The Effectiveness of Mental Health Court as a Treatment for Violent Inmates

The Effectiveness of Mental Health Court as a Treatment for Violent Inmates

Introduction

Per the Cook County Illinois website nearly 25-30% of inmates are described as having a mental illness (“Cook County Sheriff – Office of Mental Health Policy and Advocacy,” n.d.).  The growing number of inmates with mental illness has been more prevalent throughout the years. There were approximately 1 or 2 mental health courts in 1997, today the number of such courts has risen to around 250 (Steadman, Redlich, Callahan, Robbins, & Vesselinov, 2011). Mental health court is described as a specialized court with a docket of defendants with mental illness, the use of a collaborative team, a link to the mental health system, compliance with the court and seen as therapeutic (Wolff, Fabrikant, & Belenko, 2011). The increase in mental health courts shows a shifting focus on increasing mental health treatment for inmates in hopes to lower recidivism and overall treat the mental health population in correctional facilities. Due to the disproportionate amount of arrests and incarcerations among individuals with mental illness, the need for mental health courts in jurisdictions continues to rise (Ray, Hood, & Canada, 2015). There is also a constant rise in inmate populations who may not have access to necessary mental health support. Many researchers acknowledge the fact that there is a need for therapeutic jurisprudence, which is a theory many courts abide by that “views the law (and the legal actors who practice it) as a vehicle that can be therapeutic (promote personal change and improvement) or antitherapeutic.” (Redlich & Han, 2014, p. 117). There have been increased studies to determine the various treatments that can be coined as successful in reducing overall recidivism and criminality in the community. The main purpose of treatment for inmates is to acknowledge that treatment may help decrease the symptoms of their mental illness, therefor reducing the likelihood of committing further offenses and protecting the community.

Studies have shown that the uses of mental health courts (MHC) are effective in treating inmates with mental illness (Steadman et al., 2011). “People with mental disorders who are incarcerated tend to stay longer in jail than others charged with similar crimes and to cycle through the criminal justice system” (McNiel & Binder, 2007, p. 1395). These multiple studies while reviewing mental health court outcomes show that this treatment will not only reduce the amount of days an inmate is in jail, but decrease future crime and lower new offenses deeming this treatment as ‘effective’ (Kennedy, 2012; McNiel & Binder, 2007). Inmates who participate in mental health court increase the use of outpatient mental health services as a result of participating in mental health court (Luskin, 2013). The research shows an increase in outpatient mental health outreach and informs researchers they have increased their knowledge in other services that may be available to them. Majority of inmates have a positive view towards mental health court after they participated, showing that this treatment is not a deterrent for inmates but rather a beneficial implementation (Kennedy, 2012).

Previous research shows us the selection process for MHC and how different courts accept inmates for mental health court treatment. In a study of MHC selection process most courts required an Axis I Disorder, which are psychological disorders except cognitive and personality disorders (Wolff et al., 2011). A qualitative multi-site study was conducted to find out how the selection process can formulate the success of a participant in MHC. The current findings show that a majority of mental health courts in the US have multiple aspects such as type of crime, disorder eligibility, and public safety in conjunction with the legal system. They obtain a separate docket which specializes in inmates with mental health diagnosis, a collaborative legal team, links to outpatient mental health treatment and compliance monitoring (Wolff et al., 2011). The screening process in mental health court has some requirements, they screen for substance and drug abuse that may be comorbid to mental health diagnosis. “Limitation of arrestee and defendant studies is their focus on offending-related health and mental health problems like drug and alcohol abuse and mental disorder” (Ross & Graham, 2012, p. 86). It was prudent for MHCs to screen for comorbid health problems in order to locate underlying prevalent pre-dispositions to their criminal charges. Ross & Graham (2012) use the example of posttraumatic stress disorder and violence as two possible comorbid factors and therefore should increase eligibility in mental health court screenings. There is a need for increased understanding of mental health court screening and available access to all inmates with mental health diagnosis including inmates with violent offenses.

The need for further study are among inmates who commit violent offenses and have a diagnosed mental health diagnosis may continue to reoffend due to not receiving proper mental health care treatment. The literature supports that mental health court is beneficial as a treatment by decreasing jail days, a decrease in new offenses and increase in outpatient treatment. However there are limitations to look into a population that has not been used, the violent inmate population. The study hopes to shine further light on the success of mental health court with violent inmates while reducing recidivism. “The appropriate question for MHCs is not, do they work but, for whom, and under what circumstances, do they work?” (Steadman et al., 2011, p. 171). Previous literature has shown the effectiveness of mental health court to inmates but not to the researchers knowledge, specifically the effectiveness on inmates with violent felonies. So we propose, is mental health court effective for treating violent inmates and to see if there is capability for inmate and public? Subsequently is there something about the notion of violence that increases the need for more treatment than currently required by the mental health courts?

Literature Review

Research has supported mental health court as an effective treatment in regards to inmates with mental health diagnosis. The research that has occurred shows the effectiveness in the form of decrease in new offenses and jail days decrease in new charges and increase in outpatient treatment (Luskin, 2013; McNiel & Binder, 2007; Steadman et al., 2011). According to the study by Steadman et al. (2011), inmates who participated in MHC had a decrease in jail days, which proved their hypothesis as being an effective form of treatment for inmates with mental diagnosis. The study supports the idea of MHC being an effective treatment in reducing recidivism and encouraging public safety. The article views the importance on MHC with their goal to “moving persons with serious mental illness out of the criminal justice system and into community treatment without sacrificing public safety” (Steadman et al., 2011, p. 167). The results revealed a decrease in the number of jail days for inmates who attended mental health court versus those who did not. MHC’s can also help decrease the amount of new offenses by inmates with mental illness. In a 2007 study by McNeil and Binder it was demonstrated that when inmates graduated from MHC, the follow up indicated a significant decrease in new criminal offenses.  McNeil & Binder (2007) help us understand that MHC is successful with inmates by reducing the amount of jail days by inmate but also inmates were significantly less likely to obtain new charges. Another study had the hypotheses that MHC has a positive effect on recidivism no matter if the inmate successfully completed mental health court (Lowder, Desmarais, & Baucom, 2016). The study by Lowder et al (2016), proposes that the results indicated inmates had significantly lower jail days and was more successful for inmates with a mental illness diagnosis comorbid with substance use. The above-mentioned studies show the effectiveness of mental health courts with decreasing new offenses and jail days. Another study has demonstrated that MHC is effective by increasing the inmate’s use of outpatient treatment as a result of attending mental health court (Luskin, 2013). By using a longitudinal study in 2013, Luskin showed that results of mental health court increased the participation of use in outpatient treatment programs but acknowledge the fact that treatments would need to be more specialized to address criminal risk. The literature review of these earlier studies help support our study that mental health court is an effective treatment to reduce recidivism and increase mental health treatment for intimates with mental health disorders.

In order to demonstrate the effectiveness of mental health courts you must understand the idea of therapeutic jurisprudence and how it is related to MHC success, which is best explained as “The theory of TJ is one that views the law (and the legal actors who practice it) as a vehicle that can be therapeutic (promote personal change and improvement) or antitherapeutic” (Redlich & Han, 2014, p. 117). This study examines how jurisprudence and mental health court effect inmate success. The study was conducted with the hypothesis that MHC will be more successful to inmates if they “better understood court procedures, chose to enter the court and felt more respected” (Redlich & Han, 2014, p. 111). Inmates were surveyed on their initial understanding of therapeutic jurisprudence by three factors, “perceived voluntariness to enroll in the court, perceived procedural justice, and MHC knowledge” (Redlich & Han, 2014, p. 117). The study demonstrated that the inmates who had increased knowledge in mental health court knowledge increased compliance and graduation rates. Therapeutic jurisprudence also overall decreased recidivism 12 months post graduation in accordance with the therapeutic jurisprudent principles (Redlich & Han, 2014). This principle presented to researchers that inmates who are diagnosed with a mental illness can be successful in MHC. The overall knowledge about the court system and legal proceedings has a significant effect in increasing success rates. The theory of Jurisprudence is also the belief that this form of application of the law can be therapeutic (Lamb & Weinberger, 2008). This concept is how majority of the mental health courts operates and studies that have shown jurisprudence will help ensure the inmate safety and public safety.  This theory is also used to encourage positive and therapeutic change (Ray, Kubiak, Comartin, & Tillander, 2015).  Many studies in our literature review touch on Jurisprudence being a striving theme for therapeutic change, not only the inmates, but also for the public safety. The concern for public safety is important when it comes to MHC. The court will try to protect the public first; this is why many of the courts currently cater to mostly non-violent felonies.

Mental health courts are meant to be therapeutic for the inmates who are eligible for mental health court services and are selected into the program. MHCs operate on the basis that if the inmate is eligible for specialized court they will be receiving therapeutic and legal care in accordance with the law but also is voluntary in which the inmate will have the choice to participate. In a study done to view inmate perspectives on mental health court, there were clinical eligibilities the inmate must have and that these criteria differ from state to state, or even jurisdiction. Some requirements were that the inmate has an Axis I disorder (does not include cognitive or personality disorders), it is voluntary to participate, must be a non-violent misdemeanor or felony charge and they must reside within the jurisdiction of the court (Kennedy, 2012). It is important to acknowledge that there are differences within each mental health court as far as selection of an eligible inmate. Majority, if not all courts that were in the literature review, included felonies, but all indicated there were to be non-violent charges. “The large-scale criminalization of persons with severe mental illness has stimulated a variety of modalities to reduce the risk of violence for individuals with severe mental illness” (Lamb & Weinberger, 2008, p. 722). This new criminalization has increased not only the need for more therapeutic treatment, but also increased inclusion of inmates who are eligible for therapeutic jurisprudence. There is a new need to look into including inmates with violent cases to see if there is capability for the safety of the inmates and the safety of the public.

With a movement towards higher inclusion of inmates with mental illness and the selection process of the mental health courts, more courts are considering expanding to inmates with violent criminal offenses.  Around 40% of mental health courts accept only misdemeanor charges and 10% included felonies (Ray et al., 2015). According to the 2015 study by Ray et al., the researchers looked into completion status of different offenses to see if the type of offense would hinder mental health court completion and reduction in new offenses. The study results were that there was an association in reduction for both felony and misdemeanor cases, which lead to reductions in criminal offenses during mental health court and post mental health court (Ray et al., 2015). This study demonstrates that both inmates with felony and misdemeanor cases can have strong therapeutic jurisprudence outcomes by attending mental health court. These studies were done in hopes that further inclusion will prove that type of offense would result in a positive outcome for inmates and the community in reduction of new offenses. The outcomes of this study may help encourage further studies on how mental health court has an effect on violent offenders. Mental health court may be used to help serious offenders who “cycle through the criminal justice system and use the resources and supervision of the court to address the root cause of criminalization” (Ray et al, 2015, p. 330).

The selection process of the mental health court is also using the old DSM IV with requiring an AXIS I disorder for eligibility in mental health court (Wolff et al., 2011). The courts use the factor of having an already diagnosed mental illness to indicate whether an inmate can be selected for mental health court. The use of the old AXIS terms may be required to change as the recent DSM V has emerged and which no longer uses the axis terminology. Mental health courts also have a limitation by not focusing chances of reoffending with comorbidity risks with substance abuse (Ross & Graham, 2012). Screening intimates is important; you can locate comorbid factors such as substance use to inform the courts how to tailor the treatment plans. There is a correlation between mental health diagnosis and frequent substance use; the inmates with substance use disorders were still capable of being successful at mental health court (Ross & Graham, 2012). This indicates that it is important to continue research to show that inclusiveness will not diminish the success of mental health court. “Sorting out the sources of the difference will be important to understanding both courts’ selection practices and the role of judicial supervision in achieving increased treatment” (Luskin, 2013, p. 264). The more we understand about the differences in selection for mental health court across different jurisdictions will help us increase treatment inclusivity but also help us better understand our treatment population in studies. It is important to understand that many courts do not include violent felonies. Increasing inclusivity to inmates with violent felonies may be just as successful in mental health court treatment.

Treating violent offenders and including them in therapeutic jurisprudence is a topic that has not been touched on and reiterates as a limitation in the literature review. Researchers acknowledge that the population does not include certain subgroups due to the risk to the community and limited courts allowing inmates with felonies to participate in mental health court. The treatment of violent inmates will continue the question about integrating and releasing these inmates into the community, as safety is a factor in most mental health courts. “Mental health courts meet the public safety objectives of lowering post treatment arrest rates and days of incarceration” (Steadman et al., 2011, p. 167).  There are some MHCs that are now including felonies in their selection process as stated above in the literature review but it is still not inclusive of violent charges. “Staff should ask inmates for their description of what happens when they get violent, beliefs about triggers” (Lewis, 2000, p. 333). We must treat aggressive inmates as a subgroup when working with mental health court this way staff may be able to help treat underlying factors about inmate aggression. Successful treatment with aggressive inmates can be done but suggests that we determine if there are underlying symptoms we can better treat the inmate in a specialized treatment program (Lewis, 2000). In this case the successful treatment will also require aggressive inmates to cooperate with staff and the court system.

Hypothesis

To the researchers knowledge there is no current research to focus specifically on violent crimes and the treatment into mental health court with. The use of mental health court will significantly decrease recidivism for inmates charged with violent felonies participating in MHC compared to in mates charged with violent felonies in a TAU (treatment as usual) group. Subsequently is there something about the notion of violence that increases the need for more specialized treatment than currently required by the mental health courts?

Bibliography

Cook County Sheriff – Office of Mental Health Policy and Advocacy. (n.d.). Retrieved September 24, 2017, from http://www.cookcountysheriff.org/MentalHealth/MentalHealth_main.html

Kennedy, K. (2012). Mental Health Court- A Participant’s Perspective. Best Practices in Mental Health, 8(2), 38–46.

Lamb, H. R., & Weinberger, L. E. (2008). Mental health courts as a way to provide treatment to violent persons with severe mental illness. JAMA, 300(6), 722–724. https://doi.org/10.1001/jama.300.6.722

Lewis, C. F. (2000). Successfully treating aggression in mentally ill prison inmates. In Psychiatric Quarterly (Vol. 71, pp. 331–343). https://doi.org/10.1023/A:1004684223522

Lowder, E. M., Desmarais, S. L., & Baucom, D. J. (2016). Recidivism following mental health court exit: Between and within-group comparisons. Law and Human Behavior, 40(2), 118–127. https://doi.org/10.1037/lhb0000168

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Ray, B., Hood, B. J., & Canada, K. E. (2015). What Happens to Mental Health Court Noncompleters? Behavioral Sciences & the Law, 33(6), 801–814. https://doi.org/10.1002/bsl.2163

Ray, B., Kubiak, S. P., Comartin, E. B., & Tillander, E. (2015). Mental Health Court Outcomes by Offense Type at Admission. Administration and Policy in Mental Health and Mental Health Services Research. https://doi.org/10.1007/s10488-014-0572-2

Redlich, A. D., & Han, W. (2014). Examining the links between therapeutic jurisprudence and mental health court completion. Law and Human Behavior, 38(2), 109–118. https://doi.org/10.1037/lhb0000041

Ross, S., & Graham, J. (2012). Screening Offenders for Health and Mental Health Problems at Court. Psychiatry, Psychology and Law, 19(1), 75–88. https://doi.org/10.1080/13218719.2010.543407

Steadman, H. J., Redlich, A., Callahan, L., Robbins, P. C., & Vesselinov, R. (2011). Effect of Mental Health Courts on Arrests and Jail Days. Archives of General Psychiatry, 68(2), 167. https://doi.org/10.1001/archgenpsychiatry.2010.134

Wolff, N., Fabrikant, N., & Belenko, S. (2011). Mental health courts and their selection processes: Modeling variation for consistency. Law and Human Behavior, 35(5), 402–412. https://doi.org/10.1007/s10979-010-9250-4