Abstract
BackgroundBased upon therapeutic justice principles, mental health courts use legal leverage to improve access and compliance to treatment for defendants who are mentally ill. Justice-involved women have a higher prevalence of mental illness than men, and it plays a greater role in their criminal behavior. Despite this, studies examining whether women respond differently than men to mental health courts are lacking. Study goals were to examine gender-related differences in mental health court participation, and in criminal justice, psychiatric and health-related outcomes.MethodsThis study utilized a quasi-experimental pre-posttest design without a control group. The data were abstracted from administrative records of Kalamazoo Community Mental Health and Substance Abuse agency, the county jail and both county hospitals, 2008 through 2011. Generalized estimating equation regression was used to assess gender-differences in pre-post program outcomes (jail days, psychiatric and medical hospitalization days, emergency department visits) for the 30 women and 63 men with a final mental health court disposition.ResultsProgram-eligible females were more likely than males to become enrolled in mental health court. Otherwise they were similar on all measured program-participation characteristics: treatment compliance, WRAP participation and graduation rate.All participants showed significant reductions in emergency department visits, but women-completers had significantly steeper drops than males: from 6.7 emergency department visits to 1.3 for women, and from 4.1 to 2.4 for men. A similar gender pattern emerged with medical-hospitalization-days: from 2.2 medical hospital days down to 0.1 for women, and from 0.9 days up to 1.8 for men. While women had fewer psychiatric hospitalization days than men regardless of program involvement (2.5 and 4.6, respectively), both genders experienced fewer days after MHRC compared to before. Women and men showed equal gains from successful program completion in reduced jail days.ConclusionsDespite similar participation characteristics, findings point to greater health gains by female compared to male participants, and to lower overall psychiatric acuity. Mental-health-court participation was associated with decreased psychiatric hospitalization days and emergency department visits. Successful program completion correlated to fewer jail days for both women and men.Electronic supplementary materialThe online version of this article (doi:10.1186/s40352-014-0012-0) contains supplementary material, which is available to authorized users.
Highlights
Based upon therapeutic justice principles, mental health courts use legal leverage to improve access and compliance to treatment for defendants who are mentally ill
Therapeutic justice The therapeutic justice movement grew from a recognition that crimes related to certain psychosocial problems such as addiction, domestic violence and mental illness were associated with higher recidivism and were less responsive to traditional criminal justice approaches (Winick 2002)
Study purpose This study provided a unique opportunity to examine the intersection of therapeutic justice, gender, crime, and health by reporting findings from a longitudinal study of 133 participants in a mental health court (30 women and 63 men)
Summary
Based upon therapeutic justice principles, mental health courts use legal leverage to improve access and compliance to treatment for defendants who are mentally ill. Justice-involved women have a higher prevalence of mental illness than men, and it plays a greater role in their criminal behavior. Study goals were to examine gender-related differences in mental health court participation, and in criminal justice, psychiatric and health-related outcomes. Therapeutic justice The therapeutic justice movement grew from a recognition that crimes related to certain psychosocial problems such as addiction, domestic violence and mental illness were associated with higher recidivism and were less responsive to traditional criminal justice approaches (Winick 2002). Within the therapeutic justice model, “problem solving” specialty courts are established that use legal leverage to address the root cause of criminal behavior (e.g., addiction, domestic violence or mental illness) through treatment and community resources (Hora et al 1999). Benefits that are not just the result of keeping participants away from the adverse health conditions associated with incarceration, and by improving conditions that mediate health (i.e., substance abuse, mental distress and violence)
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