Courts seek to fairly and expeditiously resolve allegations of crime and impose a fair and just rehabilitative sentence on the guilty. Municipal courts are commonly viewed as “traffic courts” handing out fines for traffic and other minor violations as a way of encouraging compliance with the law.
While this is true of all municipal courts in general, the Kansas City Municipal Court has evolved into a role that is far more complex. As an inner-city court, it has become the default venue for dealing with complex behavioral health and substance use problems of offenders. These problems are often compounded by other difficult circumstances: chronic physical health issues, homelessness and no support of family and friends. In short, the court grapples with some of the most difficult cases of mental health and substance use disorders among a largely invisible population.
Grappling with these complex social problems cannot be done in a vacuum. The court has developed close working relationships with the behavioral health, substance use treatment, and emergency and transitional living communities. These and other partners have shown an impressive willingness to work with us for good reason. By complementing one another, each becomes more effective at bringing about lasting change. By working together, each can effectively monitor the individual’s progress in recovery jointly tracking any relapses.
Of course, not all people with mental health and substance use disorders have contact with emergency services or end up in jail; but some do. In fact, just a few “high-needs” individuals utilize tremendous resources. For example, the Fire Department’s ambulance service reports that the top 50 ambulance users in 2013 required 2,155 ambulance runs, with the top user receiving 127 runs. The cost: $1.76 million.And this was only the cost of ambulance service.
When the costs of other emergency services are factored in, including police, hospitals and jail, one can easily see how a small population with complex needs costs millions of tax dollars. However, when courts work cooperatively with community partners, stabilizing and tracking high users of emergency services, citizens with complex problems get the care and treatment they need and deserve.
The result is less money spent on police and ambulance runs, jails and hospital emergency rooms. While more money must be spent on behavioral health and substance treatment, the “service improvement” in better police and ambulance response times, and the appropriate use of hospital emergency rooms and jails cannot be denied.
We strive to help people with very complex needs, but we must do better. For example, police and ambulance services need a facility to transport a citizen with behavioral health or substance use emergencies that is not a jail or hospital, quickly putting emergency personnel back in service. A specialized facility, such as a crisis center, designed to triage people in distress is required. Cities such as San Antonio, Houston, and Seattle have such a facility, and Kansas has just funded the creation of such a facility for Johnson and Wyandotte counties.
A crisis center would stabilize the patient, perform mental health and substance use assessments, and make referrals to appropriate case management and treatment. Connecting individuals in crisis, who may also have shelter, medical and physical health needs, with community resources makes sense. Meanwhile, the court can track chronic offenders to assure they stay on track and, potentially, become productive taxpaying citizens.