What Happens to Mental Health Court Noncompleters?

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. Copyright © 2015 John Wiley & Sons, Ltd.     

Fixing forensic patients: Psychiatric recommendations for treatment in pretrial settings

This article is concerned with psychiatric recommendations for treatment at the Metropolitan Toronto Forensic Service (METFORS), a clinical assessment agency providing both 1-day and 30-day evaluations of criminal defendants in Toronto, Canada. Analysis of both psychiatric reports and quantitative research instruments demonstrated the saliency of treatment as a central forensic issue at METFORS. Among a sample of 592 defendants, 134 were considered in need of outpatient care. Persons recommended for hospitalization were most likely to exhibit histories of mental health rather than criminal justice contacts; to be arrested for nonviolent offenses; to manifest psychotic behavior while at METFORS; to be found unfit for bail, incompetent to stand trial, in need of further assessment and dangerous to self; and to experience higher rates of hospitalization, but lower levels of criminalization during the two years following their initial forensic assessment. Psychiatric reports at METFORS tended to merge recommendations for treatment and assessment; to suggest prison or probation as means for securing clinical treatment; and to provide little written support for judgments about the need for intervention. Along with competency and dangerousness, treatment is a key issue in forensic practice, and warrants further attention in the psycholegal literature.     

The role of competency to stand trial in mental health courts

Concerns have been raised in the literature about the competency to stand trial and competency to make treatment decisions of defendants referred to mental health courts. However, there is little information reported about the evaluation and prevalence of incompetence, characteristics of incompetent mental health court defendants, and disposition of mentally ill defendants too disturbed to be diverted from the criminal justice system through mental health courts. This study reports on the 85 potential mental health court defendants referred for trial competency evaluations during the first three years of operation of the Akron Ohio Mental Health Court. Of the 80 defendants who could be located for evaluation, 77.5% were found incompetent, and 53% of the incompetent defendants were not restored to competence even after an average of 49 days of treatment in a state psychiatric hospital. The implications of these findings in terms of the diversion potential of mental health courts for the severely mentally ill are discussed.     

Influence of judges' behaviors on perceived procedural justice

The influence of judges' behaviors on procedural justice was analyzed in a field study, observing the judges' behaviors during n = 129 trials and assessing the defendants and the audiences' justice perceptions. The observed judicial behavior was unrelated to the defendants' justice perceptions. However, the more respectful the judge treated the defendants, the fairer the audience perceived the trial. In general, the effect size of the relationship between observational measures and subjective justice ratings was small in comparison to the relationship within defendants' or audiences' ratings. There were striking differences in the justice perception between the two data sources, namely defendants and audience. Thus, the source matters, and to avoid a same‐source bias, should be taken into account when analyzing justice perceptions.     

Examining changes in procedural justice and their influence on problem‐solving court outcomes

The number of problem‐solving courts has grown substantially since the mid‐1990s. Research consistently indicates that participation in these courts lowers recidivism, which is often attributed to defendants’ increased perceptions of procedural justice in these programs. Yet, prior studies are limited in their focus, often examining interactions with the judge in a single court or examining defendant perceptions and outcomes at a single time point. In the present study, we investigate defendant perceptions of procedural justice with judges and case managers across multiple problem‐solving courts over time. Findings indicate that procedural justice varies across court actors and over time. Procedural justice is lower among judges than among case managers; however, changes in perceptions of procedural justice with the judge are associated with improved court outcomes. We suggest that defendant perceptions are variable and complex but important in explaining variations in outcomes.     

Cultural Lens on Mental Illness: Four Clients Share Their Perspectives

People served by mental health providers represent diverse cultural groups. In-depth qualitative interviews were used to collect data to examine: “How do people, diagnosed with a mental illness, perceive their experience in a partial care mental health program from the perspective of their cultural context?” Four participants described cultural identities that included ethnic, health status, and sexual orientation identities. The participants' way of participating in the world was often in conflict with cultural values and expectations of the family and counselors. Cultural competence must include understanding how complex, multiple cultural contexts interact and influence a person's participation in the therapeutic process.     

“It kind of fosters a culture of interdependence”: A participatory appraisal study exploring participants' experiences of the democratic processes of a peer‐led organisation

Peer‐led mental health organisations operate through participatory democracy, enabling participants to take an active role in decision making about the running of these organisations. U.K. national policy recommends increased involvement of people accessing statutory mental health services in service development, for example, through co‐production. This study employed a participatory research method to explore participants' perspectives of the democratic processes of a U.K.‐based peer‐led mental health organisation, The Bridge Collective, and the influence of these processes on participant wellbeing. A range of data collection methods were used to gather the perspectives of 16 participants. Participatory thematic analysis identified how the organisations' democratic processes both nurtured and challenged participants' wellbeing. Three main themes captured the influences of the democratic processes on participant wellbeing: (a) negotiating relationships, (b) feeling the responsibility of involvement, and (c) sharing power. The findings identify the value of democratic processes in enabling meaningful social support and empowerment, and also identify the challenges of inclusion and workload management in participatory democracy. These insights may inform the development of co‐production methods and enable The Bridge Collective and other peer‐led organisations to further develop their processes.     

The Clemson Juvenile Delinquency Project: Major Findings from a Multi-Agency Study

Clemson University researchers have conducted a multi-agency, multi-cohort study on juvenile offending and recidivism. Important features of the study are a sample size of approximately 100,000 delinquents and 100,000 non-delinquents; the merging of data sets from a state department of juvenile justice with those of departments of mental health, social services, education, and (adult) law enforcement; and statistical analyses focusing on the role of age, race, gender, child maltreatment, mental health disorders and school-related disabilities on juvenile referrals, prosecutions, re-offending and incarceration. Published findings strongly support earlier empirical and clinical work on influences on juvenile delinquency. The present article emphasizes our findings related to five important issues: the impact of prosecution on repeat offending, the effects of the juvenile's race on solicitor recommendations, the significance of one-time juvenile offending, the empirical support for the concept of "resilience," and the magnitude of associations between childhood history and later criminal offending.     

Factors affecting jail detention of defendants adjudicated incompetent to proceed

The movement of defendants through the legal process who have been adjudicated incompetent to proceed is little studied, yet it is important. The purpose of this study was to provide empirical data regarding factors that affected the amount of time defendants adjudicated incompetent to proceed and ordered to undergo hospitalization remained in jail while awaiting transfer to a state hospital. Statewide data collected in Florida between July 2005 and June 2008 were used to determine the lengths of time incompetent defendants spent at certain stages in the legal process. The addition of forensic bed capacity following media attention and litigation resulted in a significant decrease in the amount of time defendants adjudicated incompetent to proceed waited in jail for transfer to a state hospital for treatment. The amount of time it took for completed commitment orders to be submitted to the state mental health authority by the Clerks of Court of each county accounted for a meaningful portion of days defendants spent in jail awaiting transfer to a state hospital, with considerable variation across counties with respect to waiting times. These findings reflect how various stakeholders can affect the amount of time defendants spend in jail while awaiting hospitalization. These issues are discussed in the context of controversy related to Florida's forensic mental health system, as well as issues related to the political process and funding of the state's mental health authority.     

Effects of diversion on adults with co-occurring mental illness and substance use: outcomes from a national multi-site study

This quasi-experimental non-equivalent comparison group study examines outcomes for participants in eight programs conducting criminal justice diversion for people with co-occurring serious mental illness and substance use disorders compared with jail detainees eligible for diversion, but who were processed through standard criminal justice methods without diversion. Nearly 2000 participants were interviewed at baseline, and 1500 at 3 month and 1300 at 12 month follow-up to baseline. In these interviews, outcome measures of re-arrest, mental health functioning, substance abuse, quality of life, and service utilization were obtained. Those diverted were more likely to have received mental health counseling, mental health medication, and mental health hospitalization than those not enrolled in a diversion program, but were equally likely to have received substance abuse counseling. Overall, the differences in proportions receiving services between the two groups were small, even when these differences were statistically significant. The effect associated with diversion differed somewhat across the individual sites. However, overall cross-site pooled analyses revealed no outcome differences between groups on measures of mental health symptoms, substance use, criminal justice recidivism, or quality of life. Although the immediate benefit of diversion as an access mechanism to community treatment is indicated in pooled cross-site results, such access was driven by more coercive (pre-booking and court) models and results suggest that effecting substantially greater access to services or services use did not occur. The findings also suggest that mental health, substance abuse, and criminal justice outcomes remain dependent on the treatment intervention received, perhaps moderated by type of diversion intervention, rather than on a generic and initial diversion event.     

The admissibility of expert testimony regarding malingering and deception

This article discusses the legal admissibility of expert testimony and the ability of mental health professionals to detect malingering and deception among defendants. A legal analysis of the admissibility of expert testimony regarding malingering and deception in formal legal proceedings is presented. Some guidelines are provided to help mental health professionals and attorneys determine the admissibility of evidence they intend to introduce. Although psychologists and psychiatrists currently have a limited ability to identify accurately malingering and deception, expert testimony about the genuineness of a defendant's mental illness is likely to be held admissible for both practical and evidentiary reasons. In contrast, evidence about a witness' credibility is rarely admissible. In addition, psychologists are ethically obliged to recognize their limitations in making representations about their skills.     

Integrating the criminal justice system into mental health service delivery: the worcester diversion experience

The substantial number of persons with mental illness encountered in many sectors of the criminal justice system has spurred actors from various agencies within that system to take actions aimed at reducing the growth of this population. These actions have included the development of specialty police units, jail diversion programs, and other mechanisms for channeling persons with mental illness out of the criminal justice system and into mental health treatment. The courts, too, have become involved in this effort with the recent development of the "mental health court," the latest of the "specialty" or "problem solving courts." These courts have not been without their critics, however, nor are they the only feasible approach to court-based diversion. This paper identifies and explores a range of options for structuring the relationship between criminal courts and local mental health systems. Beginning with a discussion of the rationale motivating the development of mental health courts, two alternatives to this specialty court model are discussed. One involves judges dealing with defendants having mental illness and substance abuse on a case-by-case basis. The other takes advantages of linkages that may already exist between most courts and the mental health providers who conduct their forensic assessments, expanding the role of these providers to serve as boundary spanners between courts and the components of local mental health systems. Regardless of the model adopted, however, appropriate linkages must exist between the courts and relevant providers. A case study is provided that demonstrates how the status of a locale's linkages can be evaluated and how the information derived from such evaluation can be used to improve the linkages between police, courts, and health and human services agencies.     

Effects of a Visual Technology on Mock Juror Decision Making

Two studies explored the effects of lawyers' use of PowerPoint on liability judgments in a case involving statistical evidence. Participants (Study 1, N = 192; Study 2A, N = 180; Study 2B, N = 189) watched videotaped opening statements for plaintiffs and defendant. In general, defendant's responsibility was judged to be greater when plaintiffs used PowerPoint slides than when they did not and less when defendant used PowerPoint slides than when it did not. Furthermore, PowerPoint's impact was greatest when its use was unequal. PowerPoint enhanced persuasion partly through central and partly through peripheral processing. In general, each party's use of PowerPoint increased participants' recall of that party's evidence, which in turn increased defendant's judged responsibility (when plaintiffs used PowerPoint) or reduced it (when defendants used PowerPoint), indicative of central processing. PowerPoint also functioned as a peripheral cue, influencing participants' judgments of defendant's responsibility by affecting their perceptions of the respective attorneys. Copyright © 2012 John Wiley & Sons, Ltd.     

An “issue-focused” model for mental health consultation with groups of teachers

This paper presents and evaluates a model for group mental health consultation with teachers in which sessions are organized around mental health issues rather than cases. The rationale and advantages of the model are explicated and compared with other models of group consultation and group work with teachers. The model incorporates a heavy emphasis on educational preventive measures and is designed to simultaneously satisfy a wide range of consultee needs and to reduce anxiety and defensiveness. Consultant's preparations for the group sessions are highlighted so as to maximize their contribution to the participants' level of involvement, knowledge, skills, confidence, and objectivity. The different roles of the consultant during the session and the variety of techniques employed are described as they relate to group processes and consultation needs. Specific guidelines for the organization of consultation groups and training of group consultants are offered. Evaluation data based on feedback from participants in ten groups are included.     

Effects of Mental Health and Neuroscience Evidence on Juror Perceptions of a Criminal Defendant: the Moderating Role of Political Orientation

Several recent studies have examined the effects of mental health and neuroscientific evidence on attitudes toward criminal defendants, suggesting that these factors may influence juror decision‐making in meaningful ways. Few studies to date have manipulated both of these variables while also considering theoretically important individual difference variables (e.g., political orientation). Using a criminal case simulation, this study manipulated the presence of evidence concerning mental disorders (psychopathy and schizophrenia) and increasing levels of neuroscientific detail regarding a defendant's brain injury, and examined verdicts and sentencing recommendations in over 400 persons attending jury duty. Main effects were detected for mental health testimony and political orientation, although interactions were noted as well. More negative reactions to defendants labeled as psychopaths were relatively consistent, whereas participants who identified as liberal generally were less punitive towards a defendant identified as schizophrenic than were more conservative jurors. Consistent with other recent research, juror perceptions of the defendant's level of psychopathic traits (independent of the effects of the experimental manipulations) predicted guilty verdicts and longer sentencing recommendations. Copyright © 2016 John Wiley & Sons, Ltd.     

Teenage Childbearing,Reproductive Justice,and Infant Mental Health

Reproductive justice advocates emphasize the rights of women to choose to have children, to decide the conditions under which they give birth, and to parent their children with support, safety, and dignity. This article examines what a reproductive justice perspective contributes to infant mental health work with teenage mothers and their families. It explores the historical framing of teenage pregnancy in which young mothers are the cause of a variety of social problems and in which the primary policy and practice approach is pregnancy prevention. The article offers alternative framings of teenage childbearing, based on reproductive justice principles, which focus on social conditions surrounding teenage parenthood and the meaning of motherhood in the lives of young women. These alternative frames shift the practice agenda to eradicating unjust social conditions and providing supports for young women in their roles as parents. The article then describes ways in which two infant mental health programs have incorporated reproductive justice principles into their work with young families: Chicago's community doula model and Florida's Young Parents Project for court-involved teenage parents. Finally, the article extracts a set of principles deriving from a reproductive justice perspective that are relevant to infant mental health work with young families.     

Mental Health Diversion Courts: A Two Year Recidivism Study of a South Australian Mental Health Court Program

The need to develop specialized judicial processes to deal with offenders with mental illnesses is now widely recognized and has led to the introduction of mental health court diversion programs around the world. At present, however, there is only limited evidence from which to assess the impact of these initiatives. This paper describes the South Australian model of diversion, with specific reference to the relationship between identified participant characteristics, program compliance rates, and re‐offending outcomes. The results of a two‐year recidivism study suggest that involvement with the program has a positive impact on recidivism, but that this is independent from the individual's level of success in the program. Lower risk offenders were more likely to achieve successful outcomes than those in the higher risk categories. The implications of these results, as well the factors that might inform the ongoing development of mental health court programs, are discussed. Copyright © 2014 John Wiley & Sons, Ltd.     

An analysis of post-booking jail diversion programming for persons with co-occurring disorders

For persons with co-occurring disorders, interaction with criminal justice systems is a frequent occurrence. As a result, a variety of diversionary programs have been developed nationwide. In this study, a total of 248 individuals with co-occurring disorders of serious mental illness and substance use disorders who had been arrested and booked on misdemeanor charges participated in a post-booking jail diversion program in two urban communities. A quasi-experimental design was used with individuals assigned to diversion or non-diversion status based upon the decision processes of the mental health-criminal justice systems. The effectiveness of the jail diversion program was evaluated from a variety of sources, including structured interviews, behavioral health service utilization patterns, and criminal justice recidivism patterns. Analyses revealed general main effects for time on many of the outcome variables, with few main effects or interaction effects detected on the basis of diversion status (diverted versus non-diverted). Across all measures assessing mental health and substance abuse, study participants displayed improvements over time, irrespective of their diversion status or program location. Participants generally displayed no significant changes in their rates of accessibility to, or frequency of use of, the various mental health, substance abuse, and other services, and few changes for diversion status were detected with regard to service utilization. Although a number of indicators of criminality and violence were reduced over time, these reductions were statistically insignificant, with changes for diversionary status or time identified at follow-up. These results are discussed in light of their implications for jail diversion programming and future research in this area.     

Implicit Theories of Mental Skills Abilities in Collegiate Athletes

We aimed at studying athletes' mental skills-related implicit beliefs and their susceptibility to changes. Collegiate athletes (n = 68) responded to the Theories of Mental Skills scale to determine their implicit beliefs of mental skills abilities within sport. Participants were randomly assigned to read one of two manipulation articles and complete a mental skills task. Following the manipulation, participants' beliefs were reassessed to determine changes from pre- to postmanipulation. The results revealed that implicit beliefs could be manipulated, shedding light on the malleability of implicit beliefs. The findings provide information on the nature of athletes' perceptions of mental skills.     

Graduate trends for one marriage and family therapy program in an interdisciplinary setting

This research compared trends from 1981 to 1993 in several mental health professional training programs at the University of Houston Clear Lake, surveying graduates from three professional mental health master's programs—clinical psychology, school psychology, and family therapy—with the goal of identifying trends in the status of their professional credentialing and current employment. Four mental health groups have attained licensure since a 1981 survey, resulting in graduates now seeking professional licenses and perform psychotherapy more exclusively than other mental health activities. Interdisciplinary training has become increasingly important due to the introduction of managed care and other insurance regulating entities.