CHAPTER 12

The Power of Human Connection

In a court where the people who come before it are often living on the edge, our approach is to problem-solve one step at a time. After all, the last thing a healing court wants to do is add to the stress load of people who are already overwhelmed by life itself.

Pam Hendricks, the behavioral health coordinator for Broward Health, referred Kenneth Marks to the Broward County Mental Health Court. A former baseball player in the major leagues, Ken, twenty-three, had been arrested for disorderly conduct and trespassing for allegedly failing to obey a police officer’s order to leave a nightclub a week before. He had subsequently been diagnosed with schizophrenia by a psychiatrist at Broward Health. He was scheduled to appear in court this morning, along with his parents. I had no idea what to expect.

As I walked into the courtroom, I was relieved to learn that only a handful of cases were on the docket. I thought, the fewer people the better, since I did not want the courtroom to appear too intense or chaotic. I scanned the courtroom for Ken. He was not difficult to spot: young, athletic, and tanned from his hours of play and practice in the field, he sat alongside an older couple—his parents. Ms. Hendricks’s initial report indicated that the family was having a very difficult time handling the news of their son’s arrest and subsequent schizophrenia diagnosis. From the expressions on their faces to the way each seemed to cling tightly to the other, it was abundantly clear to me that the parents were in shock and in deep emotional pain.

As I took the bench, I intentionally walked slowly and remained silent. The court staff followed my lead and waited for me to open the proceedings. I asked Janis to please introduce herself to the family and take the time necessary to explain the court process to Ken and his family and to let them know that their son had been referred to the court by the behavioral health staff at Broward Health.

After his arrest, Ken had been able to call his parents from the jail, and they had paid the required bond for his release. From there, they had driven him directly to the emergency room at Broward Health for an evaluation. After a week of observation, Mrs. Marks told Janis, “The team physician informed us that Ken had not been himself.” The team sent Ken home and notified his parents that he had to be psychiatrically evaluated. His parents blamed themselves for his arrest because, as it turned out, they had already scheduled an appointment with the family doctor. Unfortunately, the arrest occurred before the appointment with the physician.

They tortured themselves wondering whether the arrest could have been avoided if only they had scheduled an appointment earlier or had taken their son to an emergency room immediately upon his return home from training. Maybe the arrest would never have happened. They had so many questions: Why did this have to happen to their son? Would he ever be able to resume his baseball career? “He worked all of his life to get to play in the big leagues. It was his dream. And now it’s gone,” his father said in a broken voice.

As Kenneth Marks approached the bench, I was surprised that he had achieved so much at such a young age. He appeared dazed, and I speculated that was most likely from the medication and all that he’d experienced over the past week.

“Ken,” I said in a mild tone, “welcome. I understand that you have been through a great deal, and I am not going to prolong the hearing this morning.”

“I am OK, Judge,” he said. “I am up to it.”

We spoke about the court, and I listened to his parents explain that Ken had been recruited from college and had just signed with his team. Ken’s father gasped for breath as he noted that Ken had not been playing too long before his mental health began to deteriorate.

We talked for a few more minutes about where Ken would receive care. His mother had contacted a private psychiatrist who had been recommended to the family. A follow-up appointment had already been scheduled by the case manager at Broward Health.

“I think that is enough for today,” Janis said. “Let’s allow Ken to get some rest. He will come back next month, and we’ll evaluate his progress.”

I thought that was a reasonable suggestion under the circumstances. As the deputy clerk prepared the court notice for the next hearing, Ken’s mother asked if she could speak to me for a moment. She stepped toward the front of the bench and said, “Judge, we are worried that now that Ken is away from his team, he will become more depressed and lonely.”

I reassured her that Ken was going to recover and live a fully active and engaging life, but he needed a chance to get used to his treatment. I promised her that we were going connect him with additional services and peers so he would not feel alone, if he was interested. Granted, I wasn’t yet exactly sure what those supports would look like, but I bet that physical fitness, healthcare, and baseball were on the list.

At the next scheduled hearing, once again Ken appeared in court with his parents. They indicated that things were going all right at home, but that it was “going to be a long road back to health.” I could tell the family was still in shock and were trying their best to be strong for each other.

As the hearing continued, Ken said that he had played baseball in college in South Florida before he transferred to another university in Texas. He talked highly of the coaches who had mentored him and hoped to get back to the game that helped him to feel truly alive, he said. As he spoke, I reflected on the many mental health consumers I knew who had been diagnosed with a serious mental illness and gone on to reclaim their lives and accomplish tremendous goals.

During the time that Kenneth Marks was a court participant, I was honored by an appointment by President George W. Bush to serve on the New Freedom Commission on Mental Health, established in 2002.¹ The commission was a part of the president’s New Freedom Initiative, which was intended to advance the progress of the landmark legislation of the Americans with Disabilities Act, legislation that President George H. W. Bush had signed into law in 1990. The New Freedom Commission on Mental Health would convene every month to take testimony from the public and from experts and to engage in a comprehensive study and review to evaluate how best to improve mental health in America. The commission was charged with the responsibility of submitting both an interim and final report to the president.

As I boarded the plane from Fort Lauderdale to Washington, DC, to attend one of the monthly meetings, I was seated next to a tall man. Eventually, we struck up a conversation. He shared with me that he was a college baseball coach. Ken’s last court hearing was on my mind, and my curiosity was piqued. The chance coincidence that I would find myself sitting next to a college baseball coach when Ken had just described his happiness at playing college ball—and the strong relationships he had formed with former coaches—stirred something in me. I decided to continue the conversation.

Not wanting to ask him his name, I introduced myself. Then, he told me the name of the college where he coached, and I knew that this was no ordinary meeting. This might offer me a chance to get some help for Ken.

We spoke for a while, and I told him what I did for a living and about the mental health court. I wondered how I could ask for his assistance without revealing Ken’s identity. As the pilot announced that we had begun our descent for landing at Ronald Reagan Washington National Airport, I realized that this was not a coincidence, and I needed to say something before it was too late.

“Sir,” I said, turning to the coach beside me, “I was wondering if perhaps you could assist me.”

He nodded and said, “Sure.”

“There is a wonderful young man in my court who played baseball in college. He is having some challenges, and I know that if he had the chance to speak to you . . . that perhaps you could offer some words of encouragement to him and, who knows, offer him some advice and guidance about how to hold on to his love of the game and remain engaged in baseball.”

“I would be delighted,” the coach replied. “I once had a baseball coach who promised every player that, no matter what happened in life, he would always be there to support and encourage them. He inspired me to do the same.”

I watched as the coach dug into his brown leather carry-on bag and handed me his business card. As I examined it, I thanked him. I could not believe my luck. Yes, it is him, Ken’s former coach! I did not say anything about this to the coach, though, due to confidentiality required by the court.

After the weekend, I was eager to return to work and share the story of this chance meeting with the court staff. I did not know for certain whether Ken would feel comfortable reaching out to his former coach, but that would be his choice.

Soon after I returned to Fort Lauderdale, I was advised that Ken had had a mild setback and had been readmitted to the hospital. I realized that my surprising news would have to wait. The court dockets seemed to be growing longer with each session. Perhaps it was because judges and lawyers were becoming more aware of people with mental health issues in their own court divisions and wanted to give their clients the opportunity to participate in my court.

One day a special guest attended the court: Jamie Fellner, senior counsel for the United States Program of Human Rights Watch. She was visiting the court as part of a national survey and investigation into the criminalization of people with mental illness in the US. It was a great honor to have Human Rights Watch, one of the world’s most prestigious and effective global human rights and social justice organizations, in the Broward County Mental Health Court.² The fact that Fellner was focusing on the criminalization of mental illness in the US certainly suggested that the organization had identified the criminalization trend in America as a human rights issue that was in dire need of attention and action.

It was an intense and high-energy docket, as Fellner sat near me, in the witness box, to observe the court process. Since the court was a teaching model, I explained the principles of therapeutic jurisprudence as I went and emphasized the human rights elements that were embedded in the court process. This included the fact that the court was voluntary, highly individualized, and operated on a pretrial basis. The court did not require a plea of no contest in exchange for participation, which meant that the individuals retained their constitutional right to trial, should they choose to opt out of the court and return to the criminal division, to which they had originally been assigned.

I emphasized to Fellner that I rarely applied sanctions in the court and only in those circumstances where noncompliance posed a public safety risk or if there was a re-offense that required remanding a participant to the jail. Typically, in the event of noncompliance, further action would be determined on a case-by-case basis. After a reasonable effort to promote engagement, an individual’s case would either be transferred back to the original court division for case administration or would be taken care of by a plea bargain in the mental health court. The importance of procedural justice and the minimization of the coercion was a hallmark of the mental health court. Early evaluations on the court were led by Dr. John Petrila of the University of South Florida and Louis de la Parte of the Florida Mental Health Institute, in partnership with the MacArthur Foundation, and yielded the outcomes that Howard Finkelstein and Broward County’s criminal justice and mental health partners had worked so hard for: “Researchers noted, ‘The Broward court was designed to be informal, often involving interaction and dialogue between the participant about problems and treatment options. . . . The patience and tolerance . . . create an impression that speedy disposition of a large number of cases is not a priority.’”³ In the early years of the court, Professor John Monahan, when he presented the findings of the preliminary observations of the court across the country, even went so far as to say that participation in the court was almost as pleasant as “going out for an ice cream sundae.”⁴ In other words, court participation was not only voluntary but also, and primarily, therapeutic.

Within a matter of weeks, Ken returned for a status hearing in mental health court. Once again, he appeared with his parents. This time he shared the good news was that he was feeling better. His doctor had made an adjustment to his medication that significantly improved how he was feeling.

Janis reviewed his progress and was pleased. As the hearing continued, I reached down into my purse and pulled out the business card that I had received from his college baseball coach. I thought about how I was going to explain this serendipitous experience. After considering several possibilities, I decided that the best way to raise it was simply to reveal the facts and circumstances as they occurred.

I appreciated the change of roles: Now, I was the storyteller.

I started off by explaining that the most amazing thing happened when I flew to a meeting in Washington, DC, about a month before. “I sat next to a very nice man who was tall and had a mustache and we engaged in conversation. As we shared our line of work, he told me that he was a college baseball coach.”

I handed the business card to my deputy and asked him to give it to Ken.

As Ken examined the card, his face registered surprise. “What is this?” He stared at the card in disbelief, blinking fast and hard. When he looked up, his eyes glistened under the courtroom lights. “Did you really meet my coach?”

“I did,” I replied. “I want you to know that I never mentioned your name to him or revealed anything about the fact that you were a participant in the mental health court. What I did tell him was that there was a wonderful young man in my court who had played baseball in college, and he may appreciate getting a bit of encouragement and having someone to talk baseball with.”

Ken was overwhelmed with joy. “You mean I could call him and just say hello and catch up?”

“Absolutely,” I said. “He said that he would be delighted to speak to this young man. Think how surprised he will be when he finds out it’s you.”

Ken’s mother and father were overwhelmed. I explained to them that I did nothing more than take my seat in the plane. It was really a matter of fate. As soon as I uttered those words, I thought about Aaron Wynn and how, at the court’s celebratory launch, Howard Finkelstein had referred to the creation of the court as a leap of faith.

“You know,” I said, “I bet if you were interested, you could ask your coach about how to go about volunteering as a baseball coach at one of the colleges here in South Florida.” I watched Ken’s expression, which lingered on the edge of disbelief and overwhelming joy. “Only when you’re ready,” I added.

In the months that Ken and his family came to mental health court for their hearings, I found myself thinking about baseball and how it so elegantly articulated the importance of human connection and support. Beyond the mundane details—a game played in nine innings with nine players on each team; beyond the sport’s alliance with American culture as a “perpetual drumbeat keeping time through American history”—something about the interaction of the players themselves underscored what I witnessed in the mental health court each day.⁵ Perhaps it was the centrality of home plate—an apt metaphor for the importance of home and family—and the way “success” is often reliant upon the people one is surrounded with, paired with stable and safe living conditions. The hearth, the home fire, and family gatherings at holidays, happy memories of home, often form the inner layer of fortitude that mental health activists refer to as “resiliency.” Home: the place of origin and the place we perpetually return to, like the runners scattered across first, second, and third bases who all hope to cross home plate.

But it wasn’t just the home-plate metaphor. Listening to professional games on the radio on my drives to and from the courthouse, I realized that baseball was a game that consists of a series of second and even third chances. It takes three strikes for a player to be called “out,” and there are three “safe” bases a player can take refuge on to avoid being “tagged out.” It takes three “outs” to turn a team from defense to offense. And in any professional game, there are at least nine innings. It is a choreography of opportunities regained.

Baseball, in other words, isn’t a game that demands a single act of perfection. Instead, it is a game that acknowledges the human condition as one riddled with chance and failure.

Ken’s face lit up as he read the name on the card again and again. Just like the game he loved, life had offered him up second and third chances.

Violet Harrison had been arrested for disorderly intoxication at a popular bar on Fort Lauderdale Beach. At thirty-two, Violet didn’t quite look like the kind of person who would be arraigned for the reason she had been. She was diminutive—or, perhaps, diminished. Drawn into herself, her posture seemed to collapse as Allen, the court deputy, escorted her into the jury box.

“Vi, we’re here for you! We love you!” Violet’s mother called from the first row of spectator seats where she and her other daughter sat. Allen made a beeline for Violet’s mother to admonish her to maintain decorum in the court.

“Mrs. Harrison, please do not yell in the courtroom,” I said firmly. “That is not appropriate.”

The noise in the courtroom dropped to a murmur, then silence. Both Violet and her mother wore wounded expressions on their faces as though I’d taken something away from them. It was an expression I’ve seen in the court before—the expression of people who believe they have lost everything.

I wondered what this family had been through.

I called Violet’s case immediately so her mother wouldn’t have to wait and become more anxious. I introduced myself to everyone, appointed the public defender for Violet, and began to gather some basic information to find out why she had been referred to the court.

“Hello, Violet,” I said. “Before we begin our conversation, is it all right if I ask your mother a few questions?” This was a part of the court’s process—allowing defendants like Violet to maintain their constitutional rights. Anything a defendant says could be used against them in prosecution. If Violet’s case were to be transferred to a court in the criminal division, her legal rights must be protected. That is also why everyone who participates in the mental health court is appointed an attorney.

Violet nodded in response and said quietly: “Yes, you can talk to my mom.”

I turned my attention to Violet’s mother, who approached the bench. “Can you tell me anything about your daughter?” I asked.

“Judge,” Mrs. Harrison said, “my daughter is full of life and very talented. She used to dance and loves to cook. She has a heart of gold.” She took her other daughter’s hand, to compose herself.

“It’s just . . . that,” she said in a low whisper, “a very bad thing happened to Violet when she was in college.” Her words broke apart as she began to sob. She tried to control herself by taking deep breaths, but her body shook as tears rolled down her face. While I waited for Mrs. Harrison to regain her capacity to speak, I learned from Violet’s case file that Violet had been diagnosed with post-traumatic stress disorder and bulimia. After a few moments, Mrs. Harrison regained her composure and went on. “Violet rarely leaves the house anymore. She has a few girlfriends that she still sees, but they have been a bad influence on her.”

“Mom, that is not true!” Violet said forcefully, standing up.

“All right,” I said. “We all need to take it down a bit.” I turned my attention to the in-court clinician. “Janis,” I said, “I am interested in your thoughts.”

“I would rather not get into Violet’s trauma history other than to say that she is connected to a private therapist in the community who she likes very much. I am not sure what to suggest, given her insurance coverage and the fact that she has positive family support.”

“Violet,” I asked, “what are your goals? I understand you were in college. What degree were you pursuing? What was your vision?”

In a clear voice, Violet told the court that she had been studying to be an art therapist. “Once, I had a passion for art and children.” Her voice drifted as if she was talking about a different life. She had been enrolled in the school of education at a local community college but had dropped out after the traumatic event—Violet had been the victim of date rape. Since then, Violet had languished and was unable to engage in her life in any real way. She lacked the energy and the desire to return to school. For Violet, life had become a struggle to cope with mental health issues that were well beyond her capacity to understand, let alone control.

But after this pause, Violet pulled herself together and started speaking again. “It makes me feel bad to always have to rely on my mom for everything. I mean, I should be able to get out of bed in the morning without crying. I should be able to go to class without becoming so scared of what might happen to me there. I should be able to know when and how much to eat. But I can’t. . . . I just can’t do any of that.”

Violet’s mention of how disappointed she was that she had not overcome the problems in her life while she spoke about managing her mental health challenges inspired me. She acknowledged that she needed to learn how to manage her own care better and not rely on her mother to do so. In fact, this idea is very close to what social workers and therapists call health activation, which is an important idea buttressing what we attempt to do in the mental health court. I learned about health activation while attending the American Case Management Association’s Behavioral Health Leadership Conference in 2015.⁶

Health activation is a widely recognized concept of engagement for patients with chronic medical conditions such as diabetes, mental illness, obesity, and cardiac disease.⁷ Its goal is to teach self-care skill building that leads to lifelong engagement in personal wellness. The research indicates that the more a patient is engaged in his or her health, the better the health outcomes, and that to activate one’s health, one needs to shift one’s focus to positive lifestyle choices and healthy living. This can include any number of things, such as improving one’s physical fitness, following a healthy diet, getting adequate sleep, engaging in meaningful social activities, and spiritual pursuits. The higher the level of health activation, the more effective one’s healthcare management.⁸

What if I made health activation a priority in the Broward County Mental Health Court? I thought for a moment about the possibility before I decided I was ready to roll out a new court initiative to counter critical loss of mental health programs. Mental health court participants would need to step up in terms of taking responsibility for their own healthcare management and learn how to be advocates for themselves.

I asked Janis to explain health activation to Violet and her family. On the basis of the literature, Janis had prepared an example of a self-care management plan. In addition to making her therapeutic appointments each day, Violet would create her own structured wellness plan. It would include activities such as healthy living practices that she enjoyed doing and that would help her manage her PTSD symptoms and her eating disorder.

In addition to getting sufficient sleep, the plan would focus on eating nutritiously and engaging in physical activities and other pastimes that Violet had once enjoyed doing and would make her feel better. She would not be allowed to consume alcohol. To deal with her eating disorder, Janis suggested that Violet try an Overeaters Anonymous support group or a twelve-step women’s support group to help her manage the stress of facing the challenges of an eating disorder alone. Janis also suggested if Violet liked to paint, garden, or write, that time be set aside for such creative activities. Spiritual activities could also be part of Violet’s program—for example, meditation, yoga, or other spiritual or faith-based activities that would foster feelings of gratitude and of being a part of something greater than herself.

As Violet listened to Janis’s explanation, she seemed to become more alive, more vibrant. Color seemed to return to her skin, and she smiled when Janis finished her explanation. In fact, she was ecstatic.

“Judge,” she said, obviously excited, “I used to love tap dancing when I was a kid. And I used to love to try new recipes. I guess all of that just sort of stopped.” She paused as if collecting her thoughts. “Anyway, my mother has been suggesting that I eat more of a vegetarian diet. She has been reading about the benefits of diet and mental health. But I’ve always wanted to learn how to bake and decorate cakes. I think I might take a class on that.”

After Violet’s hearing, the court advocated for everyone to create their own wellness plan. Health activation became a core component of the court process. The celebration of health—of life—became, in some respects, the modality of the court. Perhaps it was no accident that I designated the mental health court a “Zero Suicide Initiative Court.”⁹ My decision came in part from reading about the recent surge in suicide rates across the country. To celebrate life was to keep it safe. And the court would do just that through its dedication to suicide prevention, which would now come under the court’s broadened health activation banner. Safety planning information would be distributed from the bench at every hearing, including the numbers for local crisis hotlines and the National Suicide Prevention Lifeline.¹⁰

Each new court initiative built on the last. Life is sacred, and to guard it would require preventative and therapeutic measures to treat not only body but mind, heart, and soul.

Within a few weeks, Violet and her family returned to court for a follow-up hearing. They were pleased to be back in court, now that the family’s circumstances had improved. Violet was dressed in a floral dress with purple, red, and orange flowers. She, like the flowers on her dress, seemed vibrant and alive.

“Judge, I brought something to show you,” she said the moment she walked into the courtroom. It seemed that Violet had embraced health activation with both arms and soul. She had prepared an elaborate demonstration board that included a large multicolor diagram with illustrations linking her daily and weekly health activation activities to specific health goals. It was a work of art. Illustrated with tasteful images clipped from magazines and books and loose sketches in watercolor that she herself had made, the plan specified her scheduled activities: dance, journaling, meditation, spiritual reading, and a power nap.

For her evening activities, she was going to prepare dinner with her mother, bake, practice yoga, and watch a few favorite shows with her family until bedtime, which was at 10 p.m. Her chart included a separate section for therapeutic appointments, highlighted by positive life affirmations and therapeutic goals. It was all written carefully in vibrant ink in a script that looped pleasantly around itself in beautiful spiral flourishes. Drawings of flowers and musical notes floated to form a loose, organic frame as if holding the plan together. It was as though Violet was signing the document with who she was and who she wanted to become.

When Violet concluded her description of her “health activation project,” the entire courtroom applauded. I am not an expert in health activation, but by anyone’s standards, Violet’s efforts demonstrated something remarkable and beautiful.

Just when I thought Violet’s presentation had concluded, she had one more surprise up her sleeve. She shared with me that she had signed up for the Whole Health Action Management (WHAM) Peer Specialist Training, offered by the National Council for Behavioral Health.¹¹ This program would allow Violet to take her lived experience in her own health management and integrate it into the WHAM program. It was a program developed by peers for peers.¹²

Health activation has been a positive addition to the court’s recovery toolbox, but it did not address the community’s lack of available residential treatment beds and housing options that were the result of a standardized level-of-care screening process and the bureaucratic allocation of available bed space. How do we provide for those who have no family or who do not have the support and backing of their family? How can the court find a way to help?

Just a few days before Violet’s presentation, I received a call from Fran L. Tetunic, a professor of law and the director of the Dispute Resolution and Restorative Justice Law Clinic at Nova Southeastern University’s Shepard Broad College of Law. She asked if we could meet to discuss how the clinic could serve the court. The clinic works across diverse areas of the law (juvenile justice, child welfare, family law, guardianship) to promote alternative dispute resolution and was interested in expansion of its scope. I scheduled a meeting immediately. My vision was to leverage the services of the clinic to expand the support network of the court and help people in mental health court find their way home.