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
