Each month the Justice Center spotlights collaborative criminal justice/mental health initiatives that have received funding from the Bureau of Justice Assistance’s Justice and Mental Health Collaboration Program (JMHCP). Justice Center staff members ask the practitioners in these programs to discuss some successes and challenges they have encountered in the planning and implementation process. This month’s profile is from the Judiciary of Guam, a 2008 Planning and Implementation grantee.
Guam, a United States territory in the Western Pacific, received a JMHCP planning and implementation grant in 2008 to develop a mental health court. The Judiciary of Guam and the Guam Department of Mental Health and Substance Abuse (DMHSA) collaborated in a planning process that led to the opening of the Guam Mental Health Court (Guam MHC) in May 2009. The Guam MHC targets adult offenders with serious mental illnesses or developmental disabilities who are charged with nonviolent crimes and express interest in treatment. The court provides much-needed structure for, and coordination of, mental health and substance use services in a jurisdiction with limited health care resources.
How did your jurisdiction realize that there was a need to respond to the high prevalence of individuals with mental illnesses in the criminal justice system?
Judges in Guam expressed concern about what seemed like an increasing number of criminal defendants diagnosed with serious mental illnesses (SMI) who seemed to cycle between the criminal justice system and treatment in the community. A federal injunction provided the galvanizing push; in 2004, a U.S. District Court imposed an injunction on Guam’s Department of Mental Health and Substance Abuse (DMHSA) to improve its practices. This led to the formation of a working group comprising members of the judiciary, DMHSA, Court Programs, and other stakeholders, which developed the mental health court concept and submitted the grant application to the Bureau of Justice Assistance.
How did your initiative leverage pre-existing relationships or partnerships in the jurisdiction, or build new ones?
Prior to the U.S. District Court’s injunction, the Guam courts’ relationship with DMHSA was an informal working partnership. With the injunction in place, DMHSA contracted with two consultants, Chad Morris (clinical psychologist) and Stephen Haimowitz (attorney), to assist the Department. The consultants convened several work groups, one of which addressed the needs of justice-involved individuals with mental illnesses. Associate Justice Katherine Maraman, at that time a Guam trial court judge, established a specialized docket for criminal cases involving defendants with mental illnesses. This informal specialized docket continued without outside support for three years while the work group continued to explore ideas and additional funding opportunities.
How did you identify your program’s target population?
The work team convened stakeholders from the Office of the Attorney General, the Public Defender, the Guam Police Department, the Guam Department of Corrections, and others to formalize the Guam MHC structure, including the criteria for admission into the program. The work team decided to focus on adult residents of Guam who were charged with nonviolent offenses and who express interest in treatment. The group set clinical eligibility for individuals with a broad range of mental health disorders including, but not limited to, schizophrenia, schizoaffective disorder, delusional disorder, depressive disorder, bipolar disorder, and post-traumatic stress disorder, as well as developmental disabilities.
What has been your biggest challenge and how are you addressing it?
Our biggest challenge is the lack of mental health services available in Guam. Guam is considered underserved in terms of health resources. The one small civilian medical facility has only recently received preliminary accreditation from the Joint Commission on the Accreditation of Healthcare Organizations (JCAHO). Psychiatrists in private practice are few in number, as are many of the other mental health professionals.
For several years, we also struggled with frequent personnel changes at the Department of Mental Health. Without continuity of leadership, we found it difficult to get guidance to plan or obtain commitment directing resources to potential programs. Even now that key positions in the Department of Mental Health are filled and additional staff hired, there are still serious limitations in the services available on the island.
The permanent injunction also presents challenges because there is a potential risk of going into federal receivership. We are unsure of how this would change the level of services provided to the MHC, although we believe that services would not be reduced below the level agreed upon in the current memorandum of understanding (MOU) signed by the Attorney General, the Public Defender, the Guam Police Department, DMHSA and the Guam Department of Corrections.
Provide an example of a particular success your program has had to date, either in moving from planning to implementation or in showing an impact on an individual, group, or community.
Measuring “success” in a program as small and new as Guam’s MHC is difficult. We measure success in small increments, such as the progression of a court participant from one phase of the MHC program to the next, and more broadly, in the improvements in our clients’ health and law abidingness. The “advancement ceremony” for transitions from one phase to the next is small and informal: the Judge hands the advancing client a certificate of achievement and gives a short motivational speech.
One client, who has been diagnosed with schizoaffective disorder and who was homeless prior to program participation, is now stabilized and in Phase II of the MHC program; she lives independently and has weekly, supervised visits with her child. Another successful participant has overcome her long history of violent behavior and now lives independently and works on a part time basis at Guma Mami, a local organization for persons with disabilities.
What steps have you taken or are planning to take to sustain your initiative?
The Judiciary of Guam will work with the Guam Legislature to sustain MHC operations. The Guam MHC will develop reports to senators describing the program and its successes to secure local appropriations for this program.
Jacqueline Zahnen Cruz
Court Programs Administrator