By DENA POTTER
Associated Press

NORFOLK, Va. - When the judge calls her name the lady pops up, slipping on her long, red jacket and floppy hat as she approaches the bench.

"Taking your medicine?" the judge asks.

"My prescription ran out."

"Are you keeping your appointments?" he follows.

After some excuses and a promise to see her psychiatrist, Norfolk Circuit Judge Hon. Charles Poston shoots back, this time more punisher than nurturer: "Don't let me hear that you've been missing doctors' appointments anymore, or I'll put you somewhere where you can't miss them."

The exchange is similar to dozens of others each Tuesday afternoon in Poston's courtroom and in hundreds of other mental-health courts nationwide. Similar to drug courts, mental-health courts work to place the severely depressed, paranoid and delusional into treatment instead of behind bars.

Even as the courts have ballooned from only a handful a decade ago to more than 250, experts and lawmakers remain divided on whether they are the most appropriate way to manage mentally ill people who land in trouble with the law.

Locally, there are such courts in Buffalo, Lackawanna, Lockport and Niagara Falls.

Some mental-health advocates fear that the courts lead to greater criminalization and stigma for the mentally ill. They don't like that the courts use criminal sanctions to coerce treatment or that criminal offenders can jump the line to get community-based treatment before others.

"Despite good intentions, the mental-health courts don't address the root problem, which is getting services to people before crisis hits," said Andrew Penn, a staff attorney for the Washington-based Bazelon Center for Mental Health Law.

Other groups, like the National Alliance on Mental Illness, support the courts as a way to help the mentally ill instead of punishing them while increasing public safety and cutting down on the money needed to incarcerate the same offenders over and over.

Poston, whose court started in 2004 and is the only one in Virginia, said he's "certainly not an evangelist," because something that works in Norfolk may not work elsewhere.

Over time, the nation's prisons and jails have become surrogate psychiatric hospitals. Today, there are more severely mentally ill people in the Los Angeles County Jail than there are in any psychiatric hospital in the U.S. Studies have found that mentally ill offenders stay in jail longer, return often and cost more to house than regular inmates.

Legislative efforts to create or expand mental-health courts in Virginia and other states have failed in recent years over concerns about funding and a reluctance to turn judges into social workers.

This year, bills were introduced in Virginia, Oregon, Michigan, Pennsylvania and Indiana to authorize more mental health courts, but so far they have not advanced. Similar efforts in Massachusetts and New Jersey failed in recent years, while Illinois passed authorizing legislation in 2007.

Seven states - Kansas, Massachusetts, Mississippi, the Dakotas, Wisconsin and Wyoming - do not have mental-health courts.

Ohio Supreme Court Justice Hon. Evelyn Stratton took a leading role in expanding that state's mental-health courts - there are 40 either operational or being planned - and has worked to do the same nationwide.

Stratton said the courts really are just a docket-management tool, and that judges have inherent authority to control thei own dockets. She said putting it in law could do more harm than good.

"All this is so new that to legislate it now when we're still experimenting and growing and trying to invent the wheel would just not be productive," she said.

There is no national court model. Some take only misdemeanors, while others are for felonies.

Participants can complete a program of close supervision by mental-health and law-enforcement officials and regular meetings with the judge instead of jail time. They undergo regular drug screenings and can spend days or weeks in jail for slipping up. Often their charges are dismissed if they successfully complete the program.

On court day, talk centers around new jobs, bad relationships, dirty drug tests and new beginnings. Poston's first words to participants often go something like, "What's going on in your life?"

Most of the courts rely primarily on local funding, while some receive federal grants. Some states, like Nevada, devote millions to the courts each year.

Sheila Leslie, a Nevada legislator who also works with the state's specialty courts, says the mental-health courts give offenders a chance to succeed.

"Of course you don't have 100 percent success," she said. "Of course there are issues and some people go to prison, but we literally have saved lives.''