Effectiveness of a mental health court in reducing criminal recidivism and violence

OBJECTIVE: In response to the large-scale involvement of people with mental disorders in the criminal justice system, many communities have created specialized mental health courts in recent years. However, little research has been done to evaluate the criminal justice outcomes of such courts. This study evaluated whether a mental health court can reduce the risk of recidivism and violence by people with mental disorders who have been arrested. METHOD: A retrospective observational design was used to compare the occurrence of new criminal charges for 170 people who entered a mental health court after arrest and 8,067 other adults with mental disorders who were booked into an urban county jail after arrest during the same interval. A matching strategy based on propensity scores was used to adjust analyses for nonrandom selection into mental health court. RESULTS: Propensity-weighted Cox regression analysis, controlling for other potential confounding variables (demographic characteristics, clinical variables, and criminal history), showed that participation in the mental health court program was associated with longer time without any new criminal charges or new charges for violent crimes. Successful completion of the mental health court program was associated with maintenance of reductions in recidivism and violence after graduates were no longer under supervision of the mental health court. CONCLUSIONS: The results indicate that a mental health court can reduce recidivism and violence by people with mental disorders who are involved in the criminal justice system.     

Clergy counselors and confidentiality: a case for scrutiny

As religious organizations contribute increasingly to community mental health, counseling by clergy acquires greater significance. As a result, clergy confront from time to time ethics challenges resulting from the need to balance a commitment to clients and an obligation to follow the requirements of religious doctrine. The recent New York case of Lightman v. Flaum highlights an example of this dilemma. A woman who asked two rabbis (Flaum and Weinberger) for help in her marriage complained that they had violated the confidentiality she expected of them. The rabbis requested summary judgment based on religious grounds, and the trial court rejected their request. The state's highest court concurred with an appeal court's reversal of the trial court. We discuss the arguments raised in this case about the extent to which clergy may owe a duty of confidentiality to those who consult them for psychological help, and we also consider the religion-based arguments that would fashion an exception to confidentiality in this unique context.     

Clinical outcomes of defendants in mental health court

OBJECTIVE: Mental health courts successfully divert defendants into treatment. However, few studies have examined whether this increased access to services positively affects client outcomes. This study compared changes in symptoms in a sample of defendants in Broward County mental health court with such changes in a comparison sample of defendants in a regular court. METHODS: Participants included 116 defendants from mental health court and 101 defendants from a magistrate court who were assessed one, four, and eight months after an initial court appearance by using the Brief Psychiatric Rating Scale (BPRS). Both administrative and self-report data were used to identify defendants who received treatment after their initial court appearance. Participants were included in our analysis if they had at least one follow-up interview. RESULTS: A total of 97 defendants from mental health court and 77 from the regular court were included in our analysis. Analyses of covariance performed on changes in BPRS scores revealed no significant main effects by type of court, receipt of treatment, or the interaction between type of court and receipt of treatment. CONCLUSIONS: Although mental health courts have been found to increase defendants' access to mental health services, they have little control over the type and quality of services that defendants receive. The fact that reductions in symptoms were not observed among defendants who received treatment in either court setting more likely reflects the chronic nature of their disorders and concerns about the adequacy of our public mental health system, rather than a failure of the mental health court.     

Changing a state mental health system through litigation: the Arizona experiment

Litigation may be a viable means to change mental health systems for the chronically mentally ill. Court orders achieved in the 1970s have been ignored or proven inefficient over the years. However, in Arizona, a strategy was designed by a team of lawyers and psychiatrists to deal with failures seen elsewhere in court actions seeking adequate services for chronically mentally ill patients. This novel approach produced a favorable court outcome and triggered a chain reaction at the executive and legislative levels to reform radically the system of care for the chronically mentally ill in Arizona.     

Juvenile drug courts: emerging outcomes and key research issues

PURPOSE OF REVIEW: In consideration of the widespread adoption of juvenile drug court programs during the past decade, the purpose of this review is to examine the effectiveness of juvenile drug courts and suggest priorities for juvenile drug court research. RECENT FINDINGS: Consistent with the much more extensive adult drug court literature and the few uncontrolled evaluations of juvenile drug court, findings from a recent randomized clinical trial suggest that juvenile drug court is more effective than family court in decreasing participant criminal behavior and substance use. Perhaps due to the intensive surveillance that juvenile drug court participants receive, however, these favorable outcomes did not translate to reduced rates of rearrest or incarceration during the 12-month study period. In addition, the integration of evidence-based substance-abuse treatments into juvenile drug court enhanced participant substance-related outcomes and rates of juvenile drug court completion. SUMMARY: Although the widespread dissemination of juvenile drug courts has exceeded clear and unambiguous evidence of their effectiveness, few other criminal justice programs have shown such promise with drug-abusing offenders. Moreover, the integration of evidence-based treatments of adolescent substance abuse holds the potential to further enhance the effectiveness of juvenile drug courts.     

Symptoms of Depression and Successful Drug Court Completion

The majority of drug abusing offenders who need substance abuse treatment do not receive it. Although interventions like drug court increase the probability of offender success, little is known about how co-occurring psychological symptoms impact drug court treatment outcomes. Based on previous research, we hypothesized that co-occurring psychological symptoms would have a significant relationship with successful drug court completion. Using a sample of suburban drug court enrollees (n = 122), multivariate logistic regression was conducted with successful drug court completion as the outcome variable. Predictor variables included symptom counts of depression, post-traumatic stress, obsessive–compulsive disorder, panic disorder, psychosis, generalized anxiety, and social phobia. Results indicated that participants with fewer symptoms of depression were more likely to successfully complete drug court than participants with more symptoms. The present study extends previous research by demonstrating that symptoms of depression are related to poorer outcomes for drug court enrollees. Accordingly, drug courts need to address participants’ symptoms of depression to maximize success.     

Absence of insight as a catch-all extra-legislative factor in Swedish mental health law proceedings

Previous research indicates that insight is frequently used but rarely defined in mental health proceedings. This article examines how participants in Swedish administrative court proceedings use the concept of insight when discussing decisions regarding involuntary psychiatric care. Open-ended qualitative interviews were conducted with professional mental health court participants. The results show that lack of insight is used by the informants as an argument for all three legal criteria for involuntary psychiatric care in Sweden, as well as the criterion for release from forensic psychiatric care. It is concluded that there are troublesome legal and ethical implications of courts relying on a poorly defined concept such as insight in their rulings.     

Vulnerability of witnesses with learning disabilities: preparing to give evidence against a perpetrator of sexual abuse

Testifying in court to sexual abuse is always stressful and can be particularly problematic for a witness with learning disabilities (LDs). The present case report illustrates the assessment of capacity in relation to issues such as consent, competence and ability to withstand court procedures of a witness with LDs who alleged abuse by her paid carer. It describes the support offered to her by a number of agencies, including the police, and the health and social services. Finally, new legislation is described that might enable vulnerable witnesses, including some people with LDs, to give their best evidence in criminal proceedings.     

Juveniles on trial

This article describes common forensic evaluations requested of juvenile court mental health evaluators. There has been a legal shift toward criminalization of juvenile court, with a greater emphasis on rights, abandonment of the rehabilitative model, and greater movement of adolescents into the adult criminal court. A resulting shift has been the redefinition of juvenile court forensic evaluations toward the specificity of adult forensic work. The challenge for evaluators is to refine their knowledge of the forensic standards and bring knowledge of development, assessment, and diagnosis in juveniles and interview techniques appropriate to juveniles to improve the evaluation and forensic reports.     

Admissibility of neuropsychological testimony after Daubert and Kumho

Neuropsychological testing has been used in court cases all over the United States, as testimony to provide evidence of whether or not a person has a traumatic brain injury. It has, however, been scrutinized for its admissibility in court, but recognized for objectivity in successfully documenting and proving deficits in people with traumatic brain injuries. The trial court is used as a gatekeeper, and may chose to perform assessments of the tests themselves, for validity of sensitivity, specificity, reliability and validity in determining whether a neuropsychological test may be used as testimony in a court case.     

Measuring unfitness to stand trial: psychological analysis of a legal issue.

The structure of the legal concept of unfitness to stand trial and how it corresponds to psychometric concepts is examined. We conclude that psychometric attempts at quantification and measurement are logically flawed, because they inappropriately treat fitness/unfitness as an individual trait rather than as situation-specific conjunctive/disjunctive concepts. It is argued that, whereas psychometric approaches may be suitable for measuring single components of unfitness, an overall "fitness" score is meaningless and that the assessment should focus on elements of unfitness. The determination of unfitness requires the simultaneous consideration of several different individual capabilities in reference to the demands of a specific trial. The quantification of these specific capabilities by psychologists can assist psychiatrists and the court, but the evaluation of their influence on unfitness in the instant case must be left to the court.     

Commentary: Thereby hangs a tale--the creation of tragic narratives in forensic psychiatry

In my commentary, I suggest that the criminal court is a place where justice examines tragedy, as described by Aristotle in his Poetics. I suggest that there are strong parallels with Aristotle's account of tragic narratives and the concepts of representation and performance of forensic expert testimony, as described by Griffith and Baranoski-especially in relation to the creation of voice. On this account, the forensic expert's psychiatric court report acts as a tragic narrative that makes defendants come alive as people. Such performance is crucial for the criminal justice process, where there are competing accounts of the truth, and the expert narrative can articulate the voice of different parties. However, there are other legal fora where the role of the forensic psychiatric voice may be less clear. I close by suggesting that we continue to need rich and subtle exploration of these topics, as exemplified by the work of Griffith and Baranoski.     

The effect of diversion from court: A review of the evidence

Diversion from court has become a popular solution to perceived weaknesses in the traditional justice system, particularly in recent years with the advent of family group conferences. But evidence for the detrimental effect of court is weak. Previous research into this question shows a number of deficiencies. In particular, the range of controls used to isolate treatment from selection effects are, in most cases, inadequate for this purpose, and the measurement of the dependent variable (recidivism) is typically insensitive. There is also a failure to test for subjective reactions to either court or diversion. Because the theoretical justification for diversion is derived from labelling theory, which predicts that psychological reactions to court such as feelings of stigmatization will influence future behaviour, this is a major deficiency in the literature.     

Sometimes safe,sometimes out - umpire gives split decision

Abstract

Recent court decisions may have a profound impact on the ways in which neuropsychological opinions are presented in court. Three such cases are described, with emphasis on a recent ruling establishing the competence of neuropsychological testimony but vesting judgement of the credibility of the testimony with the court. Psychologists seeking to offer neuropsychological opinion are charged to adhere to recognized standards and definitions in representing their skills to the courts and society at large.     

New York under the Rivers decision: an epidemiologic study of drug treatment refusal

OBJECTIVE: To determine the characteristics of cases of drug treatment refusal under the Rivers decision, which mandated court adjudication of such cases, the authors made a retrospective study of all applications for court review during 1 year in New York State inpatient facilities. METHOD: Sociodemographic and clinical characteristics of these 473 cases were compared with those of the 41,535 cases during the same period in which no court review was requested. RESULTS: A 1% prevalence of applications requesting court review for nonemergency administration of medication over objection was found. The patients who refused medication were more likely than the comparison patients to have a crime-associated commitment status, a diagnosis of schizophrenia, and fewer previous hospital days, and they were more likely to be discharged. Medication refusers for whom applications for court review were submitted had relatively longer hospitalizations than the rest of the patients. Almost one-third of the applications submitted were withdrawn before court hearings, yielding a 0.7% prevalence of court-reviewed applications. Ninety-two percent of these applications for medication over objection were approved with virtually no change in the requested orders. CONCLUSIONS: The study findings demonstrate that a front-end judicial determination of competency to refuse medication results in a time-consuming procedure which fails to ensure real due process or provide individualized alternative treatment. A two-tier system with in-house clinical review preceding judicial review is proposed to remedy the deficiencies of the current system.     

How not to conduct a forensic hypnosis interview: a case study

A forensic hypnosis interview played a major role in a murder conviction. Several years later, the reliability of the interview was called into question leading to a court hearing on whether the methods used by the hypnosis specialist, hired by the police, conformed to the legal guidelines established by the Wisconsin Supreme Court. This article examines the many errors committed by the hypnosis specialist, and the subsequent legal proceedings which altered the verdict.     

Psychiatric court reports in Iceland 1970-1982

This paper looks closely at psychiatric court reports in criminal cases in Iceland. Psychiatric court reports are in the great majority of cases requested by the State Criminal Investigation Police (SCIP) on behalf of the court in major criminal cases (e.g. homicide, sexual offences, arson, physical assault). Reports are very rarely requested by the defence. During the 13-year period 1970-1982 there were 97 requests for psychiatric reports by the police/court (i.e. an annual rate of about 7.5 reports). About two-thirds of the defendants were found to have some psychiatric abnormality, although only a minority (8%) were considered criminally insane at the time of the offence. Psychiatric reports were most often requested to assess criminal responsibility, and, to a much lesser extent, sentencing issues. Psychiatric experts almost never have to present their evidence in person in court, nor are they cross-examined on their evidence. This paper discusses some of the strengths and limitations of psychiatric evidence in Iceland, and the need for an organized forensic service.     

Playback Theatre: Effects on students’ views of aggression and empathy within a forensic context

The objectives of this study were twofold: to better understand urban children and adolescents’ views of aggression and empathy and how those views may change when exposed to a Playback Theatre intervention; and to measure students’ understanding of the criminal justice/court system through the impact of instructive material on their comprehension levels. In an urban middle school, fifth and eighth grade students were randomly assigned (within age and gender) to experience a Playback Theatre intervention (N = 24) or to a video intervention control group (N = 23). All of the students received instruction on the basics of the criminal justice system. Also, students in both groups received pre- and post-intervention testing, including a comprehension test of the criminal justice/court system, an aggression questionnaire and an empathy scale. Students in both groups showed a significant increase in comprehension levels of the criminal justice/court system between assessments. Also, students’ ratings of tolerance for aggression were significantly reduced after exposure to Playback Theatre, however, students’ empathy scores were not significantly affected. The intervention of Playback Theatre yielded qualitative responses from students indicating that better perspective taking might be the mechanism underlying the effects of the Playback Theatre experience.     

Visitation arrangements for impaired parents

Forensic mental health professionals are frequently asked to evaluate the parenting skills of divorcing parents because the court seeks help in determining the custody, visitation, and parenting time arrangements for the children. When one of the parents is impaired, the court wants to know the way to help the children have a good relationship with that parent and keep the children safe. There is little empirical research to answer such questions. In this article, the authors describe their methodology for providing useful clinical information to the court to help guide their decisions regarding visitation with impaired parents.