Race and Gender Recidivism Differences Among Juvenile Mental Health Court Graduates

Grounded in the theory of therapeutic jurisprudence, this research explores whether recidivism differs by race, ethnicity, or gender among juvenile mental health court graduates (N = 63). Mean number of pre‐program offenses were compared to the mean number of offenses committed by program completion. Results showed statistically significant reductions in recidivism by both males (p < .001) and females (p < .003). Racial and ethnic minorities demonstrated larger reductions when compared to Whites (p < .001 for Hispanics and p < .01 for combined ethnicities). These results contribute to the literature on effective intervention models for diverse juvenile offender populations.     

Evaluating the Effectiveness of a Juvenile Drug Court: Comparisons to Traditional Probation

Juvenile Drug Courts have been in operation in the United States for over 20 years, yet their effectiveness and design have been challenged throughout the literature. Using data collected from a Juvenile Drug Court (JDC) in Southeast Texas, this project sought to determine if the JDC intervention reduced recidivism compared to a comparison sample of juvenile offenders. Results indicate that the recidivism rates of participants in the JDC were lower than the comparison group, suggesting that the Drug Court intervention was successful. The program completion rates for JDC youths were also higher for those with fewer infractions. Although the JDC youths had statistically lower infractions, the intervention overall appears to need strengthening. A close inspection of program components could document which programmatic skills are tied to efficacy, leading to the achievement of better outcomes.     

Rethinking the Interface between Mental Illness,Criminal Justice and Academia

Punishment and treatment don’t occur within a vacuum. Responses in the justice system affect the mental health system, hospitals, clinics, and the welfare system. These systems are inextricably bound to each other. This paper, drawn from the 2009 Academy of Criminal Justice Sciences (ACJS) Presidential Address, discusses issues regarding the criminalization of mental illness, fiscal crises, and three deinstitutionalization movements. Particular attention is given to the role of academia in reshaping the criminal justice system during the current fiscal crisis.     

Violent behavior and the factors associated with the decision to report it: a retrospective study

An ample volume of research evidence supports the conclusion that severe mental illness is correlated with violent behavior. While episodes of violent behavior are included in medical notes, not all episodes of violent behavior are officially reported to the police, even when they are actual crimes. We conducted a retrospective study on the already existing clinical files of four public psychiatric outpatient facilities, based in Southern Italy, in order to assess how many cases of violent behavior are actually reported and which variables are more frequently connected with the decision to report. The data shows that the episodes known to the health services, in number and seriousness, vastly outnumber the complaints actually made towards their patients.     

Criminal Court-Ordered Psychiatric Evaluations:Does Gender Play a Role?

This study examines potential gender differences among defendants referred by criminal courts for psychiatric evaluations by analyzing demographic, clinical, and criminal history variables and evaluation findings. This study offers a large sample size of 718 females, as well as 3,627 males. Bivariate logistic regression and heterogeneity analyses were utilized to assess potential differences. Females were older; diagnosed more with mood, anxiety, and borderline personality disorders; less likely to have prior felony convictions; and more likely to be in the community than jail at the time of the evaluation. In addition, when controlling for other factors, females were more likely to be evaluated as having a mental disease or defect, to need hospitalization pending trial, and to be incompetent to stand trial.     

Referrals to a mental health criminal justice Liaison and diversion team in the North East of England

There is growing interest in the health correlates of people detained in police custody, and a number of innovations have been introduced to try to meet the complex needs of detainees. The implementation of Criminal Justice Liaison and Diversion (CJL&D) Services commissioned by the Department of Health in England is a substantial part of this investment. In this paper, we describe data from 858 detainees who were referred to the CJL&D service of a busy metropolitan police station in the North East of England. The detainees referred to the service had complex mental health needs, substance misuse and a range of vulnerabilities requiring specific intervention. The effective operation of these teams and how they interface with health and criminal justice systems also depend upon a number of systematic issues that emanate both from within the teams, and from external policy drivers.     

Overriding Psychiatric Advance Directives: Factors Associated with Psychiatrists' Decisions to Preempt Patients' Advance Refusal of Hospitalization and Medication

Psychiatric advance directives (PADs) are intended to support patients' treatment decisions during a crisis. However, PAD statutes give clinicians broad discretion over whether to carry out patients' advance instructions. This study uses data from a survey of psychiatrists (N=164) to examine reasons for overriding PADs. In response to a hypothetical vignette, 47% of psychiatrists indicated that they would override a valid, competently-executed PAD that refused hospitalization and medication. PAD override was more likely among psychiatrists who worked in hospital emergency departments; those who were concerned about patients' violence risk and lack of insight; and those who were legally defensive. PAD override was less likely among participants who believed that involuntary treatment is largely unnecessary in a high-quality mental health system.     

Competence to Complete Psychiatric Advance Directives: Effects of Facilitated Decision Making

Psychiatric advance directives (PADs) statutes presume competence to complete these documents, but the range and dimensions of decisional competence among people who actually complete PADs is unknown. This study examines clinical and neuropsychological correlates of performance on a measure to assess competence to complete PADs and investigates the effects of a facilitated PAD intervention on decisional capacity. N=469 adults with psychotic disorders were interviewed at baseline and then randomly assigned to either a control group in which they received written materials about PADs or to an intervention group in which they were offered an opportunity to meet individually with a trained facilitator to create a PAD. At baseline, domains on the Decisional Competence Assessment Tool for PADs (DCAT-PAD) were most strongly associated with IQ, verbal memory, abstract thinking, and psychiatric symptoms. At one-month follow-up, participants in the intervention group showed more improvement on the DCAT-PAD than controls, particularly among participants with pre-morbid IQ estimates below the median of 100. The results suggest that PAD facilitation is an effective method to boost competence of cognitively-impaired clients to write PADs and make treatment decisions within PADs, thereby maximizing the chances their advance directives will be valid.     

PSYCHIATRIC HOSPITAL CAPACITY,HOMELESSNESS, AND CRIME AND ARREST RATES*

As a result of developments in pharmacology, stricter standards for involuntary commitment, and changes in public expenditures, there has been a dramatic decline in the capacity of public psychiatric hospitals to maintain America's most severely mentally ill. Psychiatric deinstitutionalization has led to an increased presence of persons with mental illness in urban areas, many “falling through the cracks” of community‐based services. This is hypothesized to have contributed to homelessness, crime, and arrests. Individual‐level research has documented disproportionate and increasing numbers of mentally ill persons in jails and prisons. It has also found higher rates of violence and arrest among persons with mental illness compared to the general population. This study takes a macro‐level social control approach and examines the relationships between psychiatric hospital capacity, homelessness, and crime and arrest rates using a sample of eighty‐one U.S. cities. I find that public psychiatric hospital capacity has a statistically significant negative effect on crime and arrest rates, and that hospital capacity affects crime and arrest rates in part, through its impact on homelessness. In addition, I find no crime‐reducing effect of private and general psychiatric hospital capacity.