Mental Health Courts Research Articles

That’s What Friends Are For: Mentors, LAP Lawyers, Therapeutic Jurisprudence, and Clients with Mental Illness

This chapter serves first to introduce briefly the concept of therapeutic jurisprudence (TJ) — the study of the impact of the law, legal procedures, and the role of legal actors on the emotional well-being of those affected by the law. It explains how TJ practices of lawyers and judges often find application in special problem-solving or ‘solution-focused’ courts — such as drug treatment courts, mental health courts, domestic violence courts, DWI courts, and most recently veterans courts. Many of those courts also have volunteers — often clients who have themselves successfully completed programs in such courts — who now serve as mentors for clients newly-admitted to those courts.The chapter continues, however, by taking the ‘mentor’ concept to the professional level: speaking of lawyers and judges who have themselves confronted issues of drug and alcohol addiction and mental illness. In prior work, the author opened up this topic principally in the context of drug and alcohol addiction. Here, that work is summarized but the analysis is broadened focus principally on lawyers who have had their own struggles with mental illness — a newer area of consideration, opened up principally by a few law professors brave enough to come forth and to tell their stories of struggles with mental illness.The chapter then compares these lawyers and their ‘mentoring’ opportunities with the work of lawyers with addiction issues and begins a discussion of how they may serve, often in a ‘second chair’ advisory capacity, in civil commitment cases, mental health court cases, veterans court cases, and the like.

Mental Health Diversion Courts: Some Directions for Further Development

Recent years have seen a growth in the number of specialist courts operating in Australia, including those which aim to address the needs of mentally disordered offenders. This article describes some of the key characteristics of mental health courts, using case studies from the most established court in Australia, the South Australian Magistrates Court Diversion Program (MCDP). This is followed by a consideration of some factors that may affect the future development of this type of program. It is concluded that there is a need to pay careful attention to issues of risk assessment and risk management if the dual goals of improving both the health of individual and the safety of the community are to be realised.

Problem‐Solving Courts: Theory and Practice

AbstractProblem‐solving courts (PSCs) are a popular and fast‐growing alternative to the usual way of handling criminal cases. In place of the adversarial process, they provide court‐supervised treatment to certain groups of offenders by addressing the underlying causes of criminal behavior. They take on a variety of forms including drug courts, mental health courts, domestic violence courts, veterans’ courts, and homeless courts. PSCs, as relatively new innovations in the criminal justice system, are still evolving in scope and in practice. This article then attempts to synthesize what we know about these specialty dockets. To do so, this article (1) explores the origins and developments of PSCs as well as highlights their defining characteristics; (2) examines the theoretical approaches and empirical findings of contemporary research on problem‐solving courts; (3) critically discusses whether this new approach to old problems compromises core judicial principles; and (4) suggests directions for further research to better understand the cautionary promise of problem‐solving justice.

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.

Factors Associated with Mental Health Court Nonparticipation and Negative Termination

Mental health court outcomes research shows moderate success in reducing criminal recidivism. Far less research concentrates on defendants who do not choose to participate or are negatively terminated. Eight years of data from a suburban Midwestern mental health court indicate that substance abuse history and having multiple psychiatric diagnoses increased the odds of nonparticipation, while a bipolar diagnosis, the other category of diagnosis, and referral source, decreased the odds. For those negatively terminated, being male, racial minority status, having multiple diagnoses, a charge of stealing, and committing a new crime while under Municipal Mental Health Court supervision increased the odds of negative termination. A substance abuse history, increased mental health court attendance, receiving disability income, and psychiatric medication prescription decreased the odds of negative termination. Implications for policy, practice, and future research are discussed, including better engagement strategies for participation and treatment.

Referrals to the Washoe County Mental Health Court

This study examined the demographic, mental health, and criminal characteristics of 1,220 referrals to the Washoe County mental health court over a three-year period in order to determine which characteristics were associated with acceptance into the court. Results indicated that those with a thought disorder, a mood disorder, a felony index charge, and a misdemeanor index charge were significantly more likely to be accepted into the mental health court and those with a crime against a person, a crime against the community, and males were significantly less likely to be accepted into the court. A violent current crime and/or criminal history were also associated with rejection from the mental health court. These results have important policy implications for those who are referred to the court but who receive another disposition of their case and for those with violent crimes or criminal histories who are rejected by the court. This research is limited by its focus on one mental health court but does help to fill a void in the mental health court literature and sets the stage for a new focus on what becomes of those rejected from the mental health court.

Defendants with intellectual disabilities and mental health diagnoses: faring in a mental health court

Begun in the late 1990s, mental health courts are specialty criminal courts developed to address the needs of persons with mental illness. As many persons with intellectual disabilities (IDs) may overlap in the mental health court system, we used mental health court records to examine the phenomenology and outcomes of 224 defendants with and without co-occurring IDs in the mental health court. This study had two goals: (1) to examine the prevalence of defendants with IDs in the court and (2) to compare defendants with dual diagnoses with defendants with lone mental health disorders. Approximately 11% of defendants in the mental health court also had IDs. Compared with individuals with mental health disorders alone, individuals with dual diagnoses were more likely to be younger, male, African-American and less well-educated; these defendants were also more likely to show externalising, 'turning-against-others' symptoms, less likely to show internalising, 'turning-against-self' symptoms. Defendants with IDs (vs. those without) more often received behavioural, vocational rehabilitation and other services, although the two groups did not differ on most outcome variables. Directions for future research are discussed.

A 68-Year-Old Woman with Lung Cancer and Late-Onset Bipolar Disorder

A 68-year-old white woman was diagnosed with poorly differentiated, stage 1A, non-small cell lung cancer with possible hilar node involvement in spring 2008. To treat her cancer, she received one dose of the chemotherapeutic agents docetaxel and cisplatin and 3 days of the oral steroid dexamethasone. Within 6 weeks, she developed mild paranoid ideations and subsequent fl orid mania with delusions. All of this was despite having no prior personal or family history of psychiatric illness. Upon evaluation, she was placed on a psychiatric hold due to her inability to care for herself and was admitted for psychiatric treatment. On admission, she exhibited the following symptoms: delusions of jealousy and grandeur; increased goal-directed activity; rapid, pressured speech with fl ight of ideas; and a decreased need for sleep. After achieving a reduction in her symptoms and when it no longer appeared to be a safety concern to either herself or others, the state mental health court granted her discharge request.

Juvenile Mental Health Courts for Adjudicated Youth: Role Implications for Child and Adolescent Psychiatric Mental Health Nurses

Juvenile mental health courts for adjudicated youth. To describe the role of psychiatric nurses in reducing mental health disparities for adjudicated youth via juvenile mental health courts. ISI Web of Knowledge; Sage Journals Online; HighWire; PubMed; Google Scholar and Wiley Online Library and websites for psychiatric nursing organizations. Years included: 2000-2010. Juvenile mental health courts may provide a positive and effective alternative to incarceration for youth with mental health problems with psychiatric nurses playing a key role in program implementation.

Mental health and addiction services in the criminal justice system: Where do we sit?

Mental health and addiction services in the criminal justice system: Where do we sit?

Crimes (Mental Impairment and Fitness for Trial) Act (Victoria) R v Fitchett [2009] VSCA 150 Buchanan, Vincent and Ashley JJA

There is a concern that juries may find it difficult to deliberate upon the issue of an accused person's soundness of mind at the time of an alleged offence without being distracted by a fear that if a verdict of not guilty on the ground of insanity is returned, the accused, who the jury may consider should be kept in custody for protective purposes, may be set free. In an important appellate decision, the Victorian Court of Appeal in R v Fitchett [2009] VSCA 150 considered the proper instructions to be given to the jury when a defence of “mental impairment” is raised. The Court of Appeal held that since the changes made by s 22(2) of the Crimes (Mental Impairment and Unfitness to be Tried) Act 1997 (Vic), the common law approach previously stipulated by the High Court in R v Lucas [1970] HCA 14 had been supplanted in Victoria. The potential procedural problems created by reversing the evidentiary onus of establishing the defence of mental impairment and the alternatives of judge-only trials or an inquisitorial model (as occurs in coroners' inquests, commissions of inquiry and the Queensland Mental Health Court) are discussed.

Mental health courts and their selection processes: modeling variation for consistency.

Admission into mental health courts is based on a complicated and often variable decision-making process that involves multiple parties representing different expertise and interests. To the extent that eligibility criteria of mental health courts are more suggestive than deterministic, selection bias can be expected. Very little research has focused on the selection processes underpinning problem-solving courts even though such processes may dominate the performance of these interventions. This article describes a qualitative study designed to deconstruct the selection and admission processes of mental health courts. In this article, we describe a multi-stage, complex process for screening and admitting clients into mental health courts. The selection filtering model that is described has three eligibility screening stages: initial, assessment, and evaluation. The results of this study suggest that clients selected by mental health courts are shaped by the formal and informal selection criteria, as well as by the local treatment system.

Courting Compliance: Case Managers as “Double Agents” in the Mental Health Court

An ethnographic study of four Midwest mental health courts was focused on how case managers influence the judicial response to offender noncompliance. Mental health courts, which bear little resemblance to traditional work group models, are staffed by teams of legal and social service professionals working collaboratively toward reducing recidivism and community reintegration for high‐risk offenders. Few studies, however, have explored how treatment providers practice their trade in this new court organization. I investigate how case management professionals, working at the intersections of the social welfare and criminal justice systems, leverage courtroom decision making that results in greater leniency or enhanced punishment. The findings suggest that mental‐health‐court case managers act as boundary spanners in terms of their strategic use of resources to facilitate treatment goals. I conclude that case managers act as “double agents” challenging the state to advocate for clemency while enforcing client rules to uphold the integrity of the court.

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.

Program Planning and Staff Competencies for Forensic Assertive Community Treatment: ACT-Eligible Versus FACT-Eligible Consumers

Forensic assertive community treatment (FACT) is a recent adaptation of the assertive community treatment (ACT) model; however, more information is needed about how FACT and ACT consumers differ and how FACT should be modified to accommodate these differences. Linked, multisystem administrative data from King County, Washington, were used to compare the demographic, clinical, and criminal justice characteristics of ACT- and FACT-eligible consumers. FACT consumers were more likely to be male, persons of color, and had more complex clinical profiles. Also, some FACT consumers were incarcerated for sex offenses, and more than half had violent offenses. Traditionally, ACT teams avoid serving consumers with personality disorders, violent consumers, and sex offenders; however, given increased use of mandated outpatient treatment and mental health courts, FACT teams may have less discretion to choose whom they serve. The addition of clinical interventions and other modifications may be particularly important for FACT teams.

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.

Analyzing Offense Patterns as a Function of Mental Illness to Test the Criminalization Hypothesis

Analyzing Offense Patterns as a Function of Mental Illness to Test the Criminalization Hypothesis

Observations of reintegrative shaming in a mental health court

This study compares the use of stigmatizing and reintegrative shame – as specified in Braithwaite's Crime, shame and reintegration (1989) – across traditional criminal court and mental health court settings. Items from the Global Observational Ratings Instrument were used to gather data on 87 traditional court cases and 91 mental health court cases, presided over by five different judges. The observational items capture three constructs: respect, disapproval, and forgiveness, as they apply to Braithwaite's theory. We present means tests to examine differences in shaming between court types and judges. Findings show that the mental health court is more likely to use reintegrative shaming and show respect and forgiveness for offenders, and less likely to show disapproval. Similarly, judges who preside in both court types are significantly more likely to practice reintegrative shaming in the mental health court context. We further explore these findings using field notes and illustrate those components of a mental health court that are conducive to reintegrative shaming.

Theorizing Mental Health Courts

To date, no scholarly article has analyzed the theoretical basis of mental health courts, which currently exist in forty-three states. This article examines the two utilitarian justifications proposed by mental health court advocates - therapeutic jurisprudence and therapeutic rehabilitation - and finds both insufficient. Therapeutic jurisprudence is inadequate to justify mental health courts because of its inability, by definition, to resolve significant normative conflict. In essence, mental health courts express values fundamentally at odds with those underlying the traditional criminal justice system. Furthermore, the ability of therapeutic rehabilitation to offer sufficient theoretical grounding depends on the validity of the assumed link between mental illness and crime. In particular, mental health courts view participants’ criminal behavior as symptomatic of their mental illnesses and insist that untreated mental illness serves as a major driver of recidivism. Drawing upon social science research, this article demonstrates that these relationships may not hold for a substantial proportion of individuals served by mental health courts. The article concludes by identifying alternative theories that may justify these courts.

Mental Health Courts Lead to Fewer Arrests, Days in Jail

Mental Health Courts Lead to Fewer Arrests, Days in Jail