Mental Health Courts Research Articles

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.

Nebraska bill aims to fund mental health courts

The most recent data available indicates that at least 61,000 people in Nebraska have a serious mental health issue, 1011Now.com reported Jan. 31. A new bill introduced in the legislature aims to create and fund a pilot program for mental health courts in Nebraska. Sen. Suzanne Geist, who represents part of Lincoln, wants to help fund the state's first mental health court. “One of the things we want to do is to keep individuals who are suffering from severe mental illness out of our correctional system and put them back into society after treatment,” Geist said. “It'll be very intensive. It will be very education heavy, and treatment heavy.” Across the country, there are roughly 250 mental health courts, but there are none in Nebraska. The pilot program Geist wants to create would pull about $1.4 million from the general fund over the next two years, but Lancaster County Public Defender Joe Nigro said when you compare costs of mental health court and incarceration, taxpayers reap a benefit. “It costs probably $5–7,000 to pay for somebody going through problem‐solving court; prison is about $35,000 a year,” Nigro said.

Methodological Challenges in Retrospective Evaluation of Mental Health Court Effectiveness

Mental Health Courts (MHCs) are problem-solving courts that have been implemented throughout the United States. One critical component of MHCs is determining their effectiveness and limitations. However, unique challenges are encountered when evaluating MHCs. One major challenge, and the focus of this paper, is identifying an adequate control group. The ideal approach to determining efficacy is using a controlled group design whereby participants are randomized to treatment or control conditions. However, this approach is not possible when conducting retrospective evaluation of court data. In addition, a specific set of ethical and logistical issues arise. Propensity score matching (PSM) provides an alternative approach for comparing groups when randomization is not possible. PSM works by first identifying the characteristics that make a person likely to be in treatment. We describe our attempts to use PSM in a MHC evaluation. Specific challenges with PSM are discussed and recommendations are made for use of PSM with MHCs.

The Importance of Mental Health Courts for Psychiatry & the Criminal Justice System

Mental health courts are designed to divert mentally ill offenders away from the criminal justice system and into appropriate treatment programs. This commentary highlights the systemic issues that led to the development of mental health courts as a solution. Research has already demonstrated that these courts are associated with numerous positive psychiatric and legal outcomes. However, further research is required to determine what specifically makes them successful, and who is most likely to benefit from them. Mental health courts have earned their place as an essential part of the criminal justice system and are a promising area of future research.

Thirty years onward! Citation analysis of randomized experiments on drug and mental health courts

This study is meant to conduct the first known citation analysis on problem-solving courts (PSCs) using experimental designs. The use of citation analysis is meant to contribute to the experimental literature base by investigating the concept of “research quality.” Using Web of Science, Google Scholar, and ResearchGate, citation counts were performed on drug and mental health courts, excluding self-citations. The total number of citations for the experimental research was gathered, as well as a calculation of the average number of citations per year between 1989 and 2018. Additionally, a temporal analysis was conducted to demonstrate if certain citations were cited frequently initially after publication and then decayed over time. The most cited experiments were on drug courts (n = 12). Specifically, Gottfredson et al.’s (2003) randomized controlled trial on the effectiveness of drug courts amassed 309 citations of Google Scholar and yielded an average of 20.6 citations per year. The same study had 184 citations on ResearchGate, with an average of 12.26 citations per year. For mental health courts (n = 3), the most cited experiment was Cosden et al.’s (2005) evaluation of a mental health court with assertive community treatment, which had 199 citations on Google Scholar and an average of 13.27 citations per year. The study had 133 citations of ResearchGate, which is an average of 8.87 citations per year. The citation analysis presents an assessment of the most influential experiments regarding PSCs. The experimental research studies conducted by Gottfredson et al. (2003) and Cosden et al. (2005) were the most cited literature for drug court and mental health court, respectively, which contributes to the advancement of criminological research pertaining to PSCs.

Film Documents History of Deinstitutionalization and Its Impact on Today’s SMI Population

Film Documents History of Deinstitutionalization and Its Impact on Today’s SMI Population

Does vegetation matter for the criminal behavior among people with serious mental illness?

AbstractThis study attempts to examine the effect of vegetation on arrests of offenders with and without serious mental illness (SMI). Data from the MacArthur mental health court study were analyzed. Objective arrest data were obtained 12–18 months pre‐ and post‐court involvement between 2005 and 2007. Vegetation data were captured by the normalized difference vegetation index, which can be regarded as a general measure of “vegetation” and linked with GeoID, obtained from the American Community Survey. We analyzed data of sociodemographic factors (e.g., age, gender), crime‐related factors (e.g., age of first arrest), and vegetation in related to the crime on 652 offenders with mental illness. Multilevel negative binomial regression revealed no significant effect of vegetation on arrests among offenders without SMI; however, for those with SMI, a significant variation in vegetation on arrests was found among all study models. Our findings suggest that vegetation is significantly associated with arrests, with a positive effect on reducing the recidivism only among offenders with SMI. Given that practice and policy almost exclusively focus on individual factors of crimes, it is important to have more considerations about how neighborhood factors affect criminal behavior, depending on SMI in order to have more comprehensive methods of crime prevention.

The Brooklyn Mental Health Court—A Thousand Graduates Later

The Brooklyn Mental Health Court—A Thousand Graduates Later

Interviewing persons with mental illness charged with murder or attempted murder: a retrospective review of police interviews

Individuals with a mental illness may be particularly vulnerable during police interviews. Assessing fitness for police interview is vital for ensuring procedural fairness. This article reports the findings of a retrospective review of 31 police interviews of mentally ill persons charged with murder (n = 18) or attempted murder (n = 13) who appeared before the Queensland Mental Health Court. Police interviews were conducted for all murder and 50% of attempted murder cases. Possible or overt mental illness symptoms were present in all interviews. Symptoms of mental illness were pervasive in 36.7% of interviews, intermittent in 43.3% of interviews and seldom in 20% of interviews. Support persons were present for 9.7% of interviews, and legal representation was not present for any interview. These findings highlight the need to enhance access to support persons during interviews. Intersectoral collaboration between mental health services, forensic medical officers, police, public guardians and the legal sector is needed.

Les tribunaux de santé mentale américains, un exemple de programme de déjudiciarisation

ObjectiveThe purpose of the article is to present what are Mental Health Courts (MHC) that were developed in the wake of the movement of deinstitutionalization in the United States. Material and methodsLiterature review. ResultsDesigned in the 1990s, MHC are a form of diversion based on the principle of therapeutic jurisprudence: this individualized care program offer an alternative to prison. Today, there are more than 400 in the United States. Even though their functioning varies according to the States, they rely on common theoretical principles. Overall, many studies show a decrease of recidivism for participants of MHC compared to those who did not participate while they were eligible, whether in the short, medium or long term. Studies also present high levels of procedural justice and low levels of perceived coercion. If the studies show the efficiency of the TSM, some actors insist on their limits. They consider that a part of their efficiency would, in fact rely on a too restrictive selection amongst the potential candidates. More generally, the TSM are criticized because they have been conceived to overcome the deficiencies of a health system that would need to be reformed because it doesn’t offer care upstream the judicial system. Several other aspects are discussed but also criticised, whether it is about the consent of the participants (what understanding of the programs and their juridicial foundation and, later on, which real part of volunteering in their commitment?) or about the dropping of charges, which are apparently not systematic in some States. ConclusionMHC offer some promising leads but do not embody a solution to the complex problems found in the interface between mental care and justice.

Problem-Solving Court Policies on Cannabis Use.

Problem-solving courts have developed across the United states to offer specific offenders, including those with substance use or mental disorders, alternatives to incarceration that often involve community-based treatment services and judicial supervision. At the same time, dozens of states have legalized the use of cannabis for medical or recreational purposes, even as cannabis use remains illegal under federal law. State legalization of cannabis use has introduced legal and medical complexities for problem-solving courts, particularly concerning the management of offenders who use cannabis. This article reviews implications of cannabis use for defendants' eligibility and participation in problem-solving courts, with a focus on adult drug courts and mental health courts. This article also examines a range of policies, such as abstinence-based, tolerance-based, and adaptive approaches, that problem-solving courts may consider implementing. Further research is needed to characterize existing problem-solving court policies toward cannabis use and to develop evidence-based practices that courts may follow.

Predictors of mental health court completion

ABSTRACTWhile Mental Health Courts have been found to be effective in reducing recidivism, this is only if participants successfully complete the program. This study aimed to identify specific predictors of successful completion, particularly looking at previous mental health treatment as a predictor of completion. Two hundred and fifty-one participants discharged from a northeastern urban Mental Health Court were included in the sample. Logistic regression analysis found previous mental health treatment was not a significant predictor of successful completion; however, length of program stay and whether or not the participant is African American were found to be significant predictors.

Professional Interaction in Mental Health Courts: Processing Defendants with Mental Illness

In this paper, the author presents ethnographic research and analysis of how criminal justice and mental health professionals interact with each other and with criminal defendants with mental illness in running a mental health court (MHC) program. Ethnographic field research included observations of court programs, interviews of professionals, and gathering of textual documents, at nine MHCs in a Midwestern state. In MHC criminal defendants with mental illness participate in a program of regular court appearances, probation supervision, and mandated treatment, rather than being incarcerated in jail or prison. The author utilized the symbolic interaction perspective and examined how the professionals work together to select participants and judge their performances. Professionals interact and share case documents in socially constructing the participant. They operate the program as a filter so that a relatively small number of the population of incarcerated persons with severe mental illness in the state successfully graduate from the program. Implications of these findings are discussed.

A qualitative analysis and eleven-factor typology of hypothesized factors encouraging or discouraging the development of problem solving courts in various countries

Objectives Whereas the USA has numerous problem solving courts (e.g., drug courts, mental health courts), other countries do not have such courts, have altered versions of these courts, or have problem solving courts for other social issues. This qualitative research develops hypotheses regarding the reasons for such diversity.

Benchmarking Australian mental health court liaison services – results from the first national study

ABSTRACTMental health court liaison services (CLS) are a key component of the forensic mental health sector in Australia with a service present in each state and territory to identify and treat those with mental illness in contact with the courts. To date, limited research has been undertaken into how these services are delivered and which model is most effective. This paper describes the process and outcomes of the first national collaboration to trial a set of key performance indicators (KPIs) for Australian mental health court liaison services (CLS) using a benchmarking model. A set of nationally endorsed KPIs were found to be useful and relevant to policy and practice in terms of enabling services to compare resources and highlight areas for quality improvement. Wide variation in performance across services was observed. The ability of smaller services to provide data emerged as an issue, with several identifying the need to improve reporting capability. Benchmarking of specialised forensic mental health services was found to be a valuable process for services. Future collaborations for CLS may include refinements to the KPIs and will continue to enhance the knowledge base of this specialised area of forensic mental health service provision.

Implementation of MISSION-Criminal Justice in a Treatment Court: Preliminary Outcomes Among Individuals With Co-occurring Disorders.

Mental health courts provide an alternative to incarceration and address both mental health and criminal justice needs. Many individuals within these treatment courts also have co-occurring substance use disorders. This pilot study examined the preliminary effectiveness of Maintaining Independence and Sobriety through Systems Integration, Outreach, and Networking-Criminal Justice (MISSION-CJ), an intervention that targets co-occurring disorders and criminal justice risk factors within a mental health court. Participants (N=97) were enrolled in mental health court and MISSION-CJ community wraparound services. Participants were primarily male with an average age of 34, had spent an average of more than 5 years incarcerated, and had an average of 13.94 years of illegal drug use; 91% had experienced depression. Preliminary 6-month outcomes showed significant reduction in nights incarcerated (p<0.002), illegal drug use (p<0.003), trauma symptoms (p<0.004), and behavioral health symptoms (p<0.006). Preliminary findings suggest promise for delivery of MISSION-CJ to participants in a mental health court.

The Impact of Substance Arrests on the Efficacy of Mental Health Court

There is ample evidence that Mental Health Courts (MHCs) are effective in reducing recidivism for participants who are mentally ill. This study will examine if MHCs are effective for the large number of clients with mental illness who abuse substances. Participants in Brevard County Florida’s Mental Health Court (N = 118) were examined for a history of substance arrests. Those with a substance history (n = 63) were compared to those without a substance history and examined for the outcome variables of days free before rearrest, severity of rearrest, and offense type (e.g., substance related, etc.). A history of substance arrests resulted in more rearrests for any offense at 1 year and more rearrests for a substance offense 3 years post-MHC, compared to participants without prior substance arrests. A survival analysis demonstrated that more MHC graduates without substance arrest history were able to remain arrest free in the community than those with substance arrest history. For those participants with a substance arrest history, graduating MHC was associated with less rearrests in general, less substance rearrests, and less severe rearrests than their non-graduating comparison group. Within the first 6 months of leaving MHC, the amount of substance arrests before they enter the program predicts the amount of substance offenses committed after they leave the program, and the association is much stronger in those who do not graduate MHC. Findings suggest that MHC has a significant impact even on those with co-occurring disorders. However, they are at greatest vulnerability to relapse with substances within the first 6 months after leaving MHC, suggesting greater substance-specific supports in the community for dually diagnosed participants may be beneficial.

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.