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Over the past 10 years, competency restoration orders — court mandates issued when a defendant has been found unfit to stand trial — have increased by nearly 400% in courts across Indiana.
Competency restoration services, which are performed in state hospitals, are used to determine whether defendants understand the charges set against them and can participant in their defense.
But according to the Indiana Office of Behavioral Health’s Behavioral Health Committee, hospitals are overwhelmed with the orders, which delays court proceedings and prompts offenders to leave the system without receiving the proper treatment for mental and behavioral health issues.
Untreated mental health doesn’t just impact the individual, however. According to a 2022 report by the Indiana Behavioral Health Commission, untreated mental illness costs the state about $4 billion each year.
Armed with that information, the Indiana Supreme Court’s Office of Behavioral Health last month released the inaugural report of its Behavioral Health Committee, which examined how the state’s judicial officers can address issues of behavioral health directly in and through their courtrooms.
“We are not social workers, we’re not saying that we’re social workers, but how do we link people to community-based services so that they do not come back time, time, time again in crisis?” asked Indiana Supreme Court Chief Justice Loretta Rush.
Courts are often perceived as the “government emergency room,” acting as some of the first to see the worst situations of humanity, Rush told The Indiana Lawyer,.
An impassioned advocate for addressing behavioral health issues based on decades of experience in the legal profession, Rush and others with the office hope the committee’s report provides resources for the state’s judges to address critical problems with the help of community partners, state guidance and peer support.
Community need
The Behavioral Health Committee was established at the same time the Indiana Supreme Court’s Office of Behavioral Health was formed in May 2024. Its creation made Indiana the 10th state in the United States to create a formal infrastructure to address courts’ handling of behavioral health needs.
Now two years later, 24 states have offices or positions dedicated to addressing the topic, said Brittany Kelly, state court behavioral health administrator for the office and vice chair of the National Council of State Court Behavioral Health Administrators. Kelly helped staff the behavioral health committee in Indiana.
Indiana’s office was created as a direct result of Chief Justice Rush’s work both in Indiana courts and on federal task forces addressing the issue. In 2022, Rush served as president of the national Conference of Chief Justices, an organization bringing together the highest judicial officers in each state to exchange resources and ideas to “improve the administration of justice in the states, commonwealths and territories of the United States.”
While president, Rush co-chaired a work group for the conference’s National Judicial Task Force to Examine State Courts’ Response to Mental Illness. Together, the task force researched and identified recommendations to address several issues at the intersection of courts and mental illness on the national level.
With 98% of cases throughout the United States handled in state courts, Rush wanted to build a team that could identify and promote resources to help judicial officers address behavioral health challenges while ensuring justice is served.
“You don’t get a pass for behavior if you commit a crime because of substance abuse or something else,” she said “You’ve got dual roles as a judge. You know they’re going to get out at some point, and what can we do to make sure that recidivism goes down, that we’re not just a revolving door for this?”
From the time the office and the committee were established, the group met monthly to decide which information to include in the report.
Early on, the committee met together to discuss the most pressing issues facing Indiana’s judiciary with regard to behavioral health, Kelly said. That discussion informed how to divide the committee into separate work groups, which were tasked with identifying potential solutions to the most pressing issues in their group’s focus area.
While Kelly offered recommendations, “this is a report written by judges for judges,” she said.
Altogether, 17 judges from around the state make up the Behavioral Health Committee, representing fellow judicial officers from large counties such as Marion County to more rural communities, including Fountain and Jennings counties.
Rush ultimately chose which judges would be on the committee, prioritizing a range of counties to represent varying community interests.
“Different communities have different challenges, so I really wanted a cross section of the state,” Rush said. “If you’re seeking help in Indianapolis, it looks a lot different than if you’re seeking help out in Martin County.”
The recommendations
Recommendations were made based on work groups in the areas of education, connection to treatment, competency, and data and funding.
The education work group identified behavioral health-focused educational resources for judges to practically use in their work on the bench.
The education work group came up with a four-pronged approach to behavioral health education. One approach the group suggests is incorporating behavioral health education in judicial training with an emphasis on scenario-based learning. The workgroup stresses that scenario-based learning allows judges to “engage with complex, realistic case examples, practice trauma-informed decision-making, and explore the broader consequences of their rulings on individuals and communities.”
Vanderburgh Superior Court Magistrate Judge Jill Marcrum, a member of the education work group, leads several initiatives focused on courts addressing mental health needs in the community. Judge Marcrum helped establish the county’s crisis intervention team in 2008 and the mental health court in 2013.
Mental health, however, touches every court, Marcrum said.
“Because of their mental illness, they’ve decompensated, so they’re not paying their rent as they’re supposed to,” she said. “That’s why they commit crimes. That’s why they’re having problems in their marriage or with significant others and their children. I just really feel that until we start helping people address the mental illness in the community, we can’t really make a big difference.”
One reason Marcrum wanted to be a part of the education work group was to offer judges resources and guidelines to help them identify signs of mental illness in offenders.
In her experience, Marcrum said one of the best ways to begin addressing mental health needs is through active listening. While listening is not the entire solution, it’s part of it, and it’s important that judges establish that foundation prior to handling offenders with behavioral health challenges, she said.
“I think there are a lot of people who don’t understand mental illness, and I think sometimes it’s difficult for a judicial officer to know that someone has a mental illness,” Marcrum said.
The report lists several resources judges can use to glean a better understanding of the offenders they work with every day, including access to learning modules that address behavioral health.
Each of the work groups identified recommendations that can be reasonably acted upon. As the report’s introduction suggests, the report is “not intended to sit on a shelf” and should be put to use immediately, Kelly said.
What’s next
The report is just the beginning of the committee’s work to support the state’s judicial officers, Kelly told The Lawyer. At this spring’s judicial conference, members of the committee were able to present their recommendations to fellow judges during a breakout session focused on behavioral health.
“The spring judicial conference was a really good way to get judicial officers’ feedback,” Kelly said. “We’ve gotten a lot of positive feedback that this is really useful.”
The committee views the report as a foundation for the work to come, Kelly said, which includes hosting monthly webinars that dive into the workgroups’ recommendations.
Beyond the judiciary, Rush said the work the office is doing is meant to cross government branches. With the help of people like Kelly, the judiciary is able to work with the state’s executive and legislative branches to address these pressing issues.
“I’m just so proud of where our state is going and working together,” Rush said. “It’s impressive. I think we’re doing some of the best work in the country.”
The Behavioral Health Committee’s inaugural report is now available to judges and the general public at the Indiana Judicial Branch’s website under the Office of Behavioral Health.•
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