health services, and ninety-seven percent of the direct costs are utilized by forty-one percent of the patients utilizing mental health services. ' '4 The Bureau of Justice Statistics survey of 1999 found that, conservatively, 238,000 individuals with mental illness were incarcerated in This means that sixteen percent of state and local jail and prison populations are mentally ill, while seven percent of federal prisoners are mentally ill. Further, [w]ith the massive volumes of arrests, criminal cases processed, police contacts with citizens, persons supervised by pretrial services, and probation and parole agencies are also taken into account, the numbers of mentally ill persons dealt with and/or supervised by the criminal justice system on a routine 37. Ken Kress, An Argument for Assisted Outpatient Treatment for Persons with Serious Mental Illness Illustrated with Reference to a Proposed Statute for Iowa, 85 IOWA L. REV. 1269, 1272 n. 10 (2000). 38. Id. 39. Id. at Id. at GOLDKAMP & IRONS-GUYNN, supra note 1, at 1.
13 2004] SLIP SLIDIN' AWAY? basis is the United States is extraordinarily large. 42 Thus, "the criminal justice system has increasingly come to serve as the 'social service system of last resort.', 43 This recent increase in the percentage of mentally ill inmates raises a number of serious problems. First, many believe that the mentally ill are often incarcerated for behavior that would have been treated much more appropriately, and successfully, by the mental health community than by the penal system. Additionally, while incarcerating the mentally ill is counter-productive because they would be better treated elsewhere, it is also detrimental because the actual environment in prisons and jails often exacerbates the problem of the mentally ill more than others because they may not fully understand the implications of their incarceration, and may be suffering from paranoia or heightened levels of anxiety. Further, jails are woefully inadequate treatment sources for the mentally ill. Despite the large numbers of mentally ill who are incarcerated, a large majority of jails arm their corrections officers with little or no training in working with, and treating, mentally ill inmates. 44 Fewer than twenty percent of surveyed jails offer any mental health services to inmates, and most jail staffs receive less than three hours of training on issues related to mental illness. 45 It seems that "the jail functions as an alternative form of institutional care for the mentally disturbed, impaired and others whose deviant mental behavior violates community norms.,, 46 Treatment court advocates believe that it is imperative that the law enforcement and mental health communities bond together in order to effectively address the special needs of the mentally ill. When the two systems diverge it becomes evident that "dealing with the needs of clients in one system when they are most appropriately served by the other may make both law enforcement and mental health systems appear ineffective and inefficient., 47 The ultimate result of these problems was a call for change in the 42. Id. at Id. 44. Debra Baker, Special Treatment: A One-of-a-Kind Court May Offer the Best Hope for Steering Nonviolent Mentally Ill Defendants Into Care Instead of Jail, 84 A.B.A. J. 20, (1998). 45. Nancy Wolff, Interactions Between Mental Health and Law Enforcement Systems: Problems and Prospects for Cooperation, 23 J. HEALTH POL. POL'Y & L. 133, 144 (1998). 46. Id. at 144 (citation omitted). 47. Id. at 133.