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Bar News - April 19, 2013

Innovation in Tough Times: The Future of Drug and Mental Health Courts in NH


Innovations in Tough Times
Part 1: Probation Reform Program Brings New Hope, July 13, 2012

Part 2: Giving Children Greater Voice In Abuse & Neglect Proceedings, August 17, 2012

Part 3: Rethinking Jail: The ‘Community Corrections’ Approach in Sullivan County, September 14, 2012

Part 4: Derry Court Pilot Project Adds Misdemeanor Hearing, November 16, 2012

Part 5: Judge Holds Court in School, February 22, 2013

Part 6: The Future of Drug and Mental Health Courts in NH , April 19, 2013
As specialty courts for people with drug addictions and mental health conditions gain traction across New Hampshire, advocates for these alternative sentencing programs are exploring ways to make them more effective and financially sustainable.

NH Superior Court Chief Justice Tina Nadeau, a staunch proponent of drug courts, presides over the Rockingham County Adult Drug Court in Brentwood, which began about two years ago. With the goal of applying for a sizeable federal grant early next year that would bolster drug courts and mental health courts statewide, Nadeau and a group of other advocates have been working to keep programs consistent across jurisdictions and to track outcomes for participants. Ultimately, Nadeau hopes to convince lawmakers that these programs are worthy of some state funding.

"I hope that someday, before I leave this job, that I can convince (New Hampshire legislators) that both state sources and county sources can work together to fund this," she said.

In the meantime, supporters of these alternative sentencing programs are looking at ways to integrate medical therapies, such as methadone or Suboxone, into court-ordered treatment for defendants who are addicted to opiates. "We’re having conversations about how to incorporate that into our drug courts right now," Nadeau said.

Providing mental health supports sooner for drug court participants and gender-specific programming for women, whose completion rates are lower than those of their male counterparts, also are among the priorities for future program improvement.

Keith Eaton gives a speech during the ceremony held to celebrate his graduation from the Rockingham County Drug Court, while Chief Justice Tina Nadeau, who presided over his case for the past two years, looks on.
Both drug court and mental health court programs involve intense supervision, frequent court visits, strict monitoring, treatment plans, incentives and immediate consequences for any failure to comply with program rules. Drug courts also involve frequent random urine screenings.

New Hampshire presently has four adult drug courts located in Strafford, Grafton and Rockingham counties, and in Laconia, where District Court Judge Jim Carroll recently began hearing Belknap County drug court cases. Relying on a mix of federal grants and county funds, the drug court programs have annual budgets ranging from $200,000 to $300,000, depending on size and location, according to state sources.

Most drug court defendants face felony criminal charges related to their drug addictions, as well as significant prison sentences. Once accepted into drug court, a defendant typically remains in the program for up to two years. Any violation of program rules leads to an immediate sanction – usually a day or two, or more, behind bars. Following successful completion, the defendant’s charges either are dismissed or the convictions can be annulled after one year – more quickly than other felony convictions.

Mental health court participants usually have been accused of misdemeanors, which is why the state’s nine mental health court programs are all based at district division courts. Many of the defendants in these programs were not receiving any mental health services at the time of arrest, even though most were eligible under Medicaid.

"They’re not even aware that they’re eligible, so they don’t even try to seek out the community mental health providers," Nadeau said.

While drug courts and mental health courts are separate programs at different levels of the justice system, many of the state’s criminal offenders are both chemically dependent and mentally ill. Defendants with co-occurring mental health and drug dependency problems usually end up in drug court, Nadeau said. In the past, it was the general position of the courts that the addiction needed to be dealt with first, before the mental health condition, but those attitudes are now changing, she said.

A recent report to the Grafton County Drug Court team urged a shift in those policies, especially for women, the majority of whom could benefit from addressing mental health issues surrounding past trauma – usually physical or sexual abuse – before or during addiction-related interventions.

"Until a woman can address the violence that was done to her," wrote Clara Bailey, author of the report, "and uncover the dimensions of the trauma she is experiencing, she will be unable to address even the thought, let alone the reality, of living without alcohol or drugs."

Tracking Outcomes

Alex Casale is the NH judicial branch state drug and mental health court coordinator, a volunteer position to which he was appointed in January. Casale, who has been the director of the Strafford County Drug Court since 2005, tracks the effectiveness of the state’s alternative sentencing programs and makes sure the programs are uniform across jurisdictions. (The NH Legislature last year passed legislation that authorized drug courts and listed required program components, Casale said, and a similar bill regarding mental health courts is expected to be introduced next year.)

So far, the statistics show positive results, according to both Casale and a recent drug court study by student researchers at the Rockefeller Center at Dartmouth College. The study found that "for the most part, drug courts promote positive community trends, reduce recidivism rates, and are generally a less expensive alternative to prisons."

Most of the statistics Casale has collected relate to the Strafford and Grafton county drug court programs, which have been around the longest. Of those who have successfully completed one of those two programs, about 90 percent have so far avoided a subsequent misdemeanor charge.

Roughly half of the people accepted into the programs have graduated – the other half have failed to change their habits and ended up back in jail or prison. The completion rate is lower for women, Casale said, which has led counties to explore options for adding more gender-specific programming.

For those who are successful, the cost to the state is significantly lower than the cost of housing inmates. The annual cost per person in drug court ranges from $8,000 to $15,000, Casale said, compared with about $30,000 per inmate per year in the state’s jails and prisons. The participants who have made it through these intense outpatient programs say it forced them to claw their way to sobriety and learn new life skills.

"For them, it’s a big accomplishment," says Casale. "Some of them have never really completed anything in their lives."

Keith Eaton started doing hard drugs when he was 12.

In and out of jail, he tried various rehabilitation and diversion programs. He even graduated from the state’s academy diversion program, but his addiction – and the things he did to maintain it – continued to land him behind bars.

About two years ago, he was offered the opportunity to participate in the Rockingham County Adult Drug Court. Last month, on March 25, Eaton became the program’s first graduate.

At the superior court in Brentwood, Eaton sat at a courtroom defense table, flanked by his parents, eating red velvet cake. The ceremony to celebrate his discharge from the drug court program was attended by about two dozen friends, family members, law enforcement, corrections and probation officials, mental health care provides, Chief Justice Nadeau and other members of the county drug court team.

Eaton was asked to say a few words about the process that led him there.

"I went through a lot of bumps in the road, but I kept going," he said. "I learned a lot about myself, like I can be smart and believe in myself… I also learned that I need other people for support."

Nadeau, addressing the crowded courtroom, congratulated Eaton. "This is probably one of the most rewarding times in my life as a judge," she said. "… I never doubted your commitment or your resolve to complete this program."

Karin Goscinski-Breton, the county drug court treatment coordinator, became emotional as she talked about Eaton’s progress over the past two years. She said she watched him transform as he shed his past habits and that the best parts of his personality have now begun to shine through.

"Everything else was just bravado and defenses," she said. "It’s really been quite a ride, and it’s just a pleasure to share in this day with you. Take care of yourself."

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