Recognition and understanding of goals and roles: The key internal features of mental health court teams

The increasing involvement of people with mental illness in the criminal justice system has led to the formation of specialty programs such as mental health courts (hereafter MHCs). We discuss MHCs and the teams serving these courts. Specifically, we examine team members' perceptions of MHC goals and their own and others' roles on the MHC team. Using a semi-structured interview instrument, we conducted 59 face-to-face interviews with criminal justice and mental health treatment personnel representing 11 Ohio MHCs. Findings from our qualitative data analyses reveal that MHC personnel understand individuals' roles within the teams, recognize and appreciate the importance of different roles, and share common goals. MHCs could foster this level of understanding and agreement by working to recruit and retain individuals with experience in or willingness to learn about both the criminal justice and mental health systems. Future research should explore the impact of MHC team functioning on client outcomes.     

Psychiatric symptoms and mental health court engagement

People with mental illnesses are overrepresented in the criminal justice system. Many interventions have been implemented to treat the underlying causes of criminal justice involvement and prevent people with mental illnesses from recidivating. Mental health courts (MHC) are one of these programs. This analysis examines the relationship between psychiatric symptoms and MHC engagement. Eighty MHC participants from two Midwestern MHCs were interviewed. Symptom severity was assessed at baseline using the Brief Psychiatric Rating Scale. MHC engagement was estimated by treatment adherence, substance use, days spent in jail, probation violations, and MHC retention during a six-month follow-up period. Using nonparametric statistical tests and logistic regression, results indicate symptoms of depression, anxiety, and guilt are more severe at baseline for those people who are incarcerated during the follow-up period. Symptoms of anxiety are more severe for people who are terminated or went missing during the follow-up period. Further research is needed to determine the directionality and causality of these relationships. MHCs professionals should be aware of the relationship between symptom severity and MHC engagement and attempt to connect participants with treatment and services as early as possible and individualize treatment plans based on current symptoms and need.     

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.     

Jails in the United States: the phenomenon of mental illness in local correctional facilities

During the last decade, the number of mentally ill inmates in local jails has increased while courts have imposed standards of inmate care upon jail administrators which require appropriate treatment of that inmate group. While jail administrators are seeking assistance from mental health agencies as well as additional resources to deal with these problems, little specific information is presently available about the numbers and correlates of jail inmates nationally that are mentally ill; their prior contacts with mental health agencies, criminal histories, employment backgrounds, etc; and the services jails presently offer to that population. In addition, little is known by geographic region or by jail capacity. Such information is essential in developing future strategies to manage that population. This paper is a preliminary contribution to the development of that information. In addition, the data analysis can serve as a base line against which to evaluate in the structure of the mentally ill jail inmate population as well as changes in services provided by jails by comparing this analysis to future jail surveys conducted by the Bureau of Jail Statistics (BJS) or the National Institute of Justice. The research will be a secondary analysis of the Survey of Inmates of Local Jails, 1983, conducted by BJS, (made available through the Inter-University Consortium for Political and Social Research: University of Michigan, First Edition, Fall, 1985, #8274). In general an exploratory approach was used; however, a loglinear model has been asked to further refine and explore the phenomena of the mentally ill in jails.     

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.     

INTERORGANIZATIONAL UTILITY OF WELFARE STIGMA IN THE CRIMINAL JUSTICE SYSTEM*

The appropriation of “welfare stigma” or stereotypes about poor people's overreliance and abuse of public aid in two core criminal justice functions is examined: felony adjudication in a court system and space allocation in a jail. Through a comparative ethnographic study in which an abductive analysis of data (20 months of fieldwork) was used, we show that criminal justice gatekeepers utilize welfare stigma to create stricter eligibility criteria for due process in criminal courts and occupancy in jails. Specifically, the number of court appearances, motions, trials, jail beds, food, showers, and medical services is considered by professionals to be the benefits that individuals seek to access and abuse. Professionals view their role as preventing (rather than granting) access to these resources. The comparative nature of our data reveals that welfare stigma has interorganizational utility by serving two different organizational goals: It streamlines convictions in courts, which pulls defendants through adjudication, and conversely, it expands early release from jails, which pulls inmates out of the custody population. In the context of diminishing social safety nets, our findings have implications for understanding how discretion is exercised in an American criminal justice system increasingly tasked with the distribution of social services to the urban poor.     

Why do mental health courts work? A confluence of treatment,support & adroit judicial supervision

The article contributes to the understanding of ‘what works’ in mental health courts (MHCs). There are now almost 400 MHCs in the US and more worldwide. A substantial body of evidence demonstrates that MHCs can succeed in reducing recidivism among offenders who suffer mental disorders. This article argues that MHCs succeed when they have achieved the right confluence of essential elements, including providing evidence-based treatment and psychosocial supports and using adroit judge-craft. After a brief review of some of the studies demonstrating MHC success, this article discusses the research into the necessary foundations of rehabilitation programs. It is argued that, although treatment and psychosocial services should be supplied within an evidence-based framework, neither of the two leading conceptual models – Risk–Needs–Responsivity and the Good Lives Model – are empirically proven with offenders who suffer from mental disorders. Despite the absence of proof, the Good Lives Model is argued to be appropriate for MHCs because it is normatively consonant with therapeutic jurisprudence. The MHC judge is another essential element. The judicial role is assayed to elucidate how it functions to promote the rehabilitation of offenders with mental disorders. It is argued that the role of the MHC judge during supervisory status hearings is to establish a therapeutic alliance and practice motivational psychology with each MHC participant.     

The Politics of Benchcraft: The Role of Judges in Mental Health Courts

Mental health courts (MHCs) offer community‐based treatment in lieu of criminal prosecution for chronic offenders with psychiatric disabilities, and MHC judges enjoy expanded powers to achieve the court's objectives. Because scholars know little about how judges transition into a new occupational role in the problem‐solving courtroom, this ethnographic study of four MHCs in the United States focuses on how judges learn to orchestrate their responses to treatment noncompliance in this novel court setting. The goal of this article is to examine the professionalization of MHC judges and the emergent craft of therapeutic adjudication. To achieve this goal, I investigate judicial strategies for motivating, questioning, and defending participants accused of wrongdoing. I conclude that the art and practice of problem‐solving justice requires judges to rise to the larger institutional challenges embedded in the alternative courtroom, a process I call the politics of benchcraft.     

Going to Jail Sucks (And It Really Doesn’t Matter Who You Ask)

A growing body of research suggests that, according to both offenders and criminal justice practitioners, jails and correctional boot camps are viewed and experienced as significantly more punitive than prison. Nevertheless, limited research exists examining the perceptions of the public regarding jail conditions and operations. Using responses from 1,183 Kentucky adults, we examine public opinion regarding the punitiveness of jail when compared to prison. We determine that, with the exception of boot camp, respondents feel that jail is the most punitive noncapital sanction. Additionally, respondents who had been convicted of a felony at some point in their lives and respondents with lower household income indicated that they would serve significantly less time in jail to avoid prison than their counterparts if given the option. Implications for policy and future research are discussed.     

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.     

Why a jail or prison sentence is increasingly like a death sentence

Because of current conditions inside American jails and prisons, a sentence to a correctional facility routinely compromises the health, safety, and life of inmates. Four environmental factors can make a jail and prison sentence appear like a death sentence: poor health care, unsanitary living conditions, high levels of violence, and an increased number of people with chronic diseases living in close proximity. Thus, a de facto death penalty, the most controversial sanction of the criminal justice system, is the result for some inmates, and a misapplication of the criminal law is thus achieved. In order to present this argument, the author reviews research which increases the likelihood that a person will die behind bars.     

Procedural justice in mental health court: an investigation of the relation of perception of procedural justice to non-adherence and termination

Mental health courts (MHCs) operate on the principles of procedural justice (PJ). PJ highlights the importance of process over outcomes in encounters with authority. Subjective perceptions of having voice, being heard by decision-makers, and being treated with respect and concern by figures of authority are influential in assessment of fairness and in cooperation with decisions, regardless of favorability of the outcome. In this paper, we investigate MHC participant perception of PJ in interactions with MHC staff and the association between perceptions and recidivism (i.e. time in jail, new arrests, and probation violations), treatment adherence, and MHC termination. Participants from two MHC programs (n?=?80) took part in this study. Results suggest that perception of PJ during interactions with the entire MHC team is significantly associated with program termination, but not with participant behaviors during MHC. Implications for MHC practitioners and researchers are discussed.     

Crime and Expected Punishment: Changes in Perceptions at the Age of Criminal Majority

This paper assesses whether perceived punishment severity changesdiscontinuously when an individual becomes an adult in the eyesof the courts. I find that the perceived chance of jail increasesby 5.2 percentage points at the age of criminal majority, whichis over and above the general effect of aging. The magnitudeof this subjective change in the chance of jail at the age ofmajority appears to be substantially smaller than that foundin objective data. Finally, a reduced-form analysis of whetherself-reported criminal behavior changes discontinuously at theage of criminal majority finds little consistent evidence ofdeterrence.     

Citizenship, mental illness, and the criminal justice system

The concept of citizenship in regard to persons with mental illness has gained increasing attention in recent years, but little empirical research has been conducted on this topic. In addition, little research or conceptual writing has been done on the topic of criminal justice in regard to citizenship for people with mental illness, in spite of the high incidence of criminal charges and incarceration among this group. We review our work on an applied theoretical framework of citizenship, including its origins in mental health outreach work to people who are homeless and in a jail diversion program. We then suggest the contribution the framework can make to the intersecting issues of mental illness, its criminalization in the U.S., and the goal of community integration for people with mental illness.     

Matching consequences to behavior: implications of failing to distinguish between noncompliance and nonresponsivity

Neither punitive nor therapeutic approaches alone are effective at addressing the dual public health and public safety concerns associated with managing criminal behavior perpetrated by people who have psychiatric and substance use disorders. The optimal solution may instead require the integration of both criminal justice supervision and treatment. Using problem-solving courts (PSCs) as a model, we focus on one dimension of this integrated approach, distinguishing between behavior that stems from willful noncompliance with supervision and behavior that results from nonresponsivity to treatment. First, we discuss the public health and public safety consequences of using singular approaches to address the criminal behavior of this population. We then present lessons learned from PSCs that distinguish between noncompliant and nonresponsive behaviors in making treatment and supervision decisions. Finally, we consider how the concepts of nonresponsivity and noncompliance may be extended, via policy, to probation and parole settings as well as mental health and substance abuse treatment services outside the criminal justice setting in order to enhance public health and safety.     

Difficulties of cultural diversity. An exploratory study into forensic psychiatric reporting on serious juvenile offenders in the Netherlands

This paper discusses psychiatrists' assessments of the personalities of ethnic minority and ethnically Dutch juvenile offenders. Psychiatric reports and recommendations help courts determine the type and duration of sanctions. Psychiatrists are involved in almost all cases of serious juvenile crime, because under Dutch law, determining criminal responsibility is a matter for psychiatrists. The courts usually follow the recommendations of forensic psychiatrists when giving judgment and sentencing juvenile offenders.Far too little research has been conducted up to now on the difficulties encountered by forensic psychiatrists when making assessments. The present study discusses the nature and extent of these difficulties. It is based on an analysis of personality reports and sentence recommendations produced by psychiatrists attached to the juvenile courts in relation to youths subsequently sentenced to Placement in a Youth Custodial Institution (PIJ sanction) in the year 2000 (N = 164). A PIJ sanction is the most rigorous response available under the Dutch criminal law for juvenile offenders.The study shows, on the basis of the psychiatric reports, that arriving at a diagnosis is often more difficult when dealing with ethnic minority boys than in the case of their ethnically Dutch peers, since ethnic minority boys more frequently present themselves in a threatening and manipulative way, and tend to conceal their real selves. The reports indicate that the psychiatric assessment of personality is often difficult because forensic psychiatrists struggle with an inadequate knowledge and understanding of minority cultures, which seems to suggest that there is a need for a broader cross-cultural approach that would make it possible to conduct comprehensive personality assessments of serious juvenile offenders.This study was made possible by a grant from the Netherlands Organisation for Scientific Research (NWO), and was authorised by the Ministry of Justice.     

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.     

Criminal offense, psychiatric diagnosis, and psycholegal opinion: an analysis of 894 pretrial referrals

This article presents the results of a study of 894 criminal defendants referred by Virginia courts for evaluation of competency to stand trial or criminal responsibility. All evaluations were conducted on an outpatient basis by mental health professionals who had received specialized training in forensic evaluation. Findings as to the referral questions posed, the criminal offenses charged, and the clinical diagnoses and psycholegal opinions offered by the evaluators are described. Statistical analyses demonstrate significant relationships between both diagnosis and criminal charge and the psycholegal opinion rendered.     

TRICARE: certified mental health counselors. Interim final rule

This rule is submitted as an interim final rule (IFR) in order to meet the Congressional requirement set forth in the National Defense Authorization Act (NDAA) for Fiscal Year (FY) 2011, Section 724, which required the Department of Defense to prescribe regulations by June 20, 2011, to establish the criteria, as had previously been studied in accordance with Section 717 of the NDAA 2008, that would allow licensed or certified mental health counselors to be able to independently provide care to TRICARE beneficiaries and receive payment for those services. Under current TRICARE requirements, mental health counselors (MHCs) are authorized to practice only with physician referral and supervision. This interim final rule establishes a transition period to phase out the requirement for physician referral and supervision for MHCs and to create a new category of allied health professionals, to be known as certified mental health counselors (CMHCs), who will be authorized to practice independently under TRICARE. During this transition period the MHCs who do not meet the requirements for independent practice as established in this rule, may continue to provide services to TRICARE beneficiaries under the requirements of physician referral and ongoing supervision. This transition period, ending December 31, 2014, will allow time for those MHCs who seek to continue providing services under the TRICARE program to meet the independent practice requirements as outlined in this notice. After December 31, 2014, the Department of Defense will no longer recognize those mental health counselors who do not meet the criteria for a CMHC and will no longer allow them to provide services even upon the referral and supervision of a physician.     

Envisioning the next generation of behavioral health and criminal justice interventions

The purpose of this paper is to cast a vision for the next generation of behavioral health and criminal justice interventions for persons with serious mental illnesses in the criminal justice system. The limitations of first generation interventions, including their primary focus on mental health treatment connection, are discussed. A person–place framework for understanding the complex factors that contribute to criminal justice involvement for this population is presented. We discuss practice and research recommendations for building more effective interventions to address both criminal justice and mental health outcomes.