Effectiveness of a short-term mental health court: criminal recidivism one year postexit.

This article investigated criminal recidivism 1 year postexit from a mental health court (MHC), which has, unlike prior MHCs studied, relatively short periods of court supervision. It benefits from a federal pretrial services agency that screens all arrestees for mental illness and dedicates a specialized supervision unit (SSU) to provide supervision and services while on pretrial release to all screened positive, including MHC participants. We compared criminal activity prior to key arrest with criminal activity post court disposition in MHC participants (N = 408) and MHC-eligible mentally ill arrestees in SSU (N = 687) receiving the same supervision and services while controlling for possible confounders. The proportion of MHC participants arrested was significantly lower in the year after MHC exit and significantly lower than that of the comparison group. They also averaged fewer rearrests and had a longer time to rearrest. MHC graduates made the greatest gains and accounted for the recidivism differences between MHC participants and the comparison group. This study adds to the accumulating evidence of the effectiveness of MHCs in reducing recidivism among offenders with severe mental illness.

Procedural justice and the mental health court judge's role in reducing recidivism.

Based on qualitative observation and quantitative data from eight mental health courts (MHCs), this article argues that observed reductions in recidivism from participation in MHC are caused in part by the role of the judge in conveying elements of procedural justice. Specifically, the judge provides: (1) a heightened level of interpersonal treatment of participants that accords them dignity, respect, and voice; (2) accountability for participants and service providers alike; and (3) transparency for decisions reached through an open negotiation process. Procedural justice theory predicts that participants will thereby be more likely to see legal decisions as legitimate and incorporate the court's values and goals as their own. Preliminary qualitative and quantitative data are presented from interviews of a sample of participants in the Superior Court of the District of Columbia's Mental Health Diversion Court (DCMHDC) that support these hypotheses. DCMHDC participants hold strongly positive views about the procedural justice they receive from their court experience and of the judge's role in providing justice.

PLC or TLC: is outpatient commitment the/an answer?

The lively debate over mandated community treatment in general and outpatient commitment laws (OPC) in particular has raised many issues. At its core, the debate is over how and to what extent laws should be formulated to persuade, leverage or coerce (PLC) persons with severe mental illness living in the community to comply with medications that mental health professionals believe they need. The alternative to PLC is what we call TLC (tender loving care): a strategy of using benefits - improved patient-centered treatment, entitlements and service delivery, including assertive outreach - rather than penalties or conditions on access to services, to induce compliance. We examine three aspects of the debate: (1) the empirical case for the need for OPC court orders to maintain revolving-door severely mentally ill persons in the community; (2) the normative argument over whether such orders constitute coercion, and, if so, whether that coercion is justifiable; and (3) the incentives such orders create to leverage community providers to augment resources and tailor treatment and services to entice patients to become willing participants in the management of their disorders.

Mental health court outcomes: a comparison of re-arrest and re-arrest severity between mental health court and traditional court participants.

Mental health courts have been proliferating across the country since their establishment in the late 1990's. Although numerous advocates have proclaimed their merit, only few empirical studies have evaluated their outcomes. This paper evaluates the effect of one mental health court on criminal justice outcomes by examining arrests and offense severity from one year before to one year after entry into the court, and by comparing mental health court participants to comparable traditional criminal court defendants on these measures. Multivariate models support the prediction that mental health courts reduce the number of new arrests and the severity of such re-arrests among mentally ill offenders. Similar analysis of mental health court completers and non-completers supports the prediction that a "full dose" of mental health treatment and court monitoring produce even fewer re-arrests.

Putting community risk in perspective: a look at correlations, causes and controls.

Much research, but not all, appears to show that persons with severe mental illness are more dangerous and violent than others; but it is misleading and feeds the stigma cannon. This paper critically reviews reported correlations between severe mental illness and violence, examines their statistical confounds, highlights studies which seek causal mechanisms explaining the associations, points to what those causal mechanisms tell us about controlling risk in the community, and reviews legal attempts to control community risk in light of those causal mechanisms.

Outpatient commitment: the state of empirical research on its outcomes.

This article briefly describes the historical conditions in the origin and development of outpatient commitment that framed the discourse on its merits and the empirical studies on its outcomes. It divides those empirical studies into two sets on the basis of the questions addressed and critically reviews them. The review pays particular attention to the latest studies that were able to randomize subjects to experimental and control conditions and that were able to offer enhanced services. Finally, this article presents issues not addressed by the empirical studies on outpatient commitment but that need to be addressed in order to understand the choice of using the law to force persons with mental illness to comply with treatment and receive services in the community.

Impact of outpatient commitment on victimization of people with severe mental illness.

OBJECTIVE: The authors' goal was to evaluate the effectiveness of outpatient commitment in reducing victimization among people with severe mental illness. METHOD: One hundred eighty-four involuntarily hospitalized patients were randomly assigned to be released (N=99) or to continue under outpatient commitment (N=85) after hospital discharge. An additional group of patients with a recent history of serious violent behavior (N=39) was nonrandomly assigned to at least a brief period of outpatient commitment following hospital disharge. All three groups were followed for 1 year, and case management services plus additional outpatient treatment were provided to all subjects. Outcome data were based on interviews with the patients and informants as well as service records. RESULTS: Subjects who were ordered to outpatient commitment were less likely to be criminally victimized than those who were released without outpatient commitment. Multivariate analysis indicated that each additional day of outpatient commitment reduced the risk of criminal victimization and that outpatient commitment had its effect through improved medication adherence, reduced substance use or abuse, and fewer violent incidents. CONCLUSIONS: Protection from criminal victimization appears to be a positive, unintended consequence of outpatient commitment.