News Track: ‘Challenging, rewarding’ first year of Johnson County mental health court

The Johnson County Attorney’s Office and the Abbe Center for Community Mental Health in Iowa City last May started the first civil mental health court in the state, which monitors mental health outpatients and connects them with treatment and care to help them live independently.

The two-year pilot program is similar to other “assisted outpatient treatment” programs elsewhere that provide advocates and mental health professional teams to assist the participants. The civil court is based on many other models in different states.

A working group to establish the Iowa City program started researching and planning for the court in 2019. Assistant Johnson County Attorney Lynn Rose told The Gazette last year this specialty court provides guidance and support to help participants stay out of a hospital or jail and remain on their own in the community.

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Iowa has 39 other specialty courts that set up treatment teams for participants. But those individuals have committed criminal acts and are sent to a drug, operating while intoxicated, domestic abuse, veterans or mental health — limited to four Northwest counties — court, instead of prison.

“Typically, when people are released from hospitalization, they are given medications to help manage their mental health symptoms. But some, because of those issues, don’t properly take the medications and may not complete follow-up treatments,” Rose said. “The court will fill this gap.”

Participants for the program are outpatients who have a primary diagnosis of a mental illness. This court doesn’t accept individuals with previous criminal charges or convictions.

Don Schroeder, an Iowa City lawyer, was hired in March 2023 as the judicial hospitalization referee, or judge of the court. The court start taking referrals in May 2023. The participants started attending court once a week and a team of providers were responsible for helping them maintain medication regimens, appointments for treatment and access to other community services.

Rose previously said the weekly court helps track their progress and adjustments can be made before there is an issue. Most remain in court for 15 to 18 months.

The team of providers includes the University of Iowa Hospitals and Clinics, Iowa City VA Hospital, Abbe Center, GuideLink Center, National Alliance on Mental Illness, Shelter House and several mental health service agencies in the county.

The Mental Health/Disability Services of the East Central Region; the national Treatment Advocacy Center nonprofit; Johnson County Sheriff’s Office; and the Iowa Judicial Branch also support the pilot program.

The court sessions don’t take place in the courthouse. They are held in the Johnson County Health and Human Services building instead.

What’s happened since

Rose said the program has been “challenging but rewarding” in its first year.

“We identified gaps in service for some of the clients, which is good because we were able to get them the services they need or at least start the process,” Rose said. “Many of our participants needed assistance enrolling in Medicaid, which is something we learned was an issue.”

Rose said the case managers with other agencies are overrun and don’t always have enough time to deal with the complicated Medicaid paperwork. Eventually, the court would like to have a full-time licensed social worker who could help with that paperwork and also handle insurance issues for the participants.

The court started out slow but has had 12 participants since May 2023, which is what was anticipated, Rose said. There are seven participants still in the program and five have been discharged. Unfortunately, the five weren’t all successful, she said.

One person did graduate successfully and is living independently in the community. The graduates continue to receive aftercare and there is a “community team,” which includes service providers from the Abbe Center and the UIHC.

Two other participants will graduate in the next two or three months, Rose said. And two participants were discharged and ineligible because they received jail sentences.

Rose said, overall, the court had 28 referrals for the program. UIHC referred 12 with five of them admitted; five from the Jail Diversion Program with three admitted; four from Abbe Center Integrated Home Health with all admitted; four from the Chatham Oaks residential care facility with one admitted; and three from other providers with one admitted.

About 90 percent of the participants have mental health diagnoses and a substance use issue, Rose said. The most success in this type of mental health court or assisted outpatient treatment are individuals diagnosed with schizophrenia, bi-polar disorder or depressive disorders that lead to psychosis and psychosis.

Although the court does not accept people with previous criminal charges, participants already in the program could face charges related to actions because of their mental illness. Rose said the hospitalization and jail outcomes for participants have been reduced — which shows the positive impact of the program.

The number of psychiatric hospitalizations for each of the participants have decreased by 81 percent, according to court data. Before they joined court, those were 129 and dropped to 24 after joining the program.

The total number of jail days dropped from 18 before the court to seven while in the program, the data shows.

Rose said other counties and mental health regions in Iowa are interested in starting up their own mental health courts using Johnson County’s assisted outpatient treatment model. But Rose said the Johnson County court is concerned about future funding.

It is funded by the East Central Iowa Mental Health Region through June 30, 2025. After that, the mental health regions could be changing under a proposal in the Legislature, House File 2673, and she doesn’t know what will happen with that change.

“We are looking for more ways to work with the jail to identify potential individuals that would benefit from participation in the mental health court,” Rose said.

Comments: (319) 398-8318; trish.mehaffey@thegazette.com