In early December, Donald Brown stood nervously within the Corridor County Courthouse, involved he’d be despatched again to jail.

The 55-year-old struggles with melancholy, dependancy, and suicidal ideas. He anxious a decide would terminate him from a particular diversion program meant to maintain folks with psychological sickness from being incarcerated. He was failing to maintain up with this system’s onerous work and group service necessities.

“I am type of scared. I really feel type of defeated,” Brown mentioned.

Final yr, Brown threatened to take his life with a gun and his household known as 911 in search of assist, he mentioned. The police arrived, and Brown was arrested and charged with a felony of firearm possession.

After months in jail, Brown was supplied entry to the Well being Empowerment Linkage and Prospects, or HELP, Courtroom. If he pleaded responsible, he’d be related to companies and keep away from jail time. But when he did not full this system, he’d probably face incarceration.

“It is nearly like coercion,” Brown mentioned. “‘Right here, signal these papers and get out of jail.’ I really feel like I may have been handled rather a lot higher.”

Advocates, attorneys, clinicians, and researchers mentioned courts such because the one Brown is navigating can battle to stay as much as their promise. The diversion applications, they mentioned, are sometimes costly and resource-intensive, and serve fewer than 1% of the greater than 2 million individuals who have a severe psychological sickness and are booked into U.S. jails annually.

Folks can really feel pressured to take plea offers and enter the courts, seeing the applications as the one path to get care or keep away from jail time. The courts are selective, due partly to political pressures on elected judges and prosecutors. Members should typically meet strict necessities that critics say aren’t treatment-focused, similar to common hearings and drug screenings.

And there’s a lack of conclusive proof on whether or not the courts assist contributors long-term. Some authorized specialists, like Lea Johnston, a professor of legislation on the College of Florida, fear the applications distract from extra significant investments in psychological well being assets.

Jails and prisons should not the place for people with psychological problems, she mentioned. “However I’m additionally unsure that psychological well being court docket is the answer.”

The nation’s first psychological well being court docket was established in Broward County, Florida, in 1997, “as a approach to promote restoration and psychological well being wellness and keep away from criminalizing psychological well being issues.” The mannequin was replicated with tens of millions in funding from such federal companies because the Substance Abuse and Psychological Well being Companies Administration and the Division of Justice.

Greater than 650 grownup and juvenile psychological well being courts have been operational as of 2022, in response to the Nationwide Remedy Courtroom Useful resource Middle. There is no set approach to run them. Usually, contributors obtain therapy plans and get linked to companies. Judges and psychological well being clinicians oversee their progress.

Researchers from the middle discovered little proof that the courts enhance contributors’ psychological well being or preserve them out of the prison justice system. “Few research … assess longer-term impacts” of the applications “past one yr after program exit,” mentioned a 2022 coverage temporary on psychological well being courts.

The courts work finest when paired with investments in companies similar to medical therapy, restoration applications, and housing and employment alternatives, mentioned Kristen DeVall, the middle’s co-director.

“If all of those different helps aren’t invested in, then it is type of a wash,” she mentioned.

The courts needs to be seen as “one intervention in that bigger system,” DeVall mentioned, not “the one useful resource to serve people with psychological well being wants” who get caught up within the prison justice system.

Useful resource limitations can even improve the pressures to use for psychological well being court docket applications, mentioned Lisa M. Wayne, govt director of the Nationwide Affiliation of Legal Protection Legal professionals. Folks in search of assist may not really feel they’ve alternate options.

“It’s not going to be individuals who can afford psychological well being intervention. It’s poor folks, marginalized people,” she mentioned.

Different court docket skeptics surprise concerning the bigger prices of the applications.

In a examine of a psychological well being court docket in Pennsylvania, Johnston and a College of Florida colleague discovered contributors have been sentenced to longer time below authorities supervision than in the event that they’d gone via the common prison justice system.

“The larger downside is that they’re taking consideration away from extra necessary options that we needs to be investing in, like group psychological well being care,” Johnston mentioned.

When Melissa Vergara’s oldest son, Mychael Difrancisco, was arrested on felony gun prices in Queens in Could 2021, she thought he can be a super candidate for the New York Metropolis borough’s psychological well being court docket due to his analysis of autism spectrum dysfunction and different behavioral well being situations.

She estimated she spent tens of 1000’s of {dollars} to organize Difrancisco’s case for consideration. In the meantime, her son sat in jail on Rikers Island, the place she mentioned he was assaulted a number of instances and needed to get half a finger amputated after it was caught in a cell door.

Ultimately, his case was denied diversion into psychological well being court docket. Difrancisco, 22, is serving a jail sentence that could possibly be so long as 4 years and 6 months.

“There’s no actual urgency to assist folks with psychological well being struggles,” Vergara mentioned.

Critics fear such excessive bars to entry can lead the applications to exclude individuals who may benefit probably the most. Some courts do not permit these accused of violent or sexual crimes to take part. Prosecutors and judges can face strain from constituents that will make them block people accused of high-profile offenses.

And judges typically aren’t educated to make selections about contributors’ care, mentioned Raji Edayathumangalam, senior coverage social employee with New York County Defender Companies.

“It’s inappropriate,” she mentioned. “We’re all licensed to apply in our totally different professions for a cause. I can’t present as much as do a hernia operation simply because I examine it or sat subsequent to a hernia surgeon.”

Psychological well being courts could be overly targeted on necessities similar to drug testing, remedy compliance, and finishing workbook assignments, somewhat than progress towards restoration and medical enchancment, Edayathumangalam mentioned.

Finishing the applications can depart some contributors with clear prison data. However failing to fulfill a program’s necessities can set off penalties — together with incarceration.

Throughout a current listening to within the Clayton County Behavioral Well being Accountability Courtroom in suburban Atlanta, one girl left the courtroom in tears when Decide Shana Rooks Malone ordered her to report back to jail for a seven-day keep for “being dishonest” about whether or not she was taking court-required remedy.

It was her sixth infraction in this system — earlier penalties included written assignments and “bench responsibility,” wherein contributors should sit and take into consideration their participation in this system.

“I don’t prefer to incarcerate,” Malone mentioned. “That exact participant has had some challenges. I’m rooting for her. However all of the smaller penalties haven’t labored.”

Nonetheless, different contributors praised Malone and her program. And, generally, some say such diversion applications present a much-needed lifeline.

Michael Passion, 32, of Gainesville was hooked on heroin and fentanyl when he was arrested for drug possession in August 2021. After entry into the HELP Courtroom program, he acquired sober, began taking remedy for anxiousness and melancholy, and constructed a secure life.

“I did not know the place to succeed in out for assist,” he mentioned. “I acquired put in handcuffs, and it saved my life.”

Whilst Donald Brown awaited his destiny, he mentioned he had began taking remedy to handle his melancholy and has stayed sober due to HELP Courtroom.

“I’ve realized a brand new lifestyle. As an alternative of getting excessive, I am studying to really feel issues now,” he mentioned.

Brown averted jail that early December day. A listening to to resolve his destiny may occur within the subsequent few weeks. However even when he is allowed to stay in this system, Brown mentioned, he is anxious it is solely a matter of time earlier than he falls out of compliance.

“To attempt to enhance myself and get locked up for it’s only a kick within the intestine,” he mentioned. “I attempted actually arduous.”

KFF Well being Information senior correspondent Fred Clasen-Kelly contributed to this report.