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.     

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.     

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.     

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.     

The Courts in a Fragmented Criminal Justice System

The U.S. President's Commission on Law Enforcement and Administration of Justice under President Johnson in 1967 outlined a central role for courts in the criminal justice system. That role, however, has been somewhat diminished by the dominance of plea bargaining and the legislative enactment of mandatory minimum sentences that limit judges’ discretion. At the same time, judges have become more involved in specialized courts dealing in cases involving drugs and mental illness. A major topic of concern is the lower courts, which in many areas have changed little since the 1960s Commission. In those places, the traditional adversary process is not operating well, with many defendants pleading guilty unnecessarily in a system that may be designed primarily to collect fees. In violent crime cases, the imposition of capital punishment remains a controversial issue for states that is not likely to be resolved by a new national commission. The central court functions of sentencing and overseeing plea bargains are discussed elsewhere in this volume.     

USING RANDOM JUDGE ASSIGNMENTS TO ESTIMATE THE EFFECTS OF INCARCERATION AND PROBATION ON RECIDIVISM AMONG DRUG OFFENDERS*

Most prior studies of recidivism have used observational data to estimate the causal effect of imprisonment or probation on the probability that a convicted individual is rearrested after release. Few studies have taken advantage of the fact that, in some jurisdictions, defendants are assigned randomly to judges who vary in sentencing tendencies. This study investigates whether defendants who are assigned randomly to more punitive judges have different recidivism probabilities than defendants who are assigned to relatively lenient judges. We track 1,003 defendants charged with drug-related offenses who were assigned randomly to nine judicial calendars between June 1, 2002 and May 9, 2003. Judges on these calendars meted out sentences that varied substantially in terms of prison and probation time. We tracked defendants using court records across a 4-year period after the disposition of their cases to determine whether they subsequently were rearrested. Our results indicate that randomly assigned variations in prison and probation time have no detectable effect on rates of rearrest. The findings suggest that, at least among those facing drug-related charges, incarceration and supervision seem not to deter subsequent criminal behavior.     

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.     

Recidivism Outcomes for Suburban Mental Health Court Defendants

Mental health courts have recently emerged as one means to reduce the number of persons with mental illness in the criminal justice system. Using a post-test only comparison group design, this study examined rearrest rates for 1 year post discharge among three groups meeting admission criteria for a municipal mental health court. The rearrest rate of defendants who successfully completed the program (N = 351) was 14.5%, compared to 38% among defendants negatively terminated from the program (N = 137), and 25.8% among defendants who chose not to participate (N = 89). This positive result held even when controlling for a range of variables in a Cox regression survival analysis. Factors associated with rearrest are identified for each of the three groups.     

Punishment in Indian Country: Ironies of Federal Punishment of Native Americans

Native Americans are US citizens, but they are also tribal nationals subject to complex and unique criminal jurisdiction arrangements over Indian lands. Tribal nations typically have tribal court jurisdiction over less serious crimes, but for serious crimes the federal justice system often supersedes tribal authority, exposing Native Americans to more severe punishments. In addition, recent federal programs have attempted to foster greater tribal/federal criminal justice coupling. Yet, examinations of criminal punishment of Native Americans are few, and most are outdated and/or of very limited generalizability. We examine the punishment of Native American defendants in federal court, focusing on 28 federal districts with substantial Indian presence. Using recent US Sentencing Commission data, as well as contextual data from the Bureau of Indian Affairs and tribal courts, we focus on differences in the federal sentencing of Native American defendants, and how these differences are conditioned by indicators of tribal-federal criminal justice coupling.     

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.     

In Search of the Missing Link: Examining Contextual Variation in Federal Charge Bargains across U.S. District Courts

Abstract

Punishment scholars acknowledge the fundamental importance of both prosecutorial discretion and jurisdictional variation in punishment; yet, little is known about the extent to which charging practices vary across court contexts. This is especially true in the federal criminal justice system. This research investigates this issue by linking four years of charging data from the Administrative Office of the U.S. Courts (AOUSC) to corresponding data from the U.S. Sentencing Commission (USSC). It incorporates unique information on district court contexts from a variety of sources to investigate jurisdictional variation in charge reductions. Findings provide evidence that federal charging practices vary across district courts. In particular, several structural court characteristics are significantly related to the likelihood of charge reduction for similarly-situated defendants. Results from this study are interpreted through the lens of contemporary legal perspectives on court communities and suggest several fruitful directions for additional research on the social contexts of criminal prosecution.     

Long-term effects of participation in the Baltimore City drug treatment court: Results from an experimental study

This study uses an experimental design comparing 235 offenders assigned either to drug treatment court or treatment as usual. It extends prior analyses of this study sample to examine whether differences observed between drug treatment court subjects and control subjects at one and two years after the start of the program persist after three years, when many of the subjects had ceased active treatment. Further, it extends earlier analyses that showed that the quantity of drug treatment court services received was related to lower recidivism rates by using an instrumental variables approach to handle the endogeneity problem that sometimes arises when subjects self-select into different levels of service. Results show a sustained treatment effect on recidivism, controlling for time at risk. This effect is not limited to the period during which services are delivered. Rather, it persists even after participation in the drug court program ceases. Results also show that the recidivism is lowest among subjects who participate at higher levels in certified drug treatment, status hearings, and drug testing. These positive findings are tempered with findings that more than three-fourths of clients are re-arrested within three years, regardless of participation in the drug treatment court, and that drug treatment court cases spend approximately the same number of days incarcerated as do control cases. Implications for strengthening drug treatment courts are discussed.     

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.     

Is the Process the Only Punishment?: Racial–Ethnic Disparities in Lower-Level Courts

Although misdemeanors make up the bulk of criminal cases in the United States, the majority of research on court decision-making examines felony sentencing. In contrast to felony courts, lower-level courts are characterized by higher case volumes and increased reliance on informal sanctions, which may contribute to greater racial–ethnic disparities. To assess this possibility, we examine pretrial detention and case processing outcomes for misdemeanants in Miami-Dade County, Florida. Utilizing temporal (detention time) and monetary (bond amount) measures of pretrial detention, we assess whether and to what extent there are racial–ethnic disparities in formal and informal sanctions facing misdemeanants. Results indicate that black defendants, especially black Latinx defendants, face greater informal sanctions (longer detention and higher bond amounts), are more likely to be convicted, and experience more severe formal sanctions than do white non-Latinx defendants. These findings complicate Feeley's (1979) argument about lower-level cases, revealing that black defendants are punished by both the court process and formal sanctions. In this way, “the process is the punishment” for lower-level white and nonwhite defendants, while the punishment is also the punishment for black defendants.     

Legal narratives as significant news sources about mental illness and violent crime

Media coverage about people affected by mental illness is an area of research that is extensively examined. Many scholars argue that the media depicts people with mental illness as inherently violent and dangerous within sensational narratives. These depictions are criticized for reinforcing the social stigma and disadvantages many of the mentally ill face. The media does, however, require news sources and, in the context of crime and mental illness, the courts are a significant source. Through qualitative content analysis of Australian newspaper articles, this research examines an under-researched and incompletely theorized area. In doing so, it demonstrates that media depictions of some mentally ill offenders reflect and heavily draw upon legal narratives and what is argued in court about these offenders in the context of criminal responsibility and legal insanity.     

Correctional Policy for Offenders with Mental Illness: Creating a New Paradigm for Recidivism Reduction

Offenders with mental illness have attracted substantial attention over the recent years, given their prevalence and poor outcomes. A number of interventions have been developed for this population (e.g., mental health courts). They share an emphasis on one dimension as the source of the problem: mental illness. Their focus on psychiatric services may poorly match the policy goal of reducing recidivism. In this article, we use research to evaluate (a) the effectiveness of current interventions, and (b) the larger viability of psychiatric, criminological, and social psychological models of the link between mental illness and criminal justice involvement. We integrate theory and research to offer a multidimensional conceptual framework that may guide further research and the development of efficient interventions that meaningfully reduce recidivism. We hypothesize that the effect of mental illness on criminal behavior reflects moderated mediation (i.e., the effect is direct in the case of one subgroup, but fully mediated in another); and that the effect of mental illness on other “recidivism” is partially mediated by system bias and stigma. We use this framework to propose three priorities for advancing research, articulating policy, and improving practice.     

The feasibility of a brief evaluation of mental state at the time of the offense

If psychological evaluations of criminal defendants could be performed in the community on an outpatient basis rather than in a distant state hospital on an inpatient basis, substantial savings could result and defendants' rights to speedy trial, bail, and the least restrictive alternative would more likely be respected. The authors thus developed a protocol, the mental state at the time of the offense screening evaluation (MSE), designed to enable outpatient evaluatiors to “screen out,” in the course of a brief interview, those defendants whose alleged criminal conduct clearly was not caused by “significant mental abnormality.” They tested the validity of the MSE by having pairs of mental health professionals use the MSE to evaluate 36 criminal defendants. The professionals' conclusions were then compared with the conclusions of state hospital professionals who performed a comprehensive evaluation of each defendant. They were also compared to court adjudications of the defendant's criminal charges. They found that the MSE screened out a large proportion of defendants (sufficient to suggest an improvement in cost-efficiency) without prejudice to those defendants who might have a valid legal defense.     

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.