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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Making Friends With Your Gut (You Can Thank Us Later)
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Gut Health 101
We have so many microorganisms inside us, that by cell count, their cells outnumber ours more than ten-to-one. By gene count, we have 23,000 and they have more than 3,000,000. In effect, we are more microbe than we are human. And, importantly: they form a critical part of what keeps our overall organism ticking on.
Read all about it: The role of the gut microbiota in nutrition and health
Our trillions of tiny friends keep us alive, so it really really pays to return the favor.
But how?
Probiotics and fermented foods
You probably guessed this one, but it’d be remiss not to mention it first. It’s no surprise that probiotics help; the clue is in the name. In short, they help add diversity to your microbiome (that’s a good thing).
Read from the NIH: Probiotics: What You Need To Know
As for fermented foods, not every fermented food will boost your microbiota, but great options include…
- Fermented vegetables (sauerkraut, pickles, etc)
- You’ll often hear kimchi mentioned; that is also pickled vegetables, usually mostly cabbage. It’s just the culinary experience that differs. Unlike sauerkraut, kimchi is usually spiced, for example.
- Kombucha (a fermented sweet tea)
- Miso & tempeh (different preparations of fermented soy)
The health benefits vary based on the individual strains of bacteria involved in the fermentation, so don’t get too caught up on which is best.
The best one is the one you enjoy, because then you’ll have it regularly!
Feed them plenty of prebiotic fibers
Those probiotics you took? The bacteria in them eat the fiber that you can’t digest without them. So, feed them those sorts of fibers.
Great options include:
- Bananas
- Garlic
- Onions
- Whole grains
Read more: Effects of Probiotics, Prebiotics, and Synbiotics on Human Health
Don’t feed them sugar and sweeteners
Sugar and (and, counterintuitively, aspartame) can cause unfortunate gut microbe imbalances. Put simply, they kill some of your friends and feed some of your enemies. For example…
Candida, which we all have in us to some degree, feeds on sugar (including the sugar formed from breaking down alcohol, by the way) and refined carbs. Then it grows, and puts its roots through your intestinal walls, linking with your neural system. Then it makes you crave the very things that will feed it and allow it to put bigger holes in your intestinal walls.
Do not feed the Candida.
Don’t believe us? Read: Candida albicans-Induced Epithelial Damage Mediates Translocation through Intestinal Barriers
(That’s scientist-speak for “Candida puts holes in your intestines, and stuff can then go through those holes”)
And as for how that comes about, it’s like we said:
❝Colonization of the intestine and translocation through the intestinal barrier are fundamental aspects of the processes preceding life-threatening systemic candidiasis. In this review, we discuss the commensal lifestyle of C. albicans in the intestine, the role of morphology for commensalism, the influence of diet, and the interactions with bacteria of the microbiota.❞
Source: Candida albicans as a commensal and opportunistic pathogen in the intestine
The usual five things
- Good diet (Mediterranean Diet is good; plant-based version of it is by far the best for this)
- Good exercise (yes, really)
- Good sleep (helps them, and they’ll help you get better sleep in return)
- Limit or eliminate alcohol consumption (what a shocker)
- Don’t smoke (it’s bad for everything, including gut health)
One last thing you should know:
If you’re used to having animal products in your diet, and make a sudden change to all plants, your gut will object very strongly. This is because your gut microbiome is used to animal products, and a plant-based diet will cause many helpful microbes to flourish in great abundance, and many less helpful microbes will starve and die. And they will make it officially Not Fun™ for you.
So, you have two options to consider:
- Do it anyway, and sit it out (and believe us, you’ll be sitting), get the change over with quickly, and enjoy the benefits and much happier gut that follows.
- Make the change gradual. Reduce portions of animal products slowly, have “Meatless Mondays” etc, and slowly make the change over. This—for most people—is pretty comfortable, easy, and effective.
And remember: the effects of these things we’ve talked about today compound when you do more than one of them, but if you don’t want to take probiotics or really hate kombucha or absolutely won’t consider a plant-based diet or struggle to give up sugar or alcohol, etc… Just do what you can do, and you’ll still have a net improvement!
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- Fermented vegetables (sauerkraut, pickles, etc)
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Breadfruit vs Custard Apple – Which is Healthier?
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Our Verdict
When comparing breadfruit to custard apple, we picked the breadfruit.
Why?
Today in “fruits pretending to be less healthy things than they are”, both are great, but one of these fruits just edges out the other in all categories. This is quite simple today:
In terms of macros, being fruits they’re both fairly high in carbs and fiber, however the carbs are close to equal and breadfruit has nearly 2x the fiber.
This also means that breadfruit has the lower glycemic index, but they’re both medium-low GI foods with a low insulin index.
When it comes to vitamins, breadfruit has more of vitamins B1, B3, B5, and C, while custard apple has more of vitamins A, B2, and B6. So, a 4:3 win for breadfruit.
In the category of minerals, breadfruit has more copper, magnesium, phosphorus, potassium, and zinc, while custard apple has more calcium and iron.
In short, enjoy both, but if you’re going just for one, breadfruit is the healthiest.
Want to learn more?
You might like to read:
Which Sugars Are Healthier, And Which Are Just The Same?
Take care!
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Hoisin Sauce vs Teriyaki Sauce – Which is Healthier?
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Our Verdict
When comparing hoisin sauce to teriyaki sauce, we picked the teriyaki sauce.
Why?
Neither are great! But spoonful for spoonful, the hoisin sauce has about 5x as much sugar.
Of course, exact amounts will vary by brand, but the hoisin will invariably be much more sugary than the teriyaki.
On the flipside, the teriyaki sauce may sometimes have slightly more salt, but they are usually in approximately the same ballpark of saltiness, so this is not a big deciding factor.
As a general rule of thumb, the first few ingredients will look like this for each, respectively:
Hoisin:
- Sugar
- Water
- Soybeans
Teriyaki:
- Soy sauce (water, soybeans, salt)
- Rice wine
- Sugar
In essence: hoisin is a soy-flavored syrup, while teriyaki is a sweetened soy sauce
Wondering about that rice wine? The alcohol content is negligible, sufficiently so that teriyaki sauce is not considered alcoholic. For health purposes, it is well under the 0.05% required to be considered alcohol-free.
For religious purposes, we are not your rabbi or imam, but to our best understanding, teriyaki sauce is generally considered kosher* (the rice wine being made from rice) and halal (the rice wine being de-alcoholized by the processing, making the sauce non-intoxicating).
Want to try some?
You can compare these examples side-by-side yourself:
Enjoy!
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How To Gain Weight (Healthily!)
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What Do You Have To Gain?
We have previously promised a three-part series about changing one’s weight:
- Losing weight (specifically, losing fat)
- Gaining weight (specifically, gaining muscle)
- Gaining weight (specifically, gaining fat)
There will be, however, no need for a “losing muscle” article, because (even though sometimes a person might have some reason to want to do this), it’s really just a case of “those things we said for gaining muscle? Don’t do those and the muscle will atrophy naturally”.
Here’s our first article: How To Lose Weight (Healthily!)
While some people will want to lose fat, please do be aware that the association between weight loss and good health is not nearly so strong as the weight loss industry would have you believe:
And, while BMI is not a useful measure of health in general, it’s worth noting that over the age of 65, a BMI of 27 (which is in the high end of “overweight”, without being obese) is associated with the lowest all-cause mortality:
BMI and all-cause mortality in older adults: a meta-analysis
Here was our second article: How To Build Muscle (Healthily!)
And now, it’s time for the last part, which yes, is also something that some people want/need to do (healthily!), and want/need help with that.
How to gain fat, healthily
Fat gets a bad press, but when it comes to health, we would die without it.
Even in the case of having excess fat, the fat itself is not generally the problem, so much as comorbid metabolic issues that are often caused by the same things as the excess fat.
So, how to gain fat healthily?
- Obvious but potentially dangerously misleading answer: “in moderation”
- More useful answer: “carefully”
Because, you can “in moderation” put on less than one pound per week for a few years and be in very bad health by the end of it. So how does this “carefully” work any differently to “in moderation”?
The key is in how we store the fat
Not merely where we store it (though that’ll follow from the “how”), but specifically: how we store it.
- When we consume energy from food in excess of our immediate survival needs, our body stores what it can. This is good!
- When our body is receiving energy from food faster than it can physically process it to store it healthily, it will start shoving it wherever it can instead. This is bad!
This is the physiological equivalent of the difference between tidying a room carefully, and cramming everything into one cupboard in 30 seconds just to get it out of sight.
So, you do need to consume calories yes, but you need to consume them in a way your body can take its time about storing them.
We’ve written before about the science of this, so we’ll share some links, but first, here are the practical tips:
- Do not drink your calories. Drinking calories tends to be the equivalent of injecting sugars directly into your veins, in terms of how quickly it gets received.
- See also: How To Unfatty A Fatty Liver ← this is highly relevant, because the same process that results in unhealthy weight gain, results in liver disease, by the same mechanism (the liver gets overwhelmed).
- Eat your greens. No, they won’t provide many calories, but they are critical to your body not being overwhelmed by the arrival of sugars.
- See also: 10 Ways To Balance Blood Sugars ← the other 9 things are also helpful for not putting on fat unhealthily, so using these alongside a calorie-dense diet can result in healthy fat gain as needed
- Get more of your calories from fats than carbs. Fats will not overwhelm your body’s glycemic response in the same way that carbs will.
- Again this is about getting calories while not getting metabolic disease. See also: How To Prevent And Reverse Type Two Diabetes as the advice is the same for that, for the same reason!
- Consider going low-carb, but even if you choose not to, go for carbs with a low glycemic index instead of a high glycemic index.
- For reference, see: Glycemic Index Chart: Glycemic index and glycemic load ratings for 500+ foods
- Need healthy fats in a snack? Enjoy nuts (unless you have an allergy); they will be your best friend in this regard. As an example, a mere 1oz portion of cashew nuts has 157 calories.
- See also: Why You Should Diversify Your Nuts
- Need healthy fats for cooking? Enjoy olive oil, as it has one of the healthiest lipids profiles available, and is a great way to increase the calorific content of many meals.
Lastly…
Be patient, enjoy your food, and stick as best you can to the above considerations. All strength to you.
Take care!
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Melatonin: A Safe, Natural Sleep Aid?
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Melatonin: A safe sleep supplement?
Melatonin is a hormone normally made in our pineal gland. It helps regulate our circadian rhythm, by making us sleepy.
It has other roles too—it has a part to play in regulating immune function, something that also waxes and wanes as a typical day goes by.
Additionally, since melatonin and cortisol are antagonistic to each other, a sudden increase in either will decrease the other. Our brain takes advantage of this, by giving us a cortisol spike in the morning to help us wake up.
As a supplement, it’s generally enjoyed with the intention of inducing healthy, natural, restorative sleep.
Does it really induce healthy, natural, restorative, sleep?
Yes! Well, “natural” is a little subject and relative, if you’re taking it as a supplement, but it’s something your body produces naturally anyway.
Contrast with, for example, benzodiazepines (that whole family of medications with names ending in -azopan or -alozam), or other tranquilizing drugs that do not so much induce healthy sleep, but rather reduce your brain function and hopefully knock you out, and/but often have unwanted side effects, and a tendency to create dependency.
Melatonin, unlike most of those drugs, does not create dependency, and furthermore, we don’t develop tolerance to it. In other words, the same dose will continue working (we won’t need more and more).
In terms of benefits, melatonin not only reduces the time to fall asleep and increases total sleep time, but also (quite a bonus) improves sleep quality, too:
Meta-Analysis: Melatonin for the Treatment of Primary Sleep Disorders
Because it is a natural hormone rather than a drug with many side effects and interactions, it’s also beneficial for those who need good sleep and/but don’t want tranquilizing:
Any other benefits?
Yes! It can also help guard against Seasonal Affective Disorder, also called seasonal depression. Because SAD is not just about “not enough light = not enough serotonin”, but also partly about circadian rhythm and (the body is not so sure what time of day it is when there are long hours of darkness, or even, in the other hemisphere / other time of year, long hours of daylight), melatonin can help, by giving your brain something to “anchor” onto, provided you take it at the same time each day. See:
- Is seasonal affective disorder a disorder of circadian rhythms?
- The circadian basis of winter depression: the case for low-dose melatonin use
As a small bonus, melatonin also promotes HGH production (important for maintaining bone and muscle mass, especially in later life):
Anything we should worry about?
Assuming taking a recommended dose only (0.5mg–10mg per day), toxicity is highly unlikely, especially given that it has a half-life of only 40–60 minutes, so it’ll be eliminated quite quickly.
However! It does indeed induce sleepiness, so for example, don’t take melatonin and then try to drive or operate heavy machinery—or, ideally, do anything other than go to bed.
It can interfere with some medications. We mentioned that melatonin helps regulate immune function, so for example that’s something to bear in mind if you’re on immunosuppressants or otherwise have an autoimmune disorder. It can also interfere with blood pressure medications and blood thinners, and may make epilepsy meds less effective.
As ever, if in doubt, please speak with your doctor and/or pharmacist.
Where to get it?
As ever, we don’t sell it (or anything else), but for your convenience, here is an example product on Amazon.
Enjoy!
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How White Is Your Tongue?
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It’s Q&A Day at 10almonds!
Have a question or a request? We love to hear from you!
In cases where we’ve already covered something, we might link to what we wrote before, but will always be happy to revisit any of our topics again in the future too—there’s always more to say!
As ever: if the question/request can be answered briefly, we’ll do it here in our Q&A Thursday edition. If not, we’ll make a main feature of it shortly afterwards!
So, no question/request too big or small
❝So its normal to develop a white sort of coating on the tongue, right? It develops when I eat, and is able to (somewhat) easily be brushed off❞
If (and only if) there is no soreness and the coverage of the whiteness is not extreme, then, yes, that is normal and fine.
Your mouth has a microbiome, and it’s supposed to have one (helps keep the conditions in your mouth correct, so that food is broken down and/but your gums and teeth aren’t).
Read more: The oral microbiome: Role of key organisms and complex networks in oral health and disease
The whiteness you often see on a healthy tongue is, for the most part, bacteria and dead cells—harmless.
Cleaning the whiteness off with your brush is fine. You can also scrape off with floss is similar if you prefer. Or a tongue-scraper! Those can be especially good for people for whom brushing the tongue is an unpleasant sensation. Or you can just leave it, if it doesn’t bother you.
By the way, that microbiome is a reason it can be good to go easy on the mouthwash. Moderate use of mouthwash is usually fine, but you don’t want to wipe out your microbiome then have it taken over by unpleasantries that the mouthwash didn’t kill (unpleasantries like C. albicans).
There are other mouthwash-related considerations too:
Toothpastes and mouthwashes: which kinds help, and which kinds harm?
If you start to get soreness, that probably means the papillae (little villi-like things) are inflamed. If there is soreness, and/or the whiteness is extreme, then it could be a fungal infection (usually C. albicans, also called Thrush), in which case, antifungal medications will be needed, which you can probably get over the counter from your pharmacist.
Do not try to self-treat with antibiotics.
Antibiotics will make a fungal infection worse (indeed, antibiotic usage is often the reason for getting fungal growth in the first place) by wiping out the bacteria that normally keep it in check.
Other risk factors include a sugary diet, smoking, and medications that have “dry mouth” as a side effect.
Read more: Can oral thrush be prevented?
If you have any symptoms more exciting than the above, then definitely see a doctor.
Take care!
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