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Journal ArticleDOI

What Happens to Mental Health Court Noncompleters

01 Nov 2015-Behavioral Sciences & The Law (John Wiley & Sons, Ltd)-Vol. 33, Iss: 6, pp 801-814

AbstractMental health court (MHC) research consistently finds that defendants who successfully complete and graduate from the court are less likely to recidivate than those who do not. However, research has not assessed what happens to these noncompleters once they are sent back to traditional court. Using follow-up data on six years of noncompleters from pre-adjudication MHC, we examine what happens to these defendants in traditional court. Findings suggest that 63.7% of defendants' charges were dismissed, 21.0% received probation, and 15.3% were sentenced to incarceration. We examine the time to disposition and differences in defendant characteristics and disposition outcome as well as the relationship between disposition and subsequent recidivism. Results suggest that more severe punishments in traditional court are associated with recidivism. Logistic regression analysis shows that defendants whose charges were dismissed in traditional court were less likely to recidivate than those who were sentenced to probation or incarceration. Our findings highlight the need for future MHC evaluations to consider traditional court outcomes and support trends towards post-adjudication courts. Copyright © 2015 John Wiley & Sons, Ltd.

Topics: Mental health court (60%), Recidivism (55%)

Summary (2 min read)

The Mental Health Court

  • MHCs are local innovations, developed to fit the needs of the particular jurisdiction; however, studies across courts suggest that there are some general similarities in the MHC process (Almquist & Dodd, 2009; Thompson, Reuland, & Souweine, 2003) .
  • Courts can define compliance in different ways; however, it is generally viewed as following specific court orders (e.g., no drug or alcohol use) and adhering to treatment (e.g., attending treatment appointments, engaging with providers, taking medications).
  • If a defendant is terminated from the process in a post-adjudication MHC, the original sentence is served out; however, in a pre-adjudication MHC the criminal charges are sent back to traditional court for disposition.
  • While some recent research has examined predictors of MHC completion relative to noncompletion (Dirks-Linhorst et al., 2013; Redlich et al., 2010; Ray & Dollar, 2013) , none of these studies followed-up with the noncompleters to determine what happens to them in traditional criminal court and whether these disposition outcomes are associated with subsequent recidivism.

Study Overview

  • The MHC observed in this study is located in a midsized town in the southeastern United States and practices all of the essential elements noted above (Almquist & Dodd, 2009) .
  • It is a pre-adjudication MHC that accepts misdemeanor and felony cases.
  • If consistently noncompliant, the defendant is terminated from the program.
  • According to members of the MHC team, there are several reasons a defendant is terminated from the program; not showing up to court, noncompliance with treatment mandates, a new arrest, and drug use are the most common.
  • This study examines what happens to MHC noncompleters once their charges are adjudicated in traditional court.

Data and Methods

  • Over a six year period (2004 -2009) there were 163 defendants who were eligible, admitted, and started the MHC process but did not graduate.
  • Of these 163 defendants there were 6 defendants whom the authors were unable to locate subsequent data on leaving a final sample of 157 MHC noncompleters of which 6.4% (n = 10) were coded by court staff as opting-out while the remaining 93.6% were terminated from the MHC process.
  • Data regarding the defendant's demographic information (i.e., age, race, and gender), keyarrest characteristics (i.e., felony, misdemeanor, and type of crime), judicial disposition of the key-arrest (i.e., dismissal of charges, probation, jail/prison sentence), dates of jail entry and exit, and statewide arrests were coded for analysis.
  • In those instances where a defendant was rearrested during MHC, these additional criminal charges were added to the traditional court docket for adjudication along with initial charges that led to MHC participation.
  • All analyses were conducted using IBM's Statistical Package for the Social Sciences© (SPSS) 21.

Results

  • There were several types of dispositions listed in the court records, which the authors coded into three categories: dismissed, probation, and incarceration.
  • The least likely disposition among noncompleters was incarceration: 15% (n = 24) were sentenced to jail after MHC and no individuals were sent to prison in this MHC.
  • The authors found that the average length of By coding traditional court disposition dates they were also able to assess the time from MHC noncompletion to traditional court disposition.

Discussion

  • This study is the first to follow MHC noncompleters to determine what happens to their cases in traditional court.
  • In looking at defendant characteristics across disposition outcomes the authors found that those with a greater number of prior arrests, as well as those arrested during MHC, were more likely to be sentenced to jail (see Case, Steadman, Dupuis, & Morris, 2009; Sarteschi et al., 2011) .
  • This research was not designed to evaluate the MHC process, though it does address a growing population within the criminal justice system-who are also a large subgroup of MHC participants-that have received little attention in the academic literature: noncompleters.
  • First, only one MHC setting was examined and while the observed setting has all the essential elements of a MHC, there may be differences in the structure and process that differ from other settings.
  • Because the authors do not have treatment data one cannot speak to the potential benefits that this brings to MHC defendants' outcomes.

Conclusion

  • Several studies have compared recidivism rates between completers and noncompleters (Burns et al., 2013; Dirks-Linhorst & Linhorst, 2012; Herinckx et al., 2005; Hiday et al., 2013; McNiel & Binder, 2007; Moore & Hiday, 2006; Steadman et al., 2011) but none have examined whether traditional court outcomes of noncompleters is associated with recidivism.
  • By examining these noncompleters the authors were able to show what traditional court disposition outcomes are most common and more accurately describe the duration of the criminal justice experience for MHC participants.
  • Further research is needed to determine whether there is a relationship between disposition and recidivism among MHC noncompleters.
  • More broadly, researchers should examine whether extended judicial supervision is necessary for low-level or first time offenders with a mental illness.
  • To this end, research should continue to focus on evaluating those diversion programs aimed at high risk groups-such as those with cooccurring disorders-to determine effectiveness (Broner & Lattimore, 2004; Steadman & Naples, 2005) .

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Running Head: MENTAL HEALTH COURT NONCOMPLETERS 1
Title: What Happens to Mental Health Court Noncompleters?
Authors:
Bradley Ray, PhD
a
Brittany J. Hood, MA
a
Kelli E. Canada, PhD, MSW
b
a
Indiana University – Purdue University Indianapolis
School of Public & Environmental Affairs
Business/SPEA Building, 801 West Michigan Street
Indianapolis, IN 46202
Email: bradray@iupui.edu
Office: 317.274.8701
Fax: 317.274.5153
b
University of Missouri
School of Social Work
Columbia, Missouri, USA
This is the author's manuscript of the article published in final edited form as:
Ray, B., Hood, B. J., & Canada, K. E. (2015). What Happens to Mental Health Court
Noncompleters?. Behavioral sciences & the law. http://dx.doi.org/10.1002/bsl.2163

MENTAL HEALTH COURT NONCOMPLETERS 2
Abstract
Mental health court (MHC) research consistently finds that defendants who successfully
complete and graduate from the court are less likely to recidivate than those who do not.
However, research has not assessed what happens to these noncompleters once they are
sent back to traditional court. Using follow-up data on six years of noncompleters from
pre-adjudication MHC, we examine what happens to these defendants in traditional court.
Findings suggest that 63.7% of defendants’ charges were dismissed, 21.0% received
probation, and 15.3% were sentenced to incarceration. We examine the time to
disposition and differences in defendant characteristics and disposition outcome as well
as the relationship between disposition and subsequent recidivism. Results suggest that
more severe punishments in traditional court are associated with recidivism. Logistic
regression analysis shows that defendants whose charges were dismissed in traditional
court were less likely to recidivate than those who were sentenced to probation or
incarceration. Our findings highlight the need for future MHC evaluations to consider
traditional court outcomes and support trends towards post-adjudication courts.
Keywords
mental health court; pre-plea diversion; noncompletion; sentencing outcomes; recidivism

MENTAL HEALTH COURT NONCOMPLETERS 3
The disproportionate arrest and incarceration of persons with a serious mental
illness (Abram, Teplin, & McClelland, 2003; Kubiak, Beeble, & Bybee, 2010; Steadman,
Osher, Robbins, Case, & Samuels, 2009; Trestman, Ford, Zhang, & Wiesbrock, 2007)
has led many jurisdictions to adopt local criminal justice diversionary programs. One
such program, the mental health court (MHC), is a type of specialty court that attempts to
divert defendants with serious mental illnesses out of the criminal justice system and into
community-based treatments (Almquist & Dodd, 2009). From the first iteration of a
MHC in Indiana in the 1980s (Steadman, Davidson, & Brown, 2001) to those modeled
after drug courts in the 1990s (Boothroyd, Poythress, McGaha, & Petrila, 2003; Petrila,
Poythress, McGaha, & Boothroyd, 2001), this criminal justice program has continued to
proliferate with nearly 400 MHCs in the United States to date (Goodale, Callahan, &
Steadman, 2013).
MHCs use extended judicial supervision in which defendants are required to
appear in court on a regular basis for status review hearings. Although the model can vary
between jurisdictions and over time, the MHC team generally includes a judge,
prosecution and defense attorneys, probation and parole officers, and community
treatment and service providers (Almquist & Dodd, 2009). This team determines
defendants’ ongoing engagement in the MHC, adherence to treatment, and compliance
with other court mandates. Defendants who are compliant for a specified period of time
successfully complete the court process and have a positive legal outcome. However, not
everyone completes MHC; some defendants are noncompliant and terminated from the
MHC process while others opt-out, though in both of these circumstances criminal
charges are returned to traditional court for processing.

MENTAL HEALTH COURT NONCOMPLETERS 4
Since the first MHCs, observers have raised questions about the completion
process, noting that many of the defendants who begin MHC are deemed noncompliant
and sent back to traditional court (Wolff, 2002). Redlich and colleagues (2010) estimate
that across four different MHCs approximately 30% of defendants did not complete the
MHC (i.e., defendants who were terminated or opted out of MHC). While several studies
find that defendants who go on to complete the court process are less likely to recidivate
than those who do not complete (Burns, Hiday, & Ray, 2013; Dirks-Linhorst & Linhorst,
2012; Herinckx, Swart, Ama, Dolezal, & King, 2005; Hiday, Wales, & Ray, 2013;
McNiel & Binder, 2007; Moore & Hiday, 2006; Steadman, Redlich, Callahan, Robbins,
& Vesselinov, 2011), they focus exclusively on the MHC outcomes (completion vs.
noncompletion) with no attention to the traditional court outcomes (e.g., jail sentence,
dismissal of charges) of the noncompleters. In pre-plea MHC programs, if a defendant is
terminated from or opts out of the MHC, he/she is sent back to traditional court for case
disposition. Outcomes of these hearings are important to consider as they might also be
related to subsequent involvement in the criminal justice system.
The present study focuses specifically on MHC noncompleters to determine what
happened to these cases once they were sent back to traditional court. Using six years of
MHC defendants from a well-established MHC, we examine what type of traditional
court disposition noncompleters most commonly received, defendants’ length of time in
the criminal justice system as a result of having been involved in the MHC, differences in
traditional court disposition by defendant, and whether these dispositions are associated
with recidivism.
The Mental Health Court

MENTAL HEALTH COURT NONCOMPLETERS 5
MHCs are local innovations, developed to fit the needs of the particular
jurisdiction; however, studies across courts suggest that there are some general
similarities in the MHC process (Almquist & Dodd, 2009; Thompson, Reuland, &
Souweine, 2003). For example, in MHCs: a separate docket is maintained; participation
is voluntary so defendants decide whether to enroll in the court and can opt-out at any
time; a non-adversarial team approach is used where criminal justice and treatment
professionals work together to develop individualized treatment plans; and defendants
attend regularly scheduled status hearings where adherence to treatment (or lack thereof)
is assessed.
The MHC teams decide who is accepted onto the docket (Wolff, Fabrikant, &
Belenko, 2011) and whether the defendant is in compliance at the status hearings. Courts
can define compliance in different ways; however, it is generally viewed as following
specific court orders (e.g., no drug or alcohol use) and adhering to treatment (e.g.,
attending treatment appointments, engaging with providers, taking medications). Because
relapse is so prevalent within dually-diagnosed populations (Brunette, Drake, Woods, &
Hartnett, 2001), MHC teams often allow for regression in treatment; if problems like
relapse and medication nonadherence become persistent and chronic, MHC teams use
various sanctions to encourage compliance (Griffin, Steadman, & Petrila, 2002; Redlich,
Steadman, Monahan, Robbins, & Petrila, 2006). However, one of the key differences
among MHCs—which is directly related to completion and noncompletion— is whether
the court uses a post-adjudication or pre-adjudication approach (Almquist & Dodd, 2009;
Redlich, Steadman, Monahan, Petrila, & Griffin, 2005; Redlich et al., 2006; Steadman,
Redlich, Griffin, Petrila,& Monahan, 2005). In a post-adjudication MHC, defendants are

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References
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TL;DR: The estimates in this study have profound implications in terms of resource allocation for treatment in jails and in community-based settings for individuals with mental illness who are involved in the justice system.
Abstract: Objective: This study estimated current prevalence rates of serious mental illness among adult male and female inmates in five jails during two time periods (four jails in each period). Methods: During two data collection phases (2002–2003 and 2005–2006), recently admitted inmates at two jails in Maryland and three jails in New York were selected to receive the Structured Clinical Interview for DSM-IV (SCID). Selection was based on systematic sampling of data from a brief screen for symptoms of mental illness that was used at admission for all inmates. The SCID was administered to a total of 822 inmates—358 during phase I and 464 during phase II. To determine the current (past-month) prevalence of serious mental illness (defined as major depressive disorder; depressive disorder not otherwise specified; bipolar disorder I, II, and not otherwise specified; schizophrenia spectrum disorder; schizoaffective disorder; schizophreniform disorder; brief psychotic disorder; delusional disorder; and psychotic disorder not otherwise specified), interview data were weighted against strata constructed from the screening samples for male and female inmates by jail and study phase. Results: Across jails and study phases the rate of current serious mental illness for male inmates was 14.5% (asymmetric 95% confidence interval [CI]=11.0%–18.9%) and for female inmates it was 31.0% (asymmetric CI=21.7%–42.1%). Conclusions: The estimates in this study have profound implications in terms of resource allocation for treatment in jails and in community-based settings for individuals with mental illness who are involved in the justice system. Psychiatric Services 60:761–765, 2009)

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Abstract: Each year, more than 10 million people enter US jails, most returning home within a few weeks. Because jails concentrate people with infectious and chronic diseases, substance abuse, and mental health problems, and reentry policies often exacerbate these problems, the experiences of people leaving jail may contribute to health inequities in the low-income communities to which they return. Our study of the experiences in the year after release of 491 adolescent males and 476 adult women returning home from New York City jails shows that both populations have low employment rates and incomes and high rearrest rates. Few received services in jail. However, overall drug use and illegal activity declined significantly in the year after release. Postrelease employment and health insurance were associated with lower rearrest rates and drug use. Public policies on employment, drug treatment, housing, and health care often blocked successful reentry into society from jail, suggesting the need for new policies that support successful reentry into society.

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Frequently Asked Questions (1)
Q1. What are the contributions mentioned in the paper "Running head: mental health court noncompleters 1 title: what happens to mental health court noncompleters? authors:" ?

Using follow-up data on six years of noncompleters from pre-adjudication MHC, the authors examine what happens to these defendants in traditional court. The authors examine the time to disposition and differences in defendant characteristics and disposition outcome as well as the relationship between disposition and subsequent recidivism. Findings suggest that 63. 7 % of defendants ’ charges were dismissed, 21. 0 % received probation, and 15. Results suggest that more severe punishments in traditional court are associated with recidivism.