Every court is a drug court

May is National Treatment Court Month, described by the National Association of Drug Courts (NADCP) as an “annual opportunity to share our success, educate the public, and engage elected officials” about the benefits of treatment court programs.

There is much success to highlight. NADCP describes treatment courts as “the single most successful intervention in our nation’s history for leading people living with substance use and mental health disorders out of the justice system and into lives of recovery and stability.” There is a substantial and growing body of evidence establishing that when courts adopt best practices and strategies, and a meaningful understanding of mental illness, substance use disorders and trauma, they improve public safety and enhance the lives of the participants.

Most California courts offer at least one collaborative court calendar – drug court, mental health court, reentry court, veterans court, dependency/family court – all of which are designed to offer participants an alternative to incarceration and a pathway to treatment. These courts move beyond judgment, and instead seek to assess and provide treatment and support for underlying conditions (mental illness, addiction, trauma, and criminogenic factors), which led to the participant’s criminal justice involvement. The judges and attorneys share this space with probation officers, case managers, therapists, peer mentors and others who work collaboratively with the participant to address their needs. NADCP describes the approach as follows:

Instead of viewing addiction as a moral failing, they view it as a disease. Instead of punishment, they offer treatment. Instead of indifference, they show compassion.

Treatment courts work. They work because they intelligently apply public health best-practices and clinical wisdom to help the participants address their underlying challenges.

Drug courts dive deeper into the issues. (To quote Dr. Gabor Mate, these courts do not simply ask “why the drugs?” but go beyond to ask “why the pain which led to the drug dependence?”) Veterans courts look beyond the charges to explore the underlying trauma that preceded and often led to the subsequent conduct and distress. Juvenile treatment courts take a wrap-around approach, seeking to apply the lessons of integrative medicine (whole person, whole family) to look beyond the problematic conduct and attempt to heal the family and resolve the conflicts and dysfunctions that led the family to the courthouse.

It has been my privilege to preside over treatment courts for nearly a decade – drug and reentry courts for 8 years and now mental health and veterans’ courts. On each calendar we look beyond the offenses that landed the participants in the justice system, assess the underlying conditions and offer a path, with wisdom and empathy, to healing.

There are courtrooms throughout California with innovative programs that produce better outcomes than traditional criminal courtrooms. At Santa Clara or Orange County drug court programs you will see collaborative, welcoming spaces that offer prompt wrap-around services staffed by skilled and compassionate persons who believe in helping to heal wounded souls. At Los Angeles or Sacramento mental health courts you will see innovative mental health court programs staffed by creative judicial officers teaming with doctors and clinical staff from local hospitals and universities to collaboratively address the substantial challenges of the mentally ill clients. We have courts throughout the state working to extend lessons learned from these programs to communities in need – veterans and others struggling with trauma, families struggling with the ravages of drug abuse and emotional dysregulation, persons impacted by the overwhelming challenge of serious mental illness, and persons exiting prison and jail who need effective assistance in re-integrating to society.

Treatment courts have served as our courts’ learning lab, offering us proven methods for enhancing safety and improving the lives of participants.

We have learned the value of evidence-based cognitive behavioral therapies and other clinical approaches to teach the clients better coping mechanisms and to address underlying criminogenic thinking patterns. We have learned the importance of Medication-Assisted Treatment (MAT) as a tool to assist persons struggling to withdraw from substance use disorders. We are seeing the extraordinary power of peer mentorship and the creation of safe, supportive spaces for the clients as they engage in these programs. (To quote Johann Hari, “The opposite of addiction is not sobriety; the opposite of addiction is connection.”) We have learned the importance of Crisis Intervention Training, Motivational Interviewing techniques, and other effective tools designed to meet the clients where they are and help guide them effectively forward. We have seen the wisdom of Harm Reduction models that offer the clients support for incremental improvement rather than the traditional, moralistic, all-or-nothing response to treatment needs.

Yet for all of the successes of treatment courts, we have not fully applied the lessons learned to the vast population of persons who need them. For every drug court participant there are a dozen others struggling with substance use disorders who are not being offered the services they need. For every mentally ill person receiving effective support and wrap-around care there are too many others left to suffer – untreated in jail cells or wandering the streets impaired and alone – without the care they need. For every veteran whom we have successfully guided from despair to safety and success there are others we have failed to reach.

Indeed, although we have gained important public health lessons in our treatment courts, we have not come close to applying these tools to the challenges now filling all of our court dockets. We see far too much family violence and too many children barraged with trauma, yet more often than not fail to apply the lessons of treatment courts to address these problems and reduce the children’s trauma. We see far too many young men doing bad things with guns, yet we very rarely adopt meaningful responses to look beyond the conduct to address the underlying impulsivity and trauma that led to the bad behavior. (To quote Father Boyle, “If we do not transform their pain, they will most assuredly transmit it.”)

Every court is a drug court, because we see participants on every docket – criminal, family, civil, juvenile, probate – whose substance use disorders play a large role in the problems that brought them to the courthouse.

Every court is a mental health court, as we see a huge and growing population of persons struggling with serious mental illness on every calendar.

Every court is a veterans court, as we see veterans struggling with PTSD and other service-related challenges in every type of courtroom.

Every court is a reentry court, as we see many parolees and probationers in all of our courts struggling as they seek to integrate back into society.

Every court is a trauma court. As evidenced by the ACES and other studies, many persons in every courtroom struggle with the aftermath of trauma that influences their behavior and decisions.

Every court needs to be a treatment court, because on every calendar we see circumstances where our ability to address the clinical and behavioral conditions at issue means the difference between success and failure. Our failure to competently address these circumstances will only increase the likelihood of recurrence of the same situations that led to these folks to court in the first place.

Every court can, and should be a collaborative court. We have community partners and resources with whom we can collaborate to bring about better, more intelligent outcomes.

While we should take pride in the progress that we have made in applying intelligent health practices in some of our courts, there is much, much more work to be done to make every court an effective treatment court. Our work will not be done until every court has the knowledge, capacity and resources to offer the treatment responses and trauma competence necessary to truly meet the needs of the community.