Mental Health Court Participants Research Articles

Assessing the Effectiveness of Mental Health Courts in Reducing Recidivism: A Systematic Review with Meta-analysis

Mental Health Courts (MHCs) are a type of treatment court created to divert offenders with mental illness away from incarceration and into community-based treatment. While research on the impact of MHCs on recidivism has produced mixed results, there is a need to determine whether MHCs are effective. In light of this need, and of public support for the balanced justice approach toward mentally ill offenders, this study aims to assess the impact of MHC participation on recidivism. As such, the current study is a systematic review and a meta-analysis which replicates a study conducted by Lowder and colleagues while incorporating modifications to the methodology to reflect the new Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) guidelines to determine the effect of MHC participation on recidivism. Results from the 15 included studies show a significant reduction (42.46%) in recidivism for individuals who participated in MHC treatment program. Policy implications, in light of the MHC model’s reduction in recidivism and alignment with the ideals of balanced justice, are discussed.

Classification of Mental Health Court Participants: Implications for Completion and Recidivism

The aims of this study were to (a) classify the types of individuals who might be most appropriately served by a mental health court (MHC) and (2) describe the association between class membership on recidivism and MHC completion. Criminal and treatment history data for 350 MHC participants were used. Class memberships were derived using hidden Markov models. Mediation analysis was then used determine the relationship between class, successful MHC completion, and recidivism. Modeling identified a three-class solution and a subsequent path analysis found that those classes associated with lower criminal justice system involvement were more likely to finish MHC successfully and were less likely to recidivate. This study supports research showing patterns of criminal behavior and health/mental health service use is associated with MHC completion and recidivism. The classification of individuals presented here may help court professionals determine to whom MHC should be offered.

Making a Case for Gender-Responsive, Trauma-Informed Mental Health Courts: An Exploration of Participant Trauma Histories

Considering the disproportionate number of people in the criminal justice system with trauma histories, in conjunction with the disproportionate number of people with mental illness who have experienced trauma, examining the trauma histories of mental health court (MHC) participants is essential. However, no studies to date have explicitly examined the trauma histories of this vulnerable population. Therefore, the present study aimed to describe the lifetime prevalence of traumatic events and posttraumatic stress disorder (PTSD) diagnosis among a sample of 163 participants within a Northeastern U.S. MHC. Gender differences were also explored. Overall, about 83% of MHC participants reported any lifetime trauma, with significantly higher rates among female participants (94.2%) as compared to male participants (78.4%). Approximately half of MHC participants reported experiencing childhood maltreatment, with women being significantly more likely to have experienced physical and sexual abuse during childhood than men. Further, women had higher rates of sexual assault and intimate partner violence. The percentage of women diagnosed with PTSD was about twice that of the men. These findings underscore the need for a trauma-informed and gender responsive approach to MHCs. Suggestions for MHCs to consider are offered, including trauma screening tools into MHC assessment procedures, cultivating a more trauma-informed culture by adapting key principles, and incorporating trauma-specific programming and therapies into their offerings.

Racial and ethnic differences in behavioral health, criminal legal system involvement, and service needs among mental health court participants: Implications for service delivery.

Mental Health Courts (MHCs), an alternative to incarceration, aim to address behavioral health, social needs, and criminal recidivism and serve many adults with co-occurring mental health and substance use disorder (COD). Despite the growth in MHCs, little research has examined ethnic/racial differences in behavioral health and service needs of individuals with COD. This study used data from behavioral health and social assessments administered to 146 adults with COD entering a Massachusetts MHC. Multivariate linear and logistic regression controlling for key demographics tested differences between racial/ethnic groups on current and lifetime substance use, mental health symptoms, and history of criminal legal system involvement. Hispanic participants were more likely than non-Hispanic White participants to report current and lifetime serious mental illness and lifetime Emergency Department (ED) mental health treatment. Non-Hispanic White participants were more likely to report current and lifetime use of illicit substances, more recent outpatient and overall lifetime treatment attempts for substance use, and higher number of lifetime arrests compared to non-Hispanic Black participants. Lastly, non-Hispanic White participants also reported more recent outpatient and overall lifetime treatment attempts for substance use compared to Hispanic participants. Racial/ethnic differences in behavioral health and social needs of MHC enrollees with COD exist and should be considered in the planning and delivery of psychological and social services. Understanding the diverse population of new MHC enrollees is an important first step in identifying and addressing racial and ethnic disparities. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

Measuring Recidivism Among Mental Health Court Participants Using the Wisconsin Risk Need Assessment Tool

ABSTRACT The majority of prior research on Mental Health Courts (MHCs) and recidivism has focused on the effects of clinical and criminogenic factors. Few studies have examined the efficacy of risk assessment tools in measuring recidivism among MHC participants. The current study examines the predictive validity of the Wisconsin Risk Need assessment tool, along with other intake factors, in measuring rearrest for a sample of 318 defendants referred to a MHC in Texas. Though risk scores were significantly correlated with rearrest, other factors, such as having been placed on probation for a felony and employment at intake had stronger effects in the model. Having been arrested for an assault-related offense was not associated with rearrest. The study’s results highlight the general ineffectiveness of the Wisconsin Risk Need tool with mental health populations and the importance of accounting for other risk and protective factors separately to gauge recidivism.

An Ego-Centric Model of Criminal Arrest Among Mental Health Court Participant Network

People with serious mental illness are disproportionately represented among prison/jail populations. Mental health courts (MHC) serve as an alternative to incarceration. In this study, we explore the extent to which MHC participants have members of their social network who were reported as having a history of arrests. Multilevel logistic regression demonstrated friends who used drugs, race, and network density were all predictive of MHC participants’ friends who have a history of arrest. Results demonstrate an association between MHC participation and arrest among individuals in their social network. Given the importance of social support in recovery from mental illness and in desisting from crime, such limitations can be problematic. MHC participants may be disinclined to engage with the very individuals who are able to provide social and emotional support.

Role of Social Support and Ego Network Characteristics on Quality of Life

Mental health courts offer alternatives to incarceration for persons with severe mental illness who are involved in the criminal justice system. These courts have the dual function of ensuring treatment for persons involved in the court as well as ensuring the safety of the public. Persons with severe mental illness who are involved in mental health courts rely on others for support, such as family members. Others may buttress the participant from engaging in criminal activities and provide for needs of the participant. The supportiveness as well as the composition of one’s network members may play a role in the success of mental health court participants, such as successfully completing the mental health court program and avoiding incarceration. Little research has explored how social support impacts mental health court participants. We explored how the composition and sense of support of network members were associated with mental health court participants’ quality of life. We regressed quality of life on social support and network characteristics of 80 participants in two mental health courts. Findings suggest that perceived support is positively associated with quality of life, and the proportion of family in one’s network was negatively related to quality of life. Findings suggest that persons involved in mental health courts need supportive others in their social networks in addition to family. More research is needed to explore the reasons having a higher proportion of family members in one’s network is associated with lower quality of life. Practitioners need to pay attention to and leverage mental health court participants’ social networks to help improve their quality of life.

Review on the effectiveness of Canadian and American mental health courts

Objective: This systematic review synthesizes mental health court (MHC) research across the United States and Canada. This study reviews and compares the operations and practices of MHCs across both countries, as well as their recidivism rates. Methods: We gathered from existing literature to present common MHC practices used across the United States. However, in response to the lack of literature about Canadian day-to-day practices, we developed a questionnaire and contacted every Canadian MHC. In total, we contacted 36 Canadian MHCs, and 19 courts filled out a questionnaire. With respect to recidivism rates, we conducted a comprehensive literature search in February and March 2019 in PsycINFO, Google Scholar, Web of Science, and National Criminal Justice Reference Service Abstracts using the keywords mental health court, therapeutic justice, serious mental illness, mentally ill offenders, mental health diversion and problem-solving courts. Results: Canadian and American MHCs have similar practices. However, American MHC’s have more robust screening measures and typically admit more participants with schizophrenia, bipolar disorder, and major depressive disorder into their programs compared to Canadian MHCs. MHC participants in both countries typically had lower recidivism rates compared to regular docket court participants. Conclusions: MHC research should inform public policy. Additional research should move in the direction of discovering the predictors for why MHCs reduce recidivism.

Arrest and emergency medical services events among participants from one of the first mental health courts

ObjectiveThis study looked at, in addition to subsequent arrest, emergency medical services (EMS) events as an outcome of participation in mental health court (MHC). MethodsWe linked information from participants of a MHC in Marion County, Indiana with jail booking and EMS services data. To understand programmatic impact, we looked at differences in jail bookings and EMS events within one year prior to and one year after MHC participation. We ran paired t-tests to understand whether correlations were significant. We also considered differences in outcomes between those who successfully completed MHC versus those who did not. ResultsMHC participation was significantly associated with a reduction in jail bookings and EMS events in the 12 months after program participation compared to the 12 months before. When comparing MHC participant groups, a significant reduction in jail bookings is found consistently whereas a significant reduction in EMS events was found in only some participant groups: the entire MHC group and the misdemeanor-level court (PAIR) participants when they successfully completed the program. ConclusionsEMS utilization should be an outcome of consideration in evaluating the success and cost savings of MHCs. Where MHCs do not result in significantly reduced EMS events, communities should consider what individual-level and community-level factors contribute to this and adjust accordingly.

Connecting mental health court participants with services: Process, challenges, and recommendations.

Connecting mental health court participants with services: Process, challenges, and recommendations.

Prospective study of mental health court and life satisfaction

Many communities have created specialized mental health courts (MHCs) to reduce unnecessary criminal justice involvement of persons with mental disorders. Although MHCs have shown favorable public safety outcomes, such as reducing risk for criminal recidivism and violent behavior, there has been little study of issues important to consumers, such as life satisfaction. This study prospectively evaluated the association between MHC participation and life satisfaction using data from 140 participants in a quasi-experimental research project on the San Francisco MHC. A fixed-effects regression model was used to examine whether MHC involvement predicted life satisfaction at 6-month follow-up while controlling for baseline life satisfaction, age, gender, and schizophrenia diagnosis. MHC involvement, baseline life satisfaction, and schizophrenia diagnosis significantly predicted life satisfaction at 6-months. Although the public safety benefits of MHCs are important, the present study also shows the potential for MHC to enhance important outcomes such as life satisfaction.

Deciding to participate in mental health court: Exploring participant perspectives

As the number of mental health courts (MHC) expands across the United States, so does the body of research demonstrating its effectiveness in reducing criminal recidivism. While there has been considerable research conducted on MHC operations, less is known about how individuals decide to participate in MHCs. Data from in-depth interviews with 26 MHC participants from two MHCs in the United States were analyzed using grounded dimensional and thematic analyses. Results suggest that individuals participated in MHC to avoid incarceration and obtain treatment. Participants understood the court to function in four distinct ways: 1) to help through service provision, 2) to structure a judicial agreement allowing MHCs to make treatment decisions in exchange for community living, 3) to protect people from risks within the criminal justice system, and 4) to reward participants for treatment adherence. Findings can be used to guide the need for policy and practice for those referring to MHCs.

Racial Variation in Mental Health Court Experiences and the Associations of These Experiences With Recidivism

Little is known about how mental health court (MHC) experiences (including satisfaction and sanctioning, incentivizing, and life change events) differ by race and how this variation affects recidivism among MHC participants. This study examined how MHC experiences and recidivism differ between White ( n = 170) and Black ( n = 132) participants from four different MHCs in the United Sates. Negative binomial regression models, conducted separately for the two groups, indicated that life changes were associated with decreased arrests and that court sanctions were associated with increased number of arrests for both White and Black participants. Higher program satisfaction was positively associated with recidivism among Black participants only. To provide equitable services for people convicted of a crime with mental illness, professionals should acknowledge racial variation in the experiences of MHC participants (both within the MHC and the communities in which they are situated) and how these experiences relate to recidivism.

Voluntariness of treatment, mental health service utilization, and quality of life among mental health court participants.

Voluntariness of treatment, mental health service utilization, and quality of life among mental health court participants.

Absence of insight as a catch-all extra-legislative factor in Swedish mental health law proceedings

Previous research indicates that insight is frequently used but rarely defined in mental health proceedings. This article examines how participants in Swedish administrative court proceedings use the concept of insight when discussing decisions regarding involuntary psychiatric care. Open-ended qualitative interviews were conducted with professional mental health court participants. The results show that lack of insight is used by the informants as an argument for all three legal criteria for involuntary psychiatric care in Sweden, as well as the criterion for release from forensic psychiatric care. It is concluded that there are troublesome legal and ethical implications of courts relying on a poorly defined concept such as insight in their rulings.

Effect of behavioral health services and neighborhood disadvantages on recidivism: a comparison of mental health court and traditional court participants

This study investigates the impact of behavioral health services and neighborhood disadvantage on recidivism among offenders with mental illness in mental health courts (MHCs) and in traditional courts. Although treatment is believed to lead to reduced recidivism for offenders with mental illness, little research has been conducted with MHC participants. Furthermore, neighborhood disadvantages are known to influence recidivism generally, but environmental factors have not been examined in the MHC context. Data from the MacArthur MHC study were analyzed including 741 offenders with mental illness. Multilevel negative binomial regression was used to investigate individual and neighborhood level variances on recidivism and to control for the over-dispersion data. Neighborhood disadvantage data were obtained from the American Community Survey linked with residential data from participants. MHC participants received more behavioral health services of all types than the treatment as usual (TAU) group with the exception of substance abuse case management. However, MHC participants lived in the more disadvantaged neighborhoods compared to the TAU group. MHC participants receiving substance abuse therapy were more likely to be arrested compared to the MHC participants without this therapy. A significant effect of neighborhood disadvantage on arrests was found across all study models. Professionals should recognize the importance of issues related to treatment-related variables and neighborhood disadvantages to develop, provide, and implement innovative interventions for offenders with mental illness. Understanding behavioral health services and neighborhood disadvantage associated with recidivism can help to more efficiently target research, practice, and policy for offenders with mental illness.

Criminogenic Factors Associated with Noncompliance and Rearrest of Mental Health Court Participants

There is a considerable overrepresentation of individuals with mental health issues within the U.S. criminal justice system as compared with the general population. Mental health courts (MHCs) arose in response to this concern, with a primary aim of reducing recidivism. Thus far, MHC research has largely neglected the potential utility of criminogenic factors. A retrospective analysis of 163 MHC participants was conducted to examine the association between clinical and criminogenic factors and noncompliance, as well as for recidivism, using a series of Bayesian negative binomial regression models to compare predictors. Criminogenic factors, namely first offending prior to the age of 18, having a substance-related diagnosis, commission of a variety of crimes, historical probation or parole violation, and having less than a high school education were associated with an increased rate of engaging in noncompliant behavior and rearrest. None of the clinical factors were directly associated with noncompliance or rearrest outcomes.

The impact of mental health court: A Sacramento case study.

Mental health courts (MHCs) use a collaborative justice approach to provide a therapeutic alternative to the traditional justice process for defendants with mental illnesses directly relevant to their alleged criminal offenses. MHCs have proliferated in recent years, in light of early research reports documenting their successes. The aim of this paper is to provide further evaluation of the effects of MHCs by evaluating the impact of the Sacramento County MHC in California. We analyzed quantitative data and conducted interviews with stakeholders and MHC participants to understand how the MHC influenced individual participants' recidivism rates, mental health, and quality of life. Results from the quantitative data analysis indicate that defendants had a lower rate of recidivism after the MHC program than before it. Moreover, graduates were less likely to be rearrested and rehospitalized than non-graduates. Qualitative analyses revealed several core themes regarding participants' views on facilitators and barriers related to the MHC's success. These findings provide further insights into the effectiveness of MHCs.

Life Changes Matter More Than Satisfaction or Sanctions/Incentives: An Examination of Mental Health Court Experience Factors Associated with Arrest

While current evaluation studies have shown consistent and strong evidence of reducing recidivism for mental health court (MHC) programs, few studies have explored the potential factors that may lead to this success. The purpose of this study is to examine the effect of participants’ experiences (i.e., program satisfaction, life changes, sanction/incentives) on justice outcomes in MHC. Data are from the MacArthur MHC Project which includes objective and subjective information from four MHC samples with comparison samples at each site (CAs, MN, and IN; N = 355). Multilevel negative binomial regression was conducted to control for over-dispersion variable and site difference. Findings suggest that more sanctions are associated with increased number of future arrests whereas positive life changes (e.g., daily problems, symptoms, family relationship) are associated with reduced recidivism among MHC participants. Results underscore the importance of actual changes in the offenders’ lives to decrease recidivism. In order to effectively handle offenders with mental illness, who happen to be an over-represented population in the justice system, MHC staff and stakeholders need to work on how the program could change participants’ everyday life issues instead of proving the treatment alone.

The effect of systems collaboration on the individual outcomes of mental health court participants: A multi-site study

The effect of systems collaboration on the individual outcomes of mental health court participants: A multi-site study