The Florida Bar

Florida Bar Journal

A Court of Refuge, Stories from the Bench of America’s First Mental Health Court

Book Reviews

by Judge Ginger Lerner-Wren with Rebecca A. Eckland

Image of A Court of RefugeThis skillfully crafted book is a page turner. Judge Ginger Lerner-Wren and co-writer Rebecca A. Eckland weave a wealth of information into gripping stories of real participants (defendants) (names and details altered to protect confidentiality) in the first mental health court in the U.S., located in Broward County.

We are drawn into the lives of Roger, Rosemarie, Beatrice, Larry, Margaret, and others as they suffer loss of self to untreated mental illness. Many become homeless; many attempt to ease their emotional pain by self-medicating with street drugs, only to make matters worse. Now, they have been arrested for a misdemeanor brought on by failure to conform to “normal” conduct. For those with families, we feel the anguish of parents, siblings, and spouses who shoulder the burdens of caring for mentally ill relatives. Most have struggled, unsuccessfully, to access scarce community mental health services for their disabled loved one.

This court, born from the activism of Broward County citizens, demonstrates an alternative to the criminalization of mental illness. It aims to break the cycle that fills court dockets, packs jails, exacerbates suffering, and produces loss of future wellbeing. The cycle: people with untreated mental illness sometimes cannot conduct themselves according to accepted norms. They are arrested, typically in the beginning with low-level misdemeanors like nuisance or possession of drug paraphernalia. Many deteriorate in jail while awaiting trial, unable to pay even a small bond. A significant number cannot comprehend why they are there. Incarceration is particularly dehumanizing for the mentally ill, many of whom suffer illness because of prior trauma. Incarceration re-traumatizes and exacerbates their illnesses; they are targets of victimization in jail. If convicted, they can face more jail time. Corrections officers sometimes interpret behavioral manifestations of illness as intentional misconduct; ill inmates are subjected to further sanctions. Upon release, the person is worse off. The cycle continues, and can escalate because deepening illness can trigger worse behavior.

In traditional criminal justice, those convicted take responsibility for their actions by undergoing punishment. In Broward’s mental health court, mentally ill participants who agree to participate take responsibility, but in a different way. They become the key players in their recovery, but with treatment and services that enable success. Participation is totally voluntary. Participants are not required to admit to wrongdoing, and can opt-out at any time. The court sets a welcoming, informal tone, infused with hope because mental illness is treatable. Guided by the theory and practices of therapeutic jurisprudence, the court strives to enable participants to regain dignity by giving them a voice, and the validation that comes from genuinely listening. Clinicians use each participant’s input to formulate a treatment plan and connect participants with appropriate treatment and services. Some participants are not successful and we share their pain along with the judge; many attain the lives they had hoped for.

Much is learned from the engrossing stories: the history and funding of mental health care; the criminalization of mental illness, and its self-perpetuating cycle. Readers learn of “sanism” that discriminates against people with mental illness. Despite gains in other subject matter, outright prejudice, and stigmatization can remain socially acceptable reactions to mental illness. Readers learn of false assumptions made by society and the legal system about people living with mental disabilities. Readers are introduced to therapeutic jurisprudence, an interdisciplinary field of philosophy and practice that examines the therapeutic and antitherapeutic properties of laws, public policies, and legal processes.

This court, designed by Judge Lerner-Wren in our Florida legal community, has become an exemplar throughout the U.S. and abroad. Even therapeutic jurisprudence has Florida roots, being co-founded by law professors Bruce J. Winick of the University of Miami, and David B. Wexler of the University of Arizona/University of Puerto Rico.

This good read is equally accessible to experts in mental health law and those new to the topic. It is a “must read” for practitioners and students in mental health law, social work, criminology, and psychology. Judge Lerner-Wren’s description of how therapeutic jurisprudence can be used productively in mainstream courts makes this an informative read for judges as well.

Carol L. Zeiner is a member of The Florida Bar, and a professor of law at St. Thomas University in Miami.