Mental Health Courts Can Struggle to Fulfill Decades-Old Promise
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GAINESVILLE, Ga. — In early December, Donald Brown stood nervously in the Hall County Courthouse, concerned he’d be sent back to jail.
The 55-year-old struggles with depression, addiction, and suicidal thoughts. He worried a judge would terminate him from a special diversion program meant to keep people with mental illness from being incarcerated. He was failing to keep up with the program’s onerous work and community service requirements.
“I’m kind of scared. I feel kind of defeated,” Brown said.
Last year, Brown threatened to take his life with a gun and his family called 911 seeking help, he said. The police arrived, and Brown was arrested and charged with a felony of firearm possession.
After months in jail, Brown was offered access to the Health Empowerment Linkage and Possibilities, or HELP, Court. If he pleaded guilty, he’d be connected to services and avoid prison time. But if he didn’t complete the program, he’d possibly face incarceration.
“It’s almost like coercion,” Brown said. “‘Here, sign these papers and get out of jail.’ I feel like I could have been dealt with a lot better.”
Advocates, attorneys, clinicians, and researchers said courts such as the one Brown is navigating can struggle to live up to their promise. The diversion programs, they said, are often expensive and resource-intensive, and serve fewer than 1% of the more than 2 million people who have a serious mental illness and are booked into U.S. jails each year.
People can feel pressured to take plea deals and enter the courts, seeing the programs as the only route to get care or avoid prison time. The courts are selective, due in part to political pressures on elected judges and prosecutors. Participants must often meet strict requirements that critics say aren’t treatment-focused, such as regular hearings and drug screenings.
And there is a lack of conclusive evidence on whether the courts help participants long-term. Some legal experts, like Lea Johnston, a professor of law at the University of Florida, worry the programs distract from more meaningful investments in mental health resources.
Jails and prisons are not the place for individuals with mental disorders, she said. “But I’m also not sure that mental health court is the solution.”
The country’s first mental health court was established in Broward County, Florida, in 1997, “as a way to promote recovery and mental health wellness and avoid criminalizing mental health problems.” The model was replicated with millions in funding from such federal agencies as the Substance Abuse and Mental Health Services Administration and the Department of Justice.
More than 650 adult and juvenile mental health courts were operational as of 2022, according to the National Treatment Court Resource Center. There’s no set way to run them. Generally, participants receive treatment plans and get linked to services. Judges and mental health clinicians oversee their progress.
Researchers from the center found little evidence that the courts improve participants’ mental health or keep them out of the criminal justice system. “Few studies … assess longer-term impacts” of the programs “beyond one year after program exit,” said a 2022 policy brief on mental health courts.
The courts work best when paired with investments in services such as clinical treatment, recovery programs, and housing and employment opportunities, said Kristen DeVall, the center’s co-director.
“If all of these other supports aren’t invested in, then it’s kind of a wash,” she said.
The courts should be seen as “one intervention in that larger system,” DeVall said, not “the only resource to serve folks with mental health needs” who get caught up in the criminal justice system.
Resource limitations can also increase the pressures to apply for mental health court programs, said Lisa M. Wayne, executive director of the National Association of Criminal Defense Lawyers. People seeking help might not feel they have alternatives.
“It’s not going to be people who can afford mental health intervention. It’s poor people, marginalized folks,” she said.
Other court skeptics wonder about the larger costs of the programs.
In a study of a mental health court in Pennsylvania, Johnston and a University of Florida colleague found participants were sentenced to longer time under government supervision than if they’d gone through the regular criminal justice system.
“The bigger problem is they’re taking attention away from more important solutions that we should be investing in, like community mental health care,” Johnston said.
When Melissa Vergara’s oldest son, Mychael Difrancisco, was arrested on felony gun charges in Queens in May 2021, she thought he would be an ideal candidate for the New York City borough’s mental health court because of his diagnosis of autism spectrum disorder and other behavioral health conditions.
She estimated she spent tens of thousands of dollars to prepare Difrancisco’s case for consideration. Meanwhile, her son sat in jail on Rikers Island, where she said he was assaulted multiple times and had to get half a finger amputated after it was caught in a cell door.
In the end, his case was denied diversion into mental health court. Difrancisco, 22, is serving a prison sentence that could be as long as four years and six months.
“There’s no real urgency to help people with mental health struggles,” Vergara said.
Critics worry such high bars to entry can lead the programs to exclude people who could benefit the most. Some courts don’t allow those accused of violent or sexual crimes to participate. Prosecutors and judges can face pressure from constituents that may lead them to block individuals accused of high-profile offenses.
And judges often aren’t trained to make decisions about participants’ care, said Raji Edayathumangalam, senior policy social worker with New York County Defender Services.
“It’s inappropriate,” she said. “We’re all licensed to practice in our different professions for a reason. I can’t show up to do a hernia operation just because I read about it or sat next to a hernia surgeon.”
Mental health courts can be overly focused on requirements such as drug testing, medication compliance, and completing workbook assignments, rather than progress toward recovery and clinical improvement, Edayathumangalam said.
Completing the programs can leave some participants with clean criminal records. But failing to meet a program’s requirements can trigger penalties — including incarceration.
During a recent hearing in the Clayton County Behavioral Health Accountability Court in suburban Atlanta, one woman left the courtroom in tears when Judge Shana Rooks Malone ordered her to report to jail for a seven-day stay for “being dishonest” about whether she was taking court-required medication.
It was her sixth infraction in the program — previous consequences included written assignments and “bench duty,” in which participants must sit and think about their participation in the program.
“I don’t like to incarcerate,” Malone said. “That particular participant has had some challenges. I’m rooting for her. But all the smaller penalties haven’t worked.”
Still, other participants praised Malone and her program. And, in general, some say such diversion programs provide a much-needed lifeline.
Michael Hobby, 32, of Gainesville was addicted to heroin and fentanyl when he was arrested for drug possession in August 2021. After entry into the HELP Court program, he got sober, started taking medication for anxiety and depression, and built a stable life.
“I didn’t know where to reach out for help,” he said. “I got put in handcuffs, and it saved my life.”
Even as Donald Brown awaited his fate, he said he had started taking medication to manage his depression and has stayed sober because of HELP Court.
“I’ve learned a new way of life. Instead of getting high, I’m learning to feel things now,” he said.
Brown avoided jail that early December day. A hearing to decide his fate could happen in the next few weeks. But even if he’s allowed to remain in the program, Brown said, he’s worried it’s only a matter of time before he falls out of compliance.
“To try to improve myself and get locked up for it is just a kick in the gut,” he said. “I tried really hard.”
KFF Health News senior correspondent Fred Clasen-Kelly contributed to this report.
KFF Health News is a national newsroom that produces in-depth journalism about health issues and is one of the core operating programs at KFF—an independent source of health policy research, polling, and journalism. Learn more about KFF.
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Why are tall people more likely to get cancer? What we know, don’t know and suspect
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People who are taller are at greater risk of developing cancer. The World Cancer Research Fund reports there is strong evidence taller people have a higher chance of of developing cancer of the:
- pancreas
- large bowel
- uterus (endometrium)
- ovary
- prostate
- kidney
- skin (melanoma) and
- breast (pre- and post-menopausal).
But why? Here’s what we know, don’t know and suspect.
Pexels/Andrea Piacquadio Height does increase your cancer risk – but only by a very small amount. Christian Vinces/Shutterstock A well established pattern
The UK Million Women Study found that for 15 of the 17 cancers they investigated, the taller you are the more likely you are to have them.
It found that overall, each ten-centimetre increase in height increased the risk of developing a cancer by about 16%. A similar increase has been found in men.
Let’s put that in perspective. If about 45 in every 10,000 women of average height (about 165 centimetres) develop cancer each year, then about 52 in each 10,000 women who are 175 centimetres tall would get cancer. That’s only an extra seven cancers.
So, it’s actually a pretty small increase in risk.
Another study found 22 of 23 cancers occurred more commonly in taller than in shorter people.
Why?
The relationship between height and cancer risk occurs across ethnicities and income levels, as well as in studies that have looked at genes that predict height.
These results suggest there is a biological reason for the link between cancer and height.
While it is not completely clear why, there are a couple of strong theories.
The first is linked to the fact a taller person will have more cells. For example, a tall person probably has a longer large bowel with more cells and thus more entries in the large bowel cancer lottery than a shorter person.
Scientists think cancer develops through an accumulation of damage to genes that can occur in a cell when it divides to create new cells.
The more times a cell divides, the more likely it is that genetic damage will occur and be passed onto the new cells.
The more damage that accumulates, the more likely it is that a cancer will develop.
A person with more cells in their body will have more cell divisions and thus potentially more chance that a cancer will develop in one of them.
Some research supports the idea having more cells is the reason tall people develop cancer more and may explain to some extent why men are more likely to get cancer than women (because they are, on average, taller than women).
However, it’s not clear height is related to the size of all organs (for example, do taller women have bigger breasts or bigger ovaries?).
One study tried to assess this. It found that while organ mass explained the height-cancer relationship in eight of 15 cancers assessed, there were seven others where organ mass did not explain the relationship with height.
It is worth noting this study was quite limited by the amount of data they had on organ mass.
Is it because tall people have more cells? Halfpoint/Shutterstock Another theory is that there is a common factor that makes people taller as well as increasing their cancer risk.
One possibility is a hormone called insulin-like growth factor 1 (IGF-1). This hormone helps children grow and then continues to have an important role in driving cell growth and cell division in adults.
This is an important function. Our bodies need to produce new cells when old ones are damaged or get old. Think of all the skin cells that come off when you use a good body scrub. Those cells need to be replaced so our skin doesn’t wear out.
However, we can get too much of a good thing. Some studies have found people who have higher IGF-1 levels than average have a higher risk of developing breast or prostate cancer.
But again, this has not been a consistent finding for all cancer types.
It is likely that both explanations (more cells and more IGF-1) play a role.
But more research is needed to really understand why taller people get cancer and whether this information could be used to prevent or even treat cancers.
I’m tall. What should I do?
If you are more LeBron James than Lionel Messi when it comes to height, what can you do?
Firstly, remember height only increases cancer risk by a very small amount.
Secondly, there are many things all of us can do to reduce our cancer risk, and those things have a much, much greater effect on cancer risk than height.
We can take a look at our lifestyle. Try to:
- eat a healthy diet
- exercise regularly
- maintain a healthy weight
- be careful in the sun
- limit alcohol consumption.
And, most importantly, don’t smoke!
If we all did these things we could vastly reduce the amount of cancer.
You can also take part in cancer screening programs that help pick up cancers of the breast, cervix and bowel early so they can be treated successfully.
Finally, take heart! Research also tells us that being taller might just reduce your chance of having a heart attack or stroke.
Susan Jordan, Associate Professor of Epidemiology, The University of Queensland and Karen Tuesley, Postdoctoral Research Fellow, School of Public Health, The University of Queensland
This article is republished from The Conversation under a Creative Commons license. Read the original article.
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Science of Yoga – by Ann Swanson
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There are a lot of yoga books out there to say “bend this way, hold this that way” and so forth, but few that really explain what is going on, how, and why. And understanding those things is of course key to motivation and adherence. So that’s what this book provides!
The book is divided into sections, and in the first part we have a tour of human anatomy and physiology. This may seem almost unrelated to yoga, but is valuable necessary-knowledge to get the most out of the next section:
The next few parts are given over to yoga asanas (stretches, positions, poses, call them what you will in English) and now we are given a clear idea of what it is doing: we get to understand exactly what’s being stretched, what blood flow is being increased and how, what organs are being settled into their correct place, and many other such things.
Importantly, this means we also understand why certain things are the way they are, and why they can’t be done in some other slightly different but perhaps superficially easier way.
The style of the book is like a school textbook, really, but without patronizing the reader. The illustrations, of which there are many, are simple enough to be clear while being detailed enough to be informative.
Bottom line: if you’re ever doing yoga at home and wondering if you should cut a certain corner, this is the book that will tell you why you shouldn’t.
Click here to check out Science of Yoga, and optimize your practice!
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Hate salad or veggies? Just keep eating them. Here’s how our tastebuds adapt to what we eat
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Do you hate salad? It’s OK if you do, there are plenty of foods in the world, and lots of different ways to prepare them.
But given almost all of us don’t eat enough vegetables, even though most of us (81%) know eating more vegetables is a simple way to improve our health, you might want to try.
If this idea makes you miserable, fear not, with time and a little effort you can make friends with salad.
Why don’t I like salads?
It’s an unfortunate quirk of evolution that vegetables are so good for us but they aren’t all immediately tasty to all of us. We have evolved to enjoy the sweet or umami (savoury) taste of higher energy foods, because starvation is a more immediate risk than long-term health.
Vegetables aren’t particularly high energy but they are jam-packed with dietary fibre, vitamins and minerals, and health-promoting compounds called bioactives.
Those bioactives are part of the reason vegetables taste bitter. Plant bioactives, also called phytonutrients, are made by plants to protect themselves against environmental stress and predators. The very things that make plant foods bitter, are the things that make them good for us.
Unfortunately, bitter taste evolved to protect us from poisons, and possibly from over-eating one single plant food. So in a way, plant foods can taste like poison.
For some of us, this bitter sensing is particularly acute, and for others it isn’t so bad. This is partly due to our genes. Humans have at least 25 different receptors that detect bitterness, and we each have our own genetic combinations. So some people really, really taste some bitter compounds while others can barely detect them.
This means we don’t all have the same starting point when it comes to interacting with salads and veggies. So be patient with yourself. But the steps toward learning to like salads and veggies are the same regardless of your starting point.
It takes time
We can train our tastes because our genes and our receptors aren’t the end of the story. Repeat exposures to bitter foods can help us adapt over time. Repeat exposures help our brain learn that bitter vegetables aren’t posions.
And as we change what we eat, the enzymes and other proteins in our saliva change too. This changes how different compounds in food are broken down and detected by our taste buds. How exactly this works isn’t clear, but it’s similar to other behavioural cognitive training.
Add masking ingredients
The good news is we can use lots of great strategies to mask the bitterness of vegetables, and this positively reinforces our taste training.
Salt and fat can reduce the perception of bitterness, so adding seasoning and dressing can help make salads taste better instantly. You are probably thinking, “but don’t we need to reduce our salt and fat intake?” – yes, but you will get more nutritional bang-for-buck by reducing those in discretionary foods like cakes, biscuits, chips and desserts, not by trying to avoid them with your vegetables.
Adding heat with chillies or pepper can also help by acting as a decoy to the bitterness. Adding fruits to salads adds sweetness and juiciness, this can help improve the overall flavour and texture balance, increasing enjoyment.
Pairing foods you are learning to like with foods you already like can also help.
The options for salads are almost endless, if you don’t like the standard garden salad you were raised on, that’s OK, keep experimenting.
Experimenting with texture (for example chopping vegetables smaller or chunkier) can also help in finding your salad loves.
Challenge your biases
Challenging your biases can also help the salad situation. A phenomenon called the “unhealthy-tasty intuition” makes us assume tasty foods aren’t good for us, and that healthy foods will taste bad. Shaking that assumption off can help you enjoy your vegetables more.
When researchers labelled vegetables with taste-focused labels, priming subjects for an enjoyable taste, they were more likely to enjoy them compared to when they were told how healthy they were.
The bottom line
Vegetables are good for us, but we need to be patient and kind with ourselves when we start trying to eat more.
Try working with biology and brain, and not against them.
And hold back from judging yourself or other people if they don’t like the salads you do. We are all on a different point of our taste-training journey.
Emma Beckett, Senior Lecturer (Food Science and Human Nutrition), School of Environmental and Life Sciences, University of Newcastle
This article is republished from The Conversation under a Creative Commons license. Read the original article.
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Sensitive – by Jenn Granneman and Andre Sólo
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This book is written for what is called the “Highly Sensitive Person”, which makes it sound like a very rare snowflake condition, when in fact the diagnostic criteria (discussed early in the book) yield a population bell curve of 30:40:30, whereupon 30% are in the band of “high sensitivity”, 40% “normal sensitivity” and the remainder “low sensitivity”. You may note that “high” and “low” together outnumber “normal”, but statistics is like that.
So, if you’re one of the approximately one in three people who fall into the higher category, and/or you have a loved one who is in that category, then this book looks at the many advantages to a commonly stigmatized and (by cruel irony) criticized personality trait.
Those advantages range from personal life to work and even public life (yes, really), and can be grown, positively highlighted, used, and enjoyed.
In the category of criticism, the book does not usefully cover the benefit of psychological resilience. Resilience does not mean losing sensitivity, just, being able to also dry one’s tears and weather life’s slings and arrows when the world is harsher than one might like. But for the authors, they have stacked all their chips on “we must make the world a better place”. Which is a noble goal, if not always an immediately attainable one.
Bottom line: if you are more sensitive than average and would like to use that to benefit yourself and those around you, then this is the book for you!
Click here to check out Sensitive, and make the most of your strengths!
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Which gut drugs might end up in a lawsuit? Are there really links with cancer and kidney disease? Should I stop taking them?
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Common medicines used to treat conditions including heartburn, reflux, indigestion and stomach ulcers may be the subject of a class action lawsuit in Australia.
Lawyers are exploring whether long-term use of these over-the-counter and prescription drugs are linked to stomach cancer or kidney disease.
The potential class action follows the settlement of a related multi-million dollar lawsuit in the United States. Last year, international pharmaceutical company AstraZeneca settled for US$425 million (A$637 million) after patients made the case that two of its drugs caused significant and potentially life-threatening side effects.
Specifically, patients claimed the company’s drugs Nexium (esomeprazole) and Prilosec (omeprazole) increased the risk of kidney damage.
Doucefleur/Shutterstock Which drugs are involved in Australia?
The class of drugs we’re talking about are “proton pump inhibitors” (sometimes called PPIs). In the case of the Australian potential class action, lawyers are investigating:
- Nexium (esomeprazole)
- Losec, Asimax (omeprazole)
- Somac (pantoprazole)
- Pariet (rabeprazole)
- Zoton (lansoprazole).
Depending on their strength and quantity, these medicines are available over-the-counter in pharmacies or by prescription.
They have been available in Australia for more than 20 years and are in the top ten medicines dispensed through the Pharmaceutical Benefits Scheme.
They are used to treat conditions exacerbated by stomach acid. These include heartburn, gastric reflux and indigestion. They work by blocking the protein responsible for pumping acid into the stomach.
These drugs are also prescribed with antibiotics to treat the bacterium Helicobacter pylori, which causes stomach ulcers and stomach cancer.
This class of drugs is also used with antibiotics to treat Helicobacter pylori infections. nobeastsofierce/Shutterstock What do we know about the risks?
Appropriate use of proton pump inhibitors plays an important role in treating several serious digestive problems. Like all medicines, there are risks associated with their use depending on how much and how long they are used.
When proton pump inhibitors are used appropriately for the short-term treatment of stomach problems, they are generally well tolerated, safe and effective.
Their risks are mostly associated with long-term use (using them for more than a year) due to the negative effects from having reduced levels of stomach acid. In elderly people, these include an increased risk of gut and respiratory tract infections, nutrient deficiencies and fractures. Long-term use of these drugs in elderly people has also been associated with an increased risk of dementia.
In children, there is an increased risk of serious infection associated with using these drugs, regardless of how long they are used.
How about the cancer and kidney risk?
Currently, the Australian consumer medicine information sheets that come with the medicines, like this one for esomeprazole, do not list stomach cancer or kidney injury as a risk associated with using proton pump inhibitors.
So what does the evidence say about the risk?
Over the past few years, there have been large studies based on observing people in the general population who have used proton pump inhibitors. These studies have found people who take them are almost two times more likely to develop stomach cancer and 1.7 times more likely to develop chronic kidney disease when compared with people who are not taking them.
In particular, these studies report that users of the drugs lansoprazole and pantoprazole have about a three to four times higher risk than non-users of developing chronic kidney disease.
While these observational studies show a link between using the drugs and these outcomes, we cannot say from this evidence that one causes the other.
Researchers have not yet shown these drugs cause kidney disease. crystal light/Shutterstock What can I do if I’m worried?
Several digestive conditions, especially reflux and heartburn, may benefit from simple dietary and lifestyle changes. But the overall evidence for these is not strong and how well they work varies between individuals.
But it may help to avoid large meals within two to three hours before bed, and reduce your intake of fatty food, alcohol and coffee. Eating slowly and getting your weight down if you are overweight may also help your symptoms.
There are also medications other than proton pump inhibitors that can be used for heartburn, reflux and stomach ulcers.
These include over-the-counter antacids (such as Gaviscon and Mylanta), which work by neutralising the acidic environment of the stomach.
Alternatives for prescription drugs include nizatidine and famotidine. These work by blocking histamine receptors in the stomach, which decreases stomach acid production.
If you are concerned about your use of proton pump inhibitors it is important to speak with your doctor or pharmacist before you stop using them. That’s because when you have been using them for a while, stopping them may result in increased or “rebound” acid production.
Nial Wheate, Professor and Director – Academic Excellence, Macquarie University; Joanna Harnett, Senior Lecturer – Sydney Pharmacy School, Faculty of Medicine and Health, University of Sydney, and Wai-Jo Jocelin Chan, Pharmacist and Associate Lecturer, University of Sydney
This article is republished from The Conversation under a Creative Commons license. Read the original article.
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Unfuck Your Brain – by Dr. Faith Harper
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This book takes a trauma-informed care approach, which is relatively novel in the mental health field and it’s quickly becoming the industry standard because of its effectiveness.
The basic premise of trauma-informed care is that you had a bad experience (possibly even more than one—what a thought!) and that things that remind you of that will tend to prompt reactivity from you in a way that probably isn’t healthy. By identifying each part of that process, we can then interrupt it, much like we might with CBT (the main difference being that CBT, for all its effectiveness, tends to assume that the things that are bothering you are not true, while TIC acknowledges that they might well be, and that especially historically, they probably were).
A word of warning: if something that triggers a trauma-based reactivity response in you is people swearing, then this book will either cure you by exposure therapy or leave you a nervous wreck, because it’s not just the title; Dr. Harper barely gets through a sentence without swearing. It’s a lot, even by this (European) reviewer’s standards (we’re a lot more relaxed about swearing over here, than people tend to be in America).
On the other hand, something that Dr. Harper excels at is actually explaining stuff very well. So while it sometimes seems like she’s “trying too hard” style-wise in terms of being “not like other therapists”, in her defence she’s nevertheless a very good writer; she knows her stuff, and knows how to communicate it clearly.
Bottom line: if you don’t mind a writer who swears more than 99% of soldiers, then this book is an excellent how-to guide for self-administered trauma-informed care.
Click here to check out Unfuck Your Brain, and indeed unfuck it!
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