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A New Model of Forensic Mental Health Care

When facing certain mental health symptoms or intellectual disabilities, some people aren’t capable of standing trial.

A Community-Based Pilot Program Helps Patients Receive Fair Trials 

To support individuals who may not understand the legal process, or the charges brought against them, there is a program called capacity restoration. Forensic psychiatrists, therapists and forensic navigators work with patients to assess their mental health and to help them understand their legal situation and the court system. This program, like so many others, has become overburdened in recent years. In North Carolina, only three state hospitals offer capacity resolution. Until a spot opens at one of these hospitals, a patient may wait for months for their turn – and many of them wait in a jail, even if they do not represent a threat and would otherwise be released on bond.

A pilot program involving Atrium Health offers another solution. In addition to a jail-based or a hospital-based capacity restoration program, this is a community-based program. It creates a much-needed option for people who have no reason to be incarcerated and for those who don’t meet the criteria for full-time hospitalization. Instead of these patients spending unnecessary months waiting in a jail or hospital, they enter an outpatient program with a high level of services. 

“Our vision is to offer a comprehensive community program to reduce the need for unnecessary incarceration for defendants who are not dangerous and would otherwise be on bond and to offer high-quality mental health services,” says Dr. Sherif Soliman, a forensic psychiatrist at Atrium Health Behavioral Health Charlotte, who’s leading Atrium Health’s involvement in this program and has worked in this field for 17 years. “We will also link these patients to long-term care, even after their legal situation resolves.”

The program is a collaboration between Atrium Health, the North Carolina Department of Health and Human Services, Alliance Health, as well as the district attorney, judges and the public defender’s office of Mecklenburg County. It’s a unique service for a vulnerable population, as people with mental health challenges are much more likely to be victims of violence than the perpetrators of violence. Instead of being unnecessarily held in jail while they await treatment and their trial, this program allows them to spend the time receiving services in the community.

“This really has the potential to change how forensic mental health care is delivered in North Carolina,” Soliman adds.

How Community-Based Capacity Restoration Works

For four or five days a week, patients in this pilot program visit a clinic to attend groups and work with therapists and forensic psychiatrists who help them understand their legal situation and their charges. Forensic psychiatry is a medical subspecialty that focuses on the many areas in which psychiatry intersects with the law. To become board certified, forensic psychiatrists must complete a year-long fellowship and exam that explores the overlapping area between mental health and the law.

This pilot program includes capacity restoration and recovery support including education centered around basic legal concepts, pharmacotherapy, groups, individual educational sessions and additional services tailored to the needs of each patient.

“We are a perfect fit to be part of this program because Atrium Health already provides a robust array of behavioral health services,” Soliman says. “We also have a number of board-certified forensic psychiatrists on staff which puts us in  an unique position. We can offer both the forensic and legal services, as well as the clinical services of psychiatric stabilization, housing support and other therapies, depending on a patient’s need.”

To evaluate the effectiveness of this program, the partners behind it will collect data on patient safety, community safety and the rate of restoration. Existing literature of similar programs indicates that the restoration in a community setting is often decreased to about 45 days, compared to upwards of six months in a jail- or a hospital-based program.

A Potential for Big Change in North Carolina

This program, which is funded by a grant by Substance Abuse and Mental Health Services Administration, (SAMHSA) has the potential to change a decades-long shift in how mental health is delivered in North Carolina. The sharp decline in the availability of hospital beds, particularly in state hospitals from the 1960s to the present has correlated with an increase in the incarceration of people living with severe mental illness.  This program aims to provide services in the least restrictive environment, reducing the need for unnecessary civil commitment and unnecessary confinement in jail while waiting for inpatient beds.

“Our program is going to help decriminalize mental illness and give patients the help they need, rather than holding them in an environment designed to be a punishment rather than a treatment environment,” Soliman says.