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?? Course Objectives:

By the end of this course, participants will be able to:

1. Identify clinical and ethical challenges in working with legally-involved clients.
2. Describe the role of therapists in the mental health diversion process.
3. Apply culturally responsive care in court-involved treatment settings.
4. Evaluate pros and cons of working with this population, including financial considerations.

?? Course Outline:

Introduction & Context

• Instructor background
• Why this topic matters now: criminalization of mental illness, rise in diversion programs

Mental Health Diversion in California

• Overview of Penal Code §1001.36
• Eligibility criteria & clinical responsibilities
• What courts expect from therapists
• Role of progress letters, treatment plans, and testimony
• Working with attorneys and public defenders

Pros, Cons, and Financial Realities

• Pros:
• Meaningful work
• Financial benefits (full fee, court reports, appearances)
• Cross-disciplinary collaboration
• Cons:
• Emotional toll
• Documentation and liability concerns
• Difficult dynamics with involuntary clients

Clinical Considerations

• Building rapport with involuntary or mandated clients
• Trauma-informed care with individuals involved in the justice system
• Motivational work and harm reduction strategies
• Brief case example: dual diagnosis client referred by court

Legal & Ethical Considerations

• Confidentiality vs. court obligations
• Responding to subpoenas
• Avoiding dual roles: therapist vs. forensic evaluator
• Documentation tips for legal contexts
• Writing clear and objective court reports

Diversity & Cultural Considerations

• Recognizing systemic bias and racism in the criminal legal system
• Disproportionate incarceration and diversion barriers for BIPOC communities
• Culturally responsive approaches to treatment
• Addressing mistrust of providers and systems
• Language access, gender inclusion, and socioeconomic realities

Case Examples

• Real-life case examples
• As many cases as time permits

Q&A + Wrap-Up

• Open floor for questions

Working with Clients with Legal Issues

My story:

I was born and raised in Eastern Europe and came to the United States at the age of 15 through a Jewish refugee program. During my senior year, I took a psychology class in high school—and I was immediately hooked. At 18, I enrolled at UC Berkeley and later graduated with a degree in Psychology.

As an immigrant from a country where mental health wasn’t openly discussed or prioritized, I felt significant pressure to pursue a more traditional career path. At 25, I enrolled at the University of San Francisco School of Law. However, during that time, I began struggling more intensely with anxiety and addiction. Eventually, I made the difficult decision to take time off from school to focus on my well-being.  I enrolled myself into an inpatient rehab and started attending 12 step meetings.  I got clean and sober, did some deep soul-searching, and realized that my true calling was in mental health.

A few years later, I earned a Master’s degree in Psychology from Golden Gate University. I completed my clinical training at Ohlhoff Recovery Program in San Francisco, a drug and alcohol treatment center where I eventually obtained the 3,000 required hours. After becoming licensed in 2013 as an LMFT, I began a part-time private practice while continuing to work in drug and alcohol treatment settings.

Shortly after starting my practice, a former law school classmate—now a criminal defense attorney in Monterey County—reached out to me. He had seen on Facebook that I became a therapist, and he also knew my personal story of recovery. He shared that 50 to 75 percent of his clients were struggling with mental health issues, addiction, or both. Rather than simply guiding them through the criminal justice system toward punishment, he wanted to help them access meaningful treatment that could lead to lasting change. He began referring clients to me for psychotherapy.

Since then, I’ve been in private practice for over 11 years. In that time, we’ve helped numerous individuals improve their mental health, achieve sobriety, and go on to live productive and fulfilling lives.  Many of our clients were able to enroll in mental health diversion and complete it.

?? What Is Mental Health Diversion?

Mental health diversion is a pre-trial program under Penal Code §1001.36, enacted in 2018. It gives judges the discretion to pause criminal proceedings and allow eligible individuals to undergo mental health treatment, with the potential for charges to be dismissed upon successful completion of the program.

? Who Is Eligible?

To qualify for mental health diversion in California, all of the following criteria must generally be met:

1. Diagnosed Mental Health Disorder
   The individual must suffer from a diagnosable mental health condition listed in the DSM-5 (such as schizophrenia, bipolar disorder, PTSD, depression, etc.).
   ?? Exclusions: Antisocial personality disorder, borderline personality disorder, and pedophilic disorder are not eligible.
2. Mental Illness Contributed to the Offense
   There must be a clear connection between the mental illness and the commission of the crime.
3. Suitability for Treatment
   A qualified mental health expert must evaluate and confirm that the individual would benefit from treatment.
4. No Unreasonable Risk to Public Safety
   The court must find that diversion will not pose an unreasonable risk of danger to others.
5. Consent & Willingness
   The defendant must agree to participate in treatment and waive their right to a speedy trial.
6. Charge Type
   Not all crimes are eligible. Diversion typically applies to misdemeanors and some non-violent felonies.

?? How Does It Work?

1. Request for Diversion
   The defense (or sometimes the court or prosecution) requests mental health diversion and provides documentation, such as a psychological evaluation.
2. Court Hearing
   A judge reviews the evidence and determines whether the individual meets all legal requirements.
3. Treatment Plan Approval
   If approved, the judge suspends the criminal proceedings and the defendant begins a treatment plan, usually lasting up to two years.
4. Monitoring
   The court receives regular progress reports from the treatment provider. Compliance is key.
5. Completion or Termination
• If the program is successfully completed, the criminal charges are dismissed, and the arrest can be sealed from public record.
• If the person fails to comply (e.g., drops out or reoffends), the court can reinstate criminal proceedings.

Why It Matters

Mental health diversion is based on the idea that treatment and support—not jail—are more effective for individuals whose offenses are directly tied to their mental health challenges. It's a step toward a more compassionate, restorative justice system in California.

?Examples of Charges That May Be Eligible for Mental Health Diversion

These are typicallynon-violent misdemeanors or felonies, where the mental health condition may have contributed to the offense:

• Petty theft (PC 484/488)
• Shoplifting (PC 459.5)
• Trespassing (PC 602)
• Vandalism (PC 594)
• Public intoxication (PC 647(f))
• Simple assault or battery (PC 240 / 242)– depending on the severity
• Possession of a controlled substance (HS 11350)
• DUI without injury (VC 23152)
• Resisting arrest (PC 148)
• Non-violent burglary or attempted burglary (PC 459)
• Identity theft or fraud (PC 530.5)
• Possession of drug paraphernalia (HS 11364)
• Receiving stolen property (PC 496)

??Examples of Charges That Are TypicallyNotEligible

These are usuallyserious or violent felonies, or those that present a substantial risk to public safety. Judges may still consider diversion insomecases, but it's much less likely:

• Murder or attempted murder (PC 187 / 664)
• Rape (PC 261)
• Robbery (PC 211)
• Arson causing great bodily injury (PC 451(a))
• Kidnapping (PC 207)
• Sexual offenses requiring registration (PC 290)
• Child molestation (PC 288)
• Crimes involving firearms or gang enhancements
• Domestic violence with injury (PC 273.5)– may be considered in some courts, but often excluded
• Assault with a deadly weapon (PC 245(a)(1))– often excluded unless mental health played a significant role

?? Important Notes:

• Eligibility isdecided on a case-by-case basisby a judge.
• Even somefeloniescan qualify if the person posesno unreasonable risk to public safetyand the mental illness clearly contributed to the crime.
• Mental health diagnosis and expert evaluationare critical in building a successful diversion request.

?Pros of Working with Clients Involved in Legal Issues

1. Meaningful, Transformational Work
You may be helping clients at pivotal moments in their lives—offering support during crises, reducing recidivism, and promoting long-term healing and stability.

2. Social Justice Impact
Working with legally involved clients (especially those impacted by poverty, addiction, and mental illness) can support systemic change and provide alternatives to incarceration.

3. Diversified Clinical Experience
You gain valuable experience with trauma, addiction, forensic psychology, and complex cases that deepen your clinical skill set.

4. Advocacy Opportunities
Therapists can play a powerful role in advocating for clients through court reports, diversion programs, or expert letters that influence legal outcomes.

5. Growing Demand
There’s an increasing need for therapists who understand the intersection of law and mental health.

6. Opportunity for Collaboration
You may work closely with attorneys, case managers, probation officers, and the court system—offering a team-based approach to client care.

7. Financially Lucrative
When clients or their families have resources, this work can behighly lucrative:

• Full-fee sessions are paid out-of-pocket
• Extra compensation forreport writing,collateral communication, andcourt appearances
• These services can be billed athigher hourly ratesthan clinical work
• Clients are motivated to stay in therapy and be consistent

??Cons and Challenges of Working with Legally-Involved Clients

1. Legal and Ethical Complexity
You may face subpoenas, court testimony, or pressure to disclose confidential information. Knowing the limits of privilege, consent, and HIPAA is crucial.

2. Higher Risk for Dual Roles
Being both a treating therapist and a court-involved evaluator (e.g., writing reports for legal purposes) can create ethical conflicts or dual roles if not carefully managed.

3. Documentation Pressure
Your notes, assessments, and opinions might be reviewed by lawyers, judges, or opposing parties. Everything must be written with potential legal scrutiny in mind.

4. Boundary Challenges
Clients may have complex trauma, chaotic lives, or difficulty with trust and authority—making boundary-setting and therapeutic containment more challenging.

5. Emotional Toll
Exposure to intense cases—such as domestic violence, addiction, or incarceration—can increase risk of burnout or vicarious trauma.

6. Reduced Intrinsic Motivation
In court-mandated treatment, clients may be attending therapy involuntarily, affecting motivation and therapeutic alliance.  They may be dishonest and/or not motivated to make long-term changes.

7. Liability
Your clinical decisions (e.g., whether someone is safe for release, or compliant with treatment) may have legal consequences, increasing professional risk.

??Diversity & Cultural Considerations

Why This Matters

• The criminal justice system disproportionately impacts people frommarginalized communities:
  • BIPOC (Black, Indigenous, People of Color)clients are overrepresented in jails, prisons, and diversion programs.
  • Undocumented immigrants,low-income individuals, andtransgender and gender non-conforming peopleface increased vulnerability in legal systems.
  • Many clients come from communities where mental health treatment is stigmatized or under-resourced.
• Therapists need to beculturally responsiveto effectively support these clients andmitigate systemic harms.

??Systemic Factors to Acknowledge

• Structural racismin policing, sentencing, and incarceration rates
• Cultural mistrustof institutions, including courts and mental health providers
• Language barriersand lack of culturally appropriate services
• Historical traumaand intergenerational impact of systemic oppression
• Immigration statusand fear of deportation or legal repercussions

???????Clinician Responsibilities

1. Practice Cultural Humility
   • Acknowledge your own biases and limitations.
   • Approach clients as the experts of their own lived experience.
   • Be open to correction and learning from clients.
2. Assess Through a Cultural Lens
   • Understand how cultural background shapes expressions of distress.
   • Use assessment tools that areculturally adapted.
   • Don’t misinterpret culturally normative behavior as pathology.
3. Ensure Language Accessibility
   • Offer interpreters when needed.
   • Avoid assuming English proficiency equals comprehension of legal or therapeutic concepts.
   • Translate informed consent forms and reports when appropriate.
4. Honor Community and Cultural Values
   • Understand collectivist vs. individualist worldviews.
   • Explore the role of family, community, and faith in recovery.
   • Collaborate with culturally grounded healers or support networks when possible.

Case Examples

Several real-life case examples will be presented