Lisa Callahan

Effect of Mental Health Courts on Arrests and Jail Days: A Multisite Study

CONTEXT Mental health courts are growing in popularity as a form of jail diversion for justice system-involved people with serious mental illness. This is the first prospective multisite study on mental health courts with treatment and control groups. OBJECTIVES To determine if participation in a mental health court is associated with more favorable criminal justice outcomes than processing through the regular criminal court system and to identify defendants for whom mental health courts produce the most favorable criminal justice outcomes. DESIGN Longitudinal study. SETTING Four mental health courts in San Francisco County, CA, Santa Clara County, CA, Hennepin County (Minneapolis), MN, and Marion County (Indianapolis), IN. PARTICIPANTS A total 447 persons in the mental health court (MHC) and 600 treatment-as-usual (TAU) controls. INTERVENTION Eighteen months of pre-entry and postentry data for 4 jurisdictions. All subjects were interviewed at baseline, and 70% were interviewed at 6 months. Objective outcome data were obtained on all subjects from Federal Bureau of Investigation arrest records, jails, prisons, and community treatment providers. MAIN OUTCOME MEASURES Annualized rearrest rates, number of rearrests, and postentry incarceration days. RESULTS The MHC and TAU samples are similar on the major outcome measures in the pre-entry 18-month period. In the 18 months following treatment, defined as entry into mental health court, the MHC group has a lower annualized rearrest rate, fewer post-18-month arrests, and fewer post-18-month incarceration days than the TAU group. The MHC graduates had lower rearrest rates than participants whose participation was terminated both during MHC supervision and after supervision ended. Factors associated with better outcomes among the MHC participants include lower pre-18-month arrests and incarceration days, treatment at baseline, not using illegal substances, and a diagnosis of bipolar disorder rather than schizophrenia or depression. CONCLUSIONS Mental health courts meet the public safety objectives of lowering posttreatment arrest rates and days of incarceration. Both clinical and criminal justice factors are associated with better public safety outcomes for MHC participants.

The use of mental health court appearances in supervision

A defining feature of mental health courts (MHCs) is the requirement that enrollees appear periodically for status review hearings before the MHC judge. Although the research base on these specialty courts is growing, MHC appearances have yet to be examined. In the present study, the authors followed more than 400 MHC clients from four courts. We examined the number of court appearances that were mandated versus attended, the number of bench warrants issued, and the proportion of court appearances that were made in-custody versus out-of-custody. Finally, we describe and report on the proportion of clients at each court who had graduated, had been terminated, or who were still in the court one year following enrollment.

Factors associated with the conditional release of persons acquitted by reason of insanity: a decision tree approach

Most NGRI (not guilty by reason of insanity) acquittees are hospitalized for some period of time following acquittal, which raises the question of when an individual can be safely released into the community. The conditional release (CR) of persons acquitted by reason of insanity, therefore, provokes the question of public safety. This study examines the CR systems in four states—Connecticut, Maryland, New York, and Ohio. A study sample of 529 persons acquitted as NGRI from 1985 to 1987 was followed up for at least five years to determine who is conditionally released. Following a description of the CR systems, findings suggestive of the role of dangerousness and diagnosis as predictors of CR are presented. Personal characteristics are also significant factors in predicting who will be released. The length of hospitalization for this population and other descriptive factors such as history of hospitalization, arrests, substance abuse, family violence, and living arrangements are also addressed.

Law & Psychiatry: What Can We Say About Mental Health Courts Today?

Mental health courts (MHCs) are a popular type of problem-solving court, and there is ample evidence that they reduce recidivism and increase participation in community-based treatment. The authors summarize evidence for the effectiveness of MHCs and present findings from a study in which they identified and characterized 346 adult and 51 juvenile MHCs currently operating in the United States. The continued growth of MHCs will be based in large part on funding for services. The Affordable Care Act will have major consequences for services provided to this population, and its implementation may therefore affect the future of MHCs. The authors note that it is preferable that people with mental illness not become involved in the criminal justice system in the first place. Despite the success of MHCs, they are not a substitute for an adequate mental health system.

Is Diversion Swift? Comparing Mental Health Court and Traditional Criminal Justice Processing

Formal diversion programs are increasingly popular options for offenders with mental illness. Diversion is recommended, and often assumed, to be swift in that eligible persons should be quickly identified and enrolled. In this study, the authors examine the length from initial arrest to enrollment into mental health court and compare it to time from arrest to disposition for offenders with and without mental illness traditionally processed. The authors, using medians as the metric and limiting the period to 1 year, found time to mental health court was 70 days, whereas traditional processing for offenders with and without known mental illness was 37 and 76 days, respectively. The authors also found detention status during this period to have a large effect on processing time.

The impact of treatment on the public safety outcomes of mental health court participants

Three mental health courts (MHCs) are included in this study of whether enrollment in MHC affects community treatment access, utilization, time to service, program outcome, arrests, and jail days. Researchers approached newly enrolled MHC participants (n = 296) and similar “treatment as usual” (TAU) jail detainees (n = 386) screened as eligible for study participation. Baseline and 6-month interviews were conducted, and respondents allowed researchers access to their mental health and criminal justice records. We found that on discharge from jail on target charges, MHC participants accessed community treatment more quickly than did the TAU respondents. Furthermore, prior to enrollment in MHC, this sample had twice as many crisis treatment episodes as the TAUs, and they received more therapeutic treatment episodes. One year after enrollment, the MHC sample had more intensive and therapeutic treatment episodes than the TAUs. We found no relationship between the type of treatment intervention received (or not) and whether the MHC enrollees were arrested or in jail following MHC enrollment.

Criminal Justice and Behavioral Health Care Costs of Mental Health Court Participants: A Six-Year Study

OBJECTIVE This study examined whether there were differences in costs for mental health court (MHC) participants and a matched comparison group for three years after a target arrest. METHODS Data from the MacArthur Mental Health Court Study, the first multisite study of MHCs, were used to compare behavioral health treatment and criminal justice costs for MHC participants and a matched group (using coarsened exact matching) of jail detainees who were not enrolled in an MHC but who received jail-based psychiatric services in the same cities. Cost data for three years before and after a target arrest were calculated separately for each year and for each participant at three sites of the multisite study-296 MHC participants and 386 matched jail detainees. High-cost MHC participants were identified. RESULTS Total annual costs for MHC participants averaged

A National Survey of U.S. Juvenile Mental Health Courts

4,000 more for all three follow-up years. The additional costs resulted from treatment costs, which were not offset by criminal justice cost savings. The highest-cost MHC participants were those with diagnoses of co-occurring substance use disorders and those who had more arrest incarceration days before their target arrest. Separate analyses determined that the higher average costs were not the result of outlier cases. CONCLUSIONS Participation in an MHC may not result in total cost savings in the three years after enrollment. To become more efficient and to serve participants with the greatest needs, MHCs need to more effectively define the target group for intervention.

Measuring the Effects of the Guilty but Mentally Ill (GBMI) Verdict

OBJECTIVE The authors surveyed U.S. juvenile mental health courts (JMHCs). METHODS Forty-one were identified in 15 states, and 34 returned surveys; one was completed on the basis of published information. Topics included the courts history, youths served, inclusion and exclusion criteria, the court process, and services provided. RESULTS Half (51%) reported that the juvenile court was responsible for the program; for 11% the probation agency had the responsibility, and 17% reported shared responsibility by these entities. Fifty-one percent reported that all youths with any mental disorder diagnosis are eligible. The most commonly reported participant diagnoses are bipolar disorder (27%), depression (23%), and attention-deficit hyperactivity disorder (16%). Seventy percent currently include participants with felony offenses, and 91% with misdemeanors; 67% exclude status offenses, and 21% exclude violent offenses. A guilty plea was required by 63%. Incentives to participate included dismissal of charges (40%), reduction in court hearings (43%), praise by the judge and probation officer (60%), reduction in curfew restrictions (23%), and gift cards or gifts (71%). Sanctions for not participating included increased supervision or hearings (60%), performing community service (54%), and placement in residential detention (60%). Most JMHCs reported use of a multidisciplinary team to coordinate community-based services to prevent protracted justice system involvement. CONCLUSIONS JMHCs are being developed in the absence of systematically collected outcome data. Although they resemble adult mental health courts, they have unique features that are specific to addressing the complex needs of youths with mental disorders involved in the justice system. These include diagnostic and treatment challenges and issues related to involving families and schools.

The hidden effects of Montana's “abolition” of the insanity defense

We studied effects of guilty but mentally ill (GBMI) legislation on use of the insanity defense in Georgia using data on all defendants entering an insanity plea before (1976–1981) and after (1982–1985) the introduction of the GBMI verdict. In contrast to earlier studies, our results indicated that GBMI did decrease the likelihood of an insanity verdict and affected the composition of those found not guilty by reason of insanity. Defendants pleading insanity and found GBMI were typically white males with a serious mental disorder, charged with murder or robbery in which an unrelated female victim was involved. The data also indicated that defendants who pleaded insanity and were found GBMI received harsher sentences than their guilty counterparts. We conclude that the GBMI verdict will make the insanity plea a less appealing option for mentally ill defendants.