The Effectiveness of a Mental Health Court in Reducing Recidivism in Individuals with Severe Mental Illness and Comorbid Substance Use Disorder

The current study examined the efficacy of a specialized mental health court in reducing recidivism for severely mentally ill defendants with comorbid substance use disorders. There is a wealth of research supporting the efficacy of mental health courts in reducing recidivism for those with severe mental illness; however, the benefit of these courts for individuals with severe mental illness and comorbid substance use disorders has received limited empirical attention. Participants were 514 defendants enrolled in either a traditional adversarial court or a specialized mental health court. Recidivism was assessed across different outcome variables, including frequency of reoffending, severity of new offenses, and length of time to reoffend. When compared to participants in the traditional adversarial court, enrollment in mental health court was associated with a greater length of time to rearrest and fewer participants were rearrested in the mental health court than the traditional court. Group differences between those with and without comorbid substance use disorders who were enrolled in the mental health court were not found across recidivism outcome metrics. Results of the current study are particularly promising given that defendants with substance use disorders are at a greater risk for reoffending.     

Dealing with mentally ill domestic violence perpetrators: A therapeutic jurisprudence judicial model

People suffering from mental illness are increasingly referred to the domestic violence court. Yet the typical diversion programs available, including batterer's intervention programs, are inappropriate for those with serious mental illness. As a result, the Miami-Dade Domestic Violence Court has developed a new approach for dealing with this population that applies mental health court techniques in domestic violence court. This article will describe and discuss this pioneering model. It also will situate this model within the context of other problem-solving courts and discuss how the court uses principles and approaches of therapeutic jurisprudence. The paper presents some preliminary data that describe the social and legal characteristics of 20 defendants in the Domestic Violence Mental Health Court followed over a two year period between 2005 and 2007.     

Juvenile Court Clinical Services: A National Description

There have been few studies of the manner in which juvenile courts obtain clinical evaluations and consultation by juvenile court clinicians in order to identify and respond to youths with mental health problems. This study involved a telephone survey of professionals associated with juvenile court clinic (JCC) services in 87 of the largest juvenile court jurisdictions nationwide, providing data on their professional staff, functions, procedures, organizational and financial structures, and methods for providing evaluations to juvenile courts. We identified three models of JCC service delivery systems. Differences between the JCC service models offer hypotheses pertaining to potential differences in efficiency and quality of services and service delivery.     

Court outcomes for clients referred to a community mental health court liaison service

Court liaison and diversion services come in a variety of forms, but the similarities and differences between these services are not well characterized. Findings from a six-year audit of the Newcastle (Australia) Mental Health Court Liaison (MHCL) service are reported, including client characteristics, offence and service contact profiles, court outcomes, and interrelationships among these variables. During the audit period, there were 2383 service episodes by 1858 clients (1478 males, 380 females). Drug and alcohol disorders (40.9%) and psychotic disorders (17.0%) were the most prevalent mental health problems, while assault (23.1%), theft (23.1%), offences against justice procedures (15.4%), driving offences (13.4%) and malicious damage to property (8.3%) were the most frequently recorded charges. Among service episodes with a finalized court outcome, 70.0% involved a punishment (bond: 49.5%; jail term: 29.7%). Females were less likely to be punished, but more likely to have their case dismissed under sections of the relevant Act that required further assessment and monitoring. Being married, or having an adjustment or drug and alcohol disorder, were also associated with an increased likelihood of punishment, while clients with a psychotic or bipolar disorder were less likely to be punished. Among clients who were punished, those referred from inpatient mental health services were more likely to receive a non-jail punishment, while unemployed clients were more likely to be jailed. A substantial proportion of clients had court outcomes that required an ongoing involvement with local mental health services. By being part of community mental health services, our MHCL service is able to work efficiently and effectively with the criminal justice system, while facilitating ready access to existing mental health services and continuation of care.     

Enrollment in Mental Health Courts: Voluntariness,Knowingness, and Adjudicative Competence

Mental health courts (MHCs) are rapidly expanding as a form of diversion from jails and prisons for persons with mental illness charged with crimes. Although intended to be voluntary, little is known about this aspect of the courts. We examined perceptions of voluntariness, and levels of knowingness and legal competence among 200 newly enrolled clients of MHCs at two courts. Although most clients claimed to have chosen to enroll, at the same time, most claimed not to have been told the court was voluntary or told of the requirements prior to entering. The majority knew the “basics” of the courts, but fewer knew more nuanced information. A minority also were found to have impairments in legal competence. Implications are discussed.     

A prospective comparative evaluation of a Criminal Justice Liaison and Diversion Service in Belfast

There is continued interest in the planning, development and implementation of services designed to identify detainees with mental illness and connect them to health and social services. However, currently, little is known about how best to configure, organise and deliver these services. The study employed a prospective follow-up design with a comparator group to describe and evaluate a police mental health liaison service based in Belfast. Participants were recruited from two neighbouring police stations, only one of which provided a mental health liaison service. Outcomes including mental health status, drug and alcohol misuse, risk-related behaviour and ‘administrative’ outcomes were assessed at the time of arrest and six months later. The service was successful in identifying and assessing detainees, though there appeared to be similar between-group levels of mental health problems over time. Results highlight a need to develop firmer linkages and pathways between criminal justice liaison/diversion services and routine health and social services.     

Military Socialization: A Motivating Factor for Seeking Treatment in a Veterans’ Treatment Court

The veterans’ treatment court movement is just beyond the nascent period, and given the rapid proliferation of these courts in recent years it is imperative that the scientific community understand their operational procedures and assess whether they are meeting a unique need beyond those addressed by other problem-solving courts. This paper provides an in-depth examination of veteran culture and how it helps to distinguish veterans’ treatment courts from other courts that focus on similar populations (e.g., drug, DWI, and mental health courts). Using in-depth semi-structured interviews and focus group data collected from veteran participants, veteran mentors, and court team members in Pennsylvania, we employ content analysis to explore the veteran culture as a motivator for participants to enroll in a veterans’ treatment court and engage with others throughout participation in treatment. The results of this exploratory study suggest that a shared culture serves to motivate justice-involved veterans to seek out the veterans’ treatment court over other treatment options and remain engaged in this problem-solving court, while inspiring a sense of obligation to do well in treatment for them and their fellow veterans. The shared experiences of military service and across-the-board support for fellow service members suggest that the veterans’ treatment court creates a unique environment for pursuing treatment.     

Intensive case management as a jail diversion program for people with a serious mental illness: a review of the literature

This article reviews the research on intensive case management (ICM) programs as a jail diversion intervention for people with a serious mental illness (SMI). The review includes two types of ICM programs: (a) general ICM programs that included an assessment of arrests and incarceration rates for people with an SMI and (b) ICM programs specifically implemented as a component of a jail diversion intervention for people with an SMI. Results indicate that general ICM programs (19) rarely led to reductions in jail or arrest rates over time, and these rates were similar to those found in standard mental health services. General ICM programs that included an integrated addiction treatment component (8) had mixed results but a trend toward reductions in rates of arrests and incarceration over time for individuals with an SMI and a co-occurring substance use disorder. Results were mixed for jail diversion interventions with an ICM program, but most ICM programs (8) led to significant reductions in arrests and incarcerations over time. Specific elements of effective ICM jail diversion programs are discussed.     

Mental health, gender, and drug court completion

Drug-involved offenders report high rates of mental health problems that can negatively impact criminal justice outcomes. Yet, relatively little attention has been given to the mental health issues of drug court offenders. Therefore, this study examined 449 participants in a Delaware drug court and investigated relationships between mental health, gender, and program completion. Bivariate results indicated that gender was related to both mental health status and completion status. Multivariate findings revealed that two indicators of mental health, depression and being prescribed drugs for a psychological or emotional problem, were significant predictors of drug court completion. Policy implications include assessing the mental health status of all drug court participants at program entry so that services can be provided which aim to improve offender health and increase the likelihood of successful program outcomes. Drug courts must better meet the needs of participants with co-occurring disorders if they are to remain an effective and viable criminal justice intervention. This research was supported by grant RO1 DA12424 “Drug Court Offenders in Outpatient Treatment,” by the National Institute on Drug Abuse.     

Collaborations between drug courts and service providers: Characteristics and challenges

Addressing the multiple treatment needs of drug-involved offenders can enhance outcomes including sobriety and recidivism. Meeting drug court offenders' needs requires collaborative linkages between courts and providers of treatment and other services; however, there has been limited research on linkages. Using semi-structured interview data collected from administrators of fourteen drug courts and providers of services to offenders in those drug courts, this study described collaborative linkages and the challenges involved in fostering them. Although results suggest a moderate to strong level of linkage as perceived by both drug court administrators and service providers, services other than substance abuse treatment were sparsely provided through the drug courts. Limitations in funding, management information systems, and staffing were perceived as barriers to linkage. Results offer directions for enhancing linkages between drug courts and service providers and should be of value in improving quality of drug court treatment and offender outcomes.     

Courting Compliance: Case Managers as “Double Agents” in the Mental Health Court

An ethnographic study of four Midwest mental health courts was focused on how case managers influence the judicial response to offender noncompliance. Mental health courts, which bear little resemblance to traditional work group models, are staffed by teams of legal and social service professionals working collaboratively toward reducing recidivism and community reintegration for high‐risk offenders. Few studies, however, have explored how treatment providers practice their trade in this new court organization. I investigate how case management professionals, working at the intersections of the social welfare and criminal justice systems, leverage courtroom decision making that results in greater leniency or enhanced punishment. The findings suggest that mental‐health‐court case managers act as boundary spanners in terms of their strategic use of resources to facilitate treatment goals. I conclude that case managers act as “double agents” challenging the state to advocate for clemency while enforcing client rules to uphold the integrity of the court.     

Patterns of Practice in Mental Health Courts: A National Survey

Mental health courts (MHCs) represent an important new development at the interface of the criminal justice and mental health systems. MHCs are criminal courts for persons with mental illness that were in part created to divert this population from jail/prison into community treatment. MHCs are proliferating rapidly despite limited knowledge regarding their characteristics or their efficacy. We surveyed the entire population of adult MHCs in the United States, n = 90. In the past 8 years, MHCs have been created in 34 states, with an aggregate current caseload of 7,560 clients in MHCs nationally. Most courts (92%) reported using jail as a sanction for noncompliance, if only rarely. Further, jail sanction use was significantly predicted by increased judicial supervision and number of felons in the court. Implications for MHCs and social monitoring are discussed.     

Information pathways into prison mental health care

Police and court liaison and diversion services provide important specialist mental health input along critical stages of the criminal justice pathway. Effective sharing of information between the services and relevant justice agencies is essential. However, various problems exist with the flow of information between agencies and services across the criminal justice pathway. This service evaluation explored how clinically relevant information is transferred, by drawing on the perspectives of prison health care staff in a large urban UK male prison. A qualitative service evaluation was conducted using semi-structured interviews with a purposive sample of 11 prison staff. The main themes included: gaps in the transfer of essential information, (particularly concerning risk and offending information); information gathering to fill these gaps; the importance of professional relationships, information sharing between agencies; and information solutions. Improving information transfer across the criminal justice pathway could prevent treatment delays and ensure more timely mental health care in prison.     

Mental Health Court Outcomes: A Comparison of Re-Arrest and Re-Arrest Severity Between Mental Health Court and Traditional Court Participants

Mental health courts have been proliferating across the country since their establishment in the late 1990's. Although numerous advocates have proclaimed their merit, only few empirical studies have evaluated their outcomes. This paper evaluates the effect of one mental health court on criminal justice outcomes by examining arrests and offense severity from one year before to one year after entry into the court, and by comparing mental health court participants to comparable traditional criminal court defendants on these measures. Multivariate models support the prediction that mental health courts reduce the number of new arrests and the severity of such re-arrests among mentally ill offenders. Similar analysis of mental health court completers and non-completers supports the prediction that a "full dose" of mental health treatment and court monitoring produce even fewer re-arrests.     

Long-term recidivism of mental health court defendants

The first MHC was established in 1997 and now, over 15 years later, there are over 300 mental health courts in the United States. In a relatively short time these courts have become an established criminal justice intervention for persons with a mental illness. However, few studies have looked at the long-term outcomes of MHCs on criminal recidivism. Of the studies evaluating the impact of MHCs on criminal recidivism, most follow defendants after entry into the court during their participation, and only a few have followed defendants after court exit for periods of one or two years. This study follows MHC defendants for a minimum of five years to examine recidivism post-exit with particular attention to MHC completion's effect. Findings show that 53.9% of all MHC defendants were rearrested in the follow-up and averaged 15 months to rearrest. Defendants who completed MHC were significantly less likely to be rearrested (39.6% vs. 74.8%), and went longer before recidivating (17.15 months vs. 12.27 months) than those who did not complete. This study suggests that MHCs can reduce criminal recidivism among offenders with mental illness and that this effect is sustained for several years after defendants are no longer under the court's supervision.     

Worthy of Justice: A Veterans Treatment Court in Practice

This article examines the purpose and practice of a Veterans Treatment Court (VTC), a new type of problem-solving court designed to connect qualifying former service members in the criminal justice system with social services. While existing studies of VTCs explain these courts by focusing on veterans' distinct needs or deservingness based on their military service, this article argues that these courts are being created because of societal beliefs about veteran worth. By revealing how court staff, participants, and volunteers in one VTC invoke beliefs about veteran worth, the findings of this study show that VTCs link worth to veteran identity, leaving participants suspended in conflicting notions of state and individual responsibility for criminal behavior.     

Mental health services in New Zealand

The development and reorganization of mental health services in New Zealand is underpinned by a national strategy, with increased funding from the government, and is occurring on a background of radical change in health service policy and delivery. The major challenge will be to sustain the developments to date, and increase the quality and quantity of services in a climate of ongoing change. A more integrated form of service delivery and funding would potentially enhance the development of population-based mental health services, which will allow the alignment of targeting specialty service to the 3% of the population with the highest need, with a more comprehensive approach to overall mental health service through the primary sector.     

Juvenile diversion and the constitution

The juvenile justice system has been a product of interaction between legal and socio-medical forces since its inauguration near the end of the last century. While the socio-medical forces have, for the most part, been dominant over the years, concern for minimum legal standards has been a conspicuous part of the picture since the years 1966 to 1967. The result is serious attention to due process and fundamental fairness in court processing, and low tolerance for abridgement of such rights in the interests of attaining the social goal of rehabilitation. The question arises as to how early in the procedural chain for juveniles various due process rights should enter. Some have argued that important due process rights should be components in the process leading to probation, and even police, diversion. The central argument of this article is that broad directives regarding due process in diversion are inappropriate. Indeed, analysis of actual and potential losses of freedom associated with diversion decisions leads to the general conclusion that very few diversion programs require usual procedural rights. Moreover, a survey of case law indicates that there is little reason to expect that the procedural protections enunciated by the U.S. Supreme Court so strongly in the 1960s will be extended by the courts to police (or probation) decisions on diversion in the 1980s.     

The Courts,Intimate Partner Violence and Mental Illness: The Case of Dwight Lamon Jones

Through the lens of the high-profile spree killing perpetrated by Dwight Lamon Jones in 2018 in Phoenix, Arizona, this article examines the way the criminal and civil courts grappled with assessing the significance, extent, and outcome of the IPV and abuse directed at Dr. Connie Jones, Dwight Jones’s former wife. The case is unusual, not least because Dr. Jones had an upper middle-class income and numerous resources IPV victims do not normally enjoy. Nevertheless, she felt the courts let her family down. Journalists, victim advocates, and others also criticized the Arizona courts. The article outlines the spree killing and the criticisms of the courts, narrates Jones over a period of nine years including the IPV and mental illness, and, through the work of the Study Committee convened by Arizona Chief Justice Bales, explores the potential use of IPV risk assessments in the courts, particularly the family court, and related matters. It concludes with recommendations regarding possible preventive interventions in IPV cases, including those addressing mental illness.     

PLC or TLC: is outpatient commitment the/an answer?

The lively debate over mandated community treatment in general and outpatient commitment laws (OPC) in particular has raised many issues. At its core, the debate is over how and to what extent laws should be formulated to persuade, leverage or coerce (PLC) persons with severe mental illness living in the community to comply with medications that mental health professionals believe they need. The alternative to PLC is what we call TLC (tender loving care): a strategy of using benefits - improved patient-centered treatment, entitlements and service delivery, including assertive outreach - rather than penalties or conditions on access to services, to induce compliance. We examine three aspects of the debate: (1) the empirical case for the need for OPC court orders to maintain revolving-door severely mentally ill persons in the community; (2) the normative argument over whether such orders constitute coercion, and, if so, whether that coercion is justifiable; and (3) the incentives such orders create to leverage community providers to augment resources and tailor treatment and services to entice patients to become willing participants in the management of their disorders.