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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Black Coffee vs Orange Juice – Which is Healthier?
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Our Verdict
When comparing black coffee to orange juice, we picked the coffee.
Why?
While this one isn’t a very like-for-like choice, it’s a choice often made, so it bears examining.
In favor of the orange juice, it has vitamins A and C and the mineral potassium, while the coffee contains no vitamins or minerals beyond trace amounts.
However, to offset that: drinking juice is one of the worst ways to consume sugar; the fruit has not only been stripped of its fiber, but also is in its most readily absorbable state (liquid), meaning that this is going to cause a blood sugar spike, which if done often can lead to insulin resistance, type 2 diabetes, non-alcoholic fatty liver disease, and more. Now, the occasional glass of orange juice (and resultant blood sugar spike) isn’t going to cause disease by itself, but everything we consume tips the scales of our health towards wellness or illness (or sometimes both, in different ways), and in this case, juice has a rather major downside that ought not be ignored.
In favor of the coffee, it has a lot of beneficial phytochemicals (mostly antioxidant polyphenols of various kinds), with no drawbacks worth mentioning unless you have a pre-existing condition of some kind.
Coffee can of course be caffeinated or decaffeinated, and we didn’t specify which here. Caffeine has some pros and cons that at worst, balance each other out, and whether or not it’s caffeinated, there’s nothing in coffee to offset the beneficial qualities of the antioxidants we mentioned before.
Obviously, in either case we are assuming consuming in moderation.
In short:
- orange juice has negatives that at least equal, if not outweigh, its positives
- coffee‘s benefits outweigh any drawbacks for most people
Want to learn more?
You might like to read:
- The Bitter Truth About Coffee (or is it?)
- Caffeine: Cognitive Enhancer Or Brain-Wrecker?
- Which Sugars Are Healthier, And Which Are Just The Same?
Take care!
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Sprout Your Seeds, Grains, Beans, Etc
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Good Things Come In Small Packages
“Sprouting” grains and seeds—that is, allowing them to germinate and begin to grow—enhances their nutritional qualities, boosting their available vitamins, minerals, amino acids, and even antioxidants.
You may be thinking: surely whatever nutrients are in there, are in there already; how can it be increased?
Well, the grand sweeping miracle of life itself is beyond the scope of what we have room to cover today, but in few words: there are processes that allow plants to transform stuff into other stuff, and that is part of what is happening.
Additionally, in the cases of some nutrients, they were there already, but the sprouting process allows them to become more available to us. Think about the later example of how it’s easier to eat and digest a ripe fruit than an unripe one, and now scale that back to a seed and a sprouted seed.
A third way that sprouting benefits us is by reducing“antinutrients”, such as phytic acid.
Let’s drop a few examples of the “what”, before we press on to the “how”:
- Enhancement of attributes of cereals by germination and fermentation: a review
- Sprouting characteristics and associated changes in nutritional composition of cowpea (Vigna unguiculata)
- Phytic acid, in vitro protein digestibility, dietary fiber, and minerals of pulses as influenced by processing methods
- Effects of germination on the nutritional properties, phenolic profiles, and antioxidant activities of buckwheat
- Effect of several germination treatments on phosphatases activities and degradation of phytate in faba bean (Vicia faba L.) and azuki bean (Vigna angularis L.)
Sounds great! How do we do it?
First, take the seeds, grains, nuts, beans, etc that you’re going to sprout. Fine examples to try for a first sprouting session include:
- Grains: buckwheat, brown rice, quinoa
- Legumes: soy beans, black beans, kidney beans
- Greens: broccoli, mustard greens, radish
- Nuts/seeds: almonds, pumpkin seeds, chia seeds
Note: whatever you use should be as unprocessed as possible to start with:
- On the one hand, you’d be surprised how often “life finds a way” when it comes to sprouting ridiculous choices
- On the other hand, it’s usually easier if you’re not trying to sprout blanched almonds, split lentils, rolled oats, or toasted hulled buckwheat.
Second, you will need clean water, a jar with a lid, muslin cloth or similar, and a rubber band.
Next, take an amount of the plants you’ll be sprouting. Let’s say beans of some kind. Try it with ¼ cup to start with; you can do bigger batches once you’re more confident of your setup and the process.
Rinse and soak them for at least 24 hours. Take care to add more water than it looks like you’ll need, because those beans are thirsty, and sprouting is thirsty work.
Drain, rinse, and put them in a clean glass jar, covering with just the muslin cloth in place of the lid, held in place by the rubber band. No extra water in it this time, and you’re going to be storing the jar upside down (with ventilation underneath, so for example on some sort of wire rack is ideal) in a dark moderately warm place (e.g. 80℉ / 25℃ is often ideal, but it doesn’t have to be exact, you have wiggle-room, and some things will enjoy a few degrees cooler or warmer than that)
Each day, rinse and replace until you see that they are sprouting. When they’re sprouting, they’re ready to eat!
Unless you want to grow a whole plant, in which case, go for it (we recommend looking for a gardening guide in that case).
But watch out!
That 80℉ / 25℃ temperature at which our sprouting seeds, beans, grains etc thrive? There are other things that thrive at that temperature too! Things like:
- E. coli
- Salmonella
- Listeria
…amongst others.
So, some things to keep you safe:
- If it looks or smells bad, throw it out
- If in doubt, throw it out
- Even if it looks perfect, blanch it (by boiling it in water for 30 seconds, before rinsing it in cold water to take it back to a colder temperature) before eating it or refrigerating it for later.
- When you come back to get it from the fridge, see once again points 1 and 2 above.
- Ideally you should enjoy sprouted things within 5 days.
Want to know more about sprouting?
You’ll love this book that we reviewed recently:
The Sprout Book – by Doug Evans
Enjoy!
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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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The Longevity Code – by Dr. Kris Verburgh
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Notwithstanding the subtitle claim of “secrets from the leading edge of science”, we’ll note up front that this book was published in 2015, and what was new then, isn’t now. However, what was new then is still important now, so we think the book merits attention just the same.
The book examines why certain creatures (like humans) seem programmed to grow old and die, and why others (few others, but enough to make a list) either simply do not age, or else do age but can become younger when they hit a certain point. If this is the first you’re hearing of biologically immortal creatures, we’ll mention: they can and do die, just, their cause of death is usually by being eaten. But on a cellular and structural level, they don’t age. They grow to maturity and then just stay that way until one day they get eaten (or fall to some similar external circumstance).
Tackling the question of “why do we age?” (not as a philosophical question, but rather as an engineering question) is important to tackle the critical question of “…and could we not?”, and that’s what much of this book is about.
The real reason that compared to other mammals, humans live (for example) slightly longer than bats but not as long as naked mole rats, comes down mostly to genes, which makes it sound like things are set in stone, but rather, even without outright gene-editing technologies like CRISPR, gene expression is often quite modifiable, and often modifiable not just by drugs, but also by supplements, and indeed by nutraceuticals, which means also by diet, plus diet-adjacent things like fasting.
While this is mostly an explanatory book rather than a how-to, there’s enough to make practical use of, and even a recipes section.
The style is very gripping pop-science—or at least, if you’re anything like this reviewer, you’ll find it a page-turner. While being light on citations as we go (not like some authors who will mark several citations per page, or in the extreme, for every declarative sentence made), there is a reassuring bibliography at the back.
Bottom line: if you’re interested in the “under the hood” of aging, then you will love this book.
Click here to check out The Longevity Code, and slow down the aging process to live well for longer!
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The How Not to Die Cookbook – by Dr. Michael Greger
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We’ve previously reviewed Dr. Greger’s “How Not To Die”, which is excellent and/but very science-dense.
This book is different, in that the science is referenced and explained throughout, but the focus is the recipes, and how to prepare delicious healthy food in accordance with the principles laid out in How Not To Die.
It also follows “Dr Greger’s Daily Dozen“, that is to say, the 12 specific things he advises we make sure to have every day, and thus helps us to include them in an easy, no-fuss fashion.
The recipes themselves are by Robin Robertson, and/but with plenty of notes by Dr Greger; they clearly collaborated closely in creating them.
The ingredients are all things one can find in any well-stocked supermarket, so unless you live in a food desert, you can make these things easily.
And yes, the foods are delicious too.
Bottom line: if you’re interested in cooking according to perhaps the most science-based dietary system out there, then this book is a top-tier choice.
Click here to check out The How Not To Die Cookbook, and live well!
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Anti-Inflammatory Cookbook for Beginners – by Melissa Jefferson
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For some of us, avoiding inflammatory food is a particularly important consideration. For all of us, it should be anyway.
Sometimes, we know what’s good against inflammation, and we know what’s bad for inflammation… but we might struggle to come up with full meals of just-the-good, especially if we want to not repeat meals every day!
The subtitle is slightly misleading! It says “Countless Easy and Delicious Recipes”, but this depends on your counting ability. Melissa Jefferson gives us 150 anti-inflammatory recipes, which can be combined for a 12-week meal plan. We think that’s enough to at least call it “many”, though.
First comes an introduction to inflammation, inflammatory diseases, and a general overview of what to eat / what to avoid. After that, the main part of the book is divided into sections:
- Breakfasts (20)
- Soups (15)
- Beans & Grains (20)
- Meat (20)
- Fish (20)
- Vegetables (20)
- Sides (15)
- Snacks (10)
- Desserts (10)
If you’ve a knowledge of anti-inflammation diet already, you may be wondering how “Meat” and “Desserts” works.
- The meat section is a matter of going light on the meat and generally favoring white meats, and certainly unprocessed.
- Of course, if you are vegetarian or vegan, substitutions may be in order anyway.
As for the dessert section? A key factor is that fruits and chocolate are anti-inflammatory foods! Just a matter of not having desserts full of sugar, flour, etc.
The recipes themselves are simple and to-the-point, with ingredients, method, and nutritional values. Just the way we like it.
All in all, a fine addition to absolutely anyone’s kitchen library… And doubly so if you have a particular reason to focus on avoiding/reducing inflammation!
Get your copy of “Anti-Inflammatory Cookbook for Beginners” from Amazon today!
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