John Petrila

Perceived coercion and procedural justice in the Broward mental health court.

Approximately 700,000 people with major mental disorder enter United States jails each year (U.S. Department of Justice, 1999), many of whom are arrested repeatedly for minor felonies and misdemeanors. It is increasingly assumed that their mental disorder and attendant difficulties accessing clinical services and social support programs contribute to this pattern of repeated contact with the criminal justice system. This in turn frustrates the efficiency concerns of the criminal justice system because of the extensive resources consumed by repeatedly booking, jailing, and attempting to treat these individuals in the jail setting. It also frustrates therapeutic objectives because these individuals may become increasingly distant and disengaged from their families and from community-based mental health services. The most recent innovation to address this problem has come in the form of specialty courts called mental health courts. Based somewhat on the drug court model, mental health courts vary in terms of point of intervention (e.g., preversus postadjudication), eligibility requirements (most are limited people with mental illness charged with nonviolent misdemeanors), the use of sanctions, and in other particulars (see Goldkamp & Irons-Guynn, 2000). However, all appear to have as a primary goal interrupting the cycle of repeat offending and incarceration through the expeditious processing of defendants with mental illness, providing access to treatment and social supports, and assuring public safety (Lerner-Wren, 2000). To date no mental health court has been evaluated systematically to determine its efficacy and outcomes. We are currently involved in a 2-year evaluation of the Broward County

The Broward Mental Health Court: process, outcomes, and service utilization

Mental health courts are one of a variety of special jurisdiction courts that have been created in a number of countries, including the United States (Petrila, 2003). While there is no prototypical mental health court (Steadman, Davidson, & Brown, 2001; Watson, Luchins, & Hanrahan, 2001), most of those in existence today share several common characteristics. These include (a) the creation of a special docket (usually, but not always, nonviolent misdemeanants with mental illness) that is (b) handled by a particular judge, with (c) a primary goal of diverting defendants from the criminal justice system and into treatment (Goldkamp & Irons-Guynn, 2000). In addition, the principle of therapeutic jurisprudence has been influential as a philosophic basis for the creation of some if not all mental health courts. ‘‘Therapeutic jurisprudence’’ has been offered as a way for courts and attorneys to examine ‘‘the extent to which substantive rules, legal procedures, and the roles of lawyers and judges produce therapeutic or antitherapeutic consequences’’ (Wexler & Winick, 1991). Both mental health court (Wren, 1998) and drug court judges (Hora, Schma, & Rosenthal, 1999) have been explicit in their reliance on therapeutic jurisprudence as the underpinning of their courts. We are currently evaluating the Broward County Florida Mental Health Court (MHC), one of the first mental health courts in the United States. Full details of this evaluation are

THE SECOND GENERATION OF MENTAL HEALTH COURTS

Mental health courts (MHCs) generally began to appear in 1997. Today, more than 80 courts exist in the United States. In the present article, the authors argue that the 2nd generation of MHCs has arrived. The authors compare 8 previously described courts (P. A. Griffin, H. J. Steadman, & J. Petrila, 2002) with 7 newer courts that have not been previously described in the psycholegal literature. The authors identify 4 dimensions distinguishing 1stfrom 2nd-generation courts: (a) the acceptance of felony versus misdemeanant defendants, (b) preversus postadjudication models, (c) the use of jail as a sanction, and (c) the type of court supervision. The 4 dimensions are interdependent in that the acceptance of more felony cases contributes to the rise in processing cases postadjudication, using jail as a sanction and more intensive supervision. Potential reasons for the evolution of a 2nd generation are discussed.

The Use of Housing as Leverage to Increase Adherence to Psychiatric Treatment in the Community

For people with mental disorder, access to subsidized housing may be used as “leverage” to obtain adherence to treatment. Interview data from 200 outpatients at each of five sites provided the first national description of the use of housing as leverage. Results indicated that housing is most likely to be used as leverage when it is “special” housing, available only to people with mental illness. Most frequently, respondents state that the requirement that they participate in treatment is imposed by their landlord, rather than by a clinician. The use of housing as leverage strongly increases respondents’ perceptions of coercion. Despite this, however, participants who experience housing as leverage are no less satisfied than other participants with the treatment that they receive, and are much more likely than other participants to believe that using housing as leverage is effective in helping people stay well.

Effects of Outpatient Treatment on Risk of Arrest of Adults With Serious Mental Illness and Associated Costs

OBJECTIVE This study examined whether possession of psychotropic medication and receipt of outpatient services reduce the likelihood of posthospitalization arrest among adults with serious mental illness. A secondary aim was to compare service system costs for individuals who were involved with the justice system and those who were not. METHODS Claims data for prescriptions and treatments were used to describe patterns and costs of outpatient services between 2005 and 2012 for 4,056 adult Florida Medicaid enrollees with schizophrenia or bipolar disorder after discharge from an index hospitalization. Multivariable time-series analysis tested the effects of medication and outpatient services on arrest (any, felony, or misdemeanor) in subsequent 30-day periods. RESULTS A total of 1,263 participants (31%) were arrested at least once during follow-up. Monthly medication possession and receipt of outpatient services reduced the likelihood of any arrests (misdemeanor or felony) and of misdemeanor arrests. Possession of medications for 90 days after hospital discharge also reduced the likelihood of arrest. Prior justice involvement, minority racial-ethnic status, and male sex increased the risk of arrest, whereas older age decreased it. Criminal justice and behavioral health system costs were significantly higher for the justice-involved group than for the group with no justice involvement. CONCLUSIONS Routine outpatient treatment, including medication and outpatient services, may reduce the likelihood of arrest among adults with serious mental illness. Medication possession over a 90-day period after hospitalization appears to confer additional protection. Overall, costs were lower for those who were not arrested, even when they used more outpatient services.

Lessons from the Broward County Mental Health Court Evaluation

The creation of specialty mental health courts has emerged as a strategy to address the impact of persons with mental illness in the criminal justice system by consolidating the management of certain types of cases into a single court. This article describes an evaluation of the nations first such court, the Broward County Mental Health Court. The purpose is to alert those who may conduct future evaluations of these types of courts to some of the contextual, logistic, and management features of our evaluation and the challenges we have encountered doing field research in this unique legal setting.

Juveniles Evaluated Incompetence to Proceed: Characteristics and Quality of Mental Health Professionals’ Evaluations

The authors studied quality of evaluations of juveniles whose competence to proceed was at issue before the court and characteristics of mental health professionals completing these reports. Many evaluators failed to address important legal issues and offered incomplete descriptions of the youths, their capacities, and the evaluation techniques used. Evaluators commented on legal competency factors in most reports, as required by law, but often failed to identify the cause of the noted incapacity or whether children met commitment criteria (also required by law). Although core competence-related abilities identified in Florida law were addressed in the majority of evaluations, assessments were less than optimal in other psycholegal and clinical domains. Seven recommendations are offered for conducting juvenile competency evaluations that are professionally sound and meet legal requirements.

Law & Psychiatry: Florida's Outpatient Commitment Law: A Lesson in Failed Reform?

An involuntary outpatient commitment law became effective in Florida in January 2005. However, only 71 orders for outpatient commitment have been issued in three years, even though during that period 41,997 adults had two or more 72-hour involuntary emergency examinations under Floridas civil commitment law. This column describes the criteria for outpatient commitment in the Florida statute and discusses possible reasons for its low rate of use, including additional statutory criteria that make filing a petition for outpatient commitment difficult, lack of community treatment resources, and lack of enforcement mechanisms.

Violence risk assessment tools: A systematic review of surveys

The present study is a systematic review exploring the methodological quality and consistency of findings for surveys on the use of violence risk assessment tools. A systematic search was conducted to identify surveys of violence risk assessment tool use published between January 1, 2000 and January 1, 2013 using PsycINFO, MEDLINE, and EBSCO Criminal Justice Abstracts. Characteristics of survey administration and more findings were extracted, and a checklist of 26 reporting quality markers in survey research was used for coding. Nine surveys were identified, fulfilling on average approximately half of the quality markers (M = 15.5, SD = 1.6). An average of 104 respondents (SD = 93) participated, with a range of 10 to 300 respondents. Most surveys examined the practices of psychologists in the United Kingdom or the United States. The Psychopathy Checklist-Revised and the Historical, Clinical, Risk Management-20 were the most commonly used instruments by practitioners. No surveys investigated differences in assessment practices across professional disciplines or continents, and none examined the use or perceived usefulness of structured instruments in risk management or risk monitoring. There continues to be a need for transparent, high quality clinical surveys on the use and perceived utility of violence risk assessment tools in the forensic mental health field. Given the growing cross-jurisdictional use of risk assessment tools, comparisons of international practice are particularly important.

Congress Restores the Americans With Disabilities Act to Its Original Intent

The Americans With Disabilities Act (ADA) was created to prohibit discrimination based on disability. Although many individuals filed claims alleging discrimination in the workplace based on disability, the federal courts, led by the U.S. Supreme Court, adopted an increasingly constricted interpretation of key provisions of the ADA. As a result, many individuals with serious impairments were found by the courts to not be disabled. In 2008 Congress overturned these court decisions by enacting the ADA Amendments Act. These amendments overrule several decisions by the United States Supreme Court that narrowed the applicability of the ADA, and they restore the ADA to its original intent.