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  1. San Francisco (Calif.) Behavioral Health Court

San Francisco (Calif.) Behavioral Health Court

Program Goals

The San Francisco Behavioral Health Court (BHC) is a mental health court established in early 2003 in response to the increasing numbers of mentally ill defendants cycling through the jails and courts. The court aims to intensely monitor a subset of mentally ill offenders whose criminal behavior is directly linked to their mental illness. The mission of the BHC is to: 

  •  Connect criminal defendants who have serious mental illness to treatment services
  •  Find disposition to their criminal charges that take mental illness into consideration   
  • Ensure public safety by decreasing recidivism through appropriate mental health treatment and intensive supervision

Target Population/Eligibility

Participation in BHC is voluntary, and in many instances, the defendant does not have to enter a guilty plea to criminal charges in order to enter the program. To qualify for participation in the BHC, defendants must be diagnosed as having an axis I mental disorder according to the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM–IV) or, in some circumstances, developmental disabilities. Defendants must also be amenable to treatment in the community mental health system. The gravity of the criminal charges against a defendant is also considered, although BHC does accept a substantial proportion of defendants who are charged with felony offenses.


 

Services Provided

The BHC provides services to participants through a continuum of care, beginning with in-jail services, transitional care prior to release, and early release into the community. The court has adopted several practices for treating mental ill offenders, including Forensic Assertive Community Treatment, Illness Management and Recovery, Trauma Informed Care, Integrated Dual Diagnosis Treatment, Dialectical Behavior Therapy, and the Supported Employment Program. The BHC has also adopted the Women’s Integrated Skills and Health (or WISH) Project, which diverts in-custody female offenders with co-occurring disorders to appropriate community mental health treatment services. The BHC is one of the only mental health courts in the country to develop gender specific treatment.


 

Key Personnel

The BHC involves collaboration between the Superior Court, the Public Defender’s Office, the District Attorney’s Office, the Sheriff’s Department, the Haight Ashbury Free Clinic’s Jail Psychiatric Services, the University of California, San Francisco’s Citywide Case Management, and the city’s Department of Public Health. The judge and lawyers work closely with mental health providers, who provide intensive case management that centers around the client’s diagnosis and psychosocial needs rather than his or her criminal charges. The court anticipates that relapses may occur, and it emphasizes positive reinforcement for successes rather than sanctions for failure. Participants who successfully maintain a sustained period of stability “graduate” from the mental health court.

Intervention ID
39
Ages

18 to 100

Rating
Promising
Outcomes

Study 1

Recidivism Rates of All Program Participants

The outcome results from the McNiel and Binder (2007) study showed participation (even if a participant did not complete the entire program and graduate) was associated with positive results.

  • Time until a new charge: participation in the Behavioral Health Court (BHC) predicted a longer time to any new charge. At 18 months, the treatment group was 26 percent less likely to be charged with a new offense compared to the treatment-as-usual group.
  • Time until a new violent charge: participation in BHC also resulted in a longer time to a new violent charge. The treatment group was 55 percent less likely to be charged with a new violent offense compared to the treatment-as-usual group.

Recidivism Rates of Program Completers

Positive outcomes were also associated with completion and graduation from the mental health court program. Looking at individuals that graduated from the mental health court compared to individuals who received treatment-as-usual:

  • Time until a new charge: BHC graduates continued to show longer time before any new charges after graduating. At 18 months, BHC graduates were 39 percent less likely to have been charged with a new offense compared to the treatment-as-usual group.
  • Time until a new violent charge: BHC graduates also showed a longer time before any new violent charges after graduating from the program. BHC graduates were 54 percent less likely to have been charged with a new violent offense compared to the treatment-as-usual group.
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