Research on Mental Health Courts

1. Research on Mental Health Courts Collecting and Using Data to Develop and Sustain Programs Smart Responses in Tough Times: Achieving Better Outcomes for People with Mental Illnesses Involved in the Criminal Justice System July 15-17, 2009

2. Presentation Overview • Current state of mental health court research • New Policy Research Associates multi-court study • Data collection in mental health courts

3. Why Data and Research are Needed • Mental health courts proliferating across the country • Program model 10 years old, need data-driven results • Need to understand HOW MHCs work and for WHOM • Published studies have shown positive results but have limited applicability

4. MHC Effect on Recidivism • San Francisco BHC participants had a 26% lower risk of new criminal charges and a 55% lower risk of violent charges than the control group • Participants in a North Carolina MHC had a re-arrest rate of roughly half the rate of a comparison group • One study found no great difference in jail time between MHC participants and a control group; MHC participants LESS likely to incur new charges but MORE likely to serve jail time for a probation violation or sanction

5. MHC Effect on Mental Health Outcomes • MHCs effective in connecting participants to mental health treatment • Mental health of participants significantly improves compared to before the program • Mental health outcomes not always significantly different from those of people receiving treatment through the traditional system, both groups usually show improvement

6. MHC Cost Effectiveness • RAND study of Allegheny County MHC found the program did not substantially increase costs over traditional court adjudication and processing and in the second year of participation, there was the potential for cost savings • As the seriousness of a person’s charge and the severity of the mental illness increased, so did the potential for cost savings through MHC participation

7. What can we currently say about MHCs? • Participants in some MHCs have lower rates of recidivism – and are less likely to be arrested for new crimes – than individuals with mental illnesses who go through the traditional criminal court system • MHCs are a more effective means of connecting participants with mental health treatment services than the traditional court system and jails • Over time, MHCs have the potential to save money through reduced recidivism and the associated jail and court costs that are avoided and through decreased use of the most expensive treatment options, such as inpatient care

8. Preliminary Results for the MacArthur Mental Health Court Study A Prospective Multi-Site Study on the Effectiveness of Mental Health Courts Hank Steadman Allison Redlich Lisa Callahan Pam Robbins Roumen Vesselinov Asil Ozdogru Karli Keator

9. Major Research Questions • Is participation in MHC associated with more favorable CJ outcomes than processing through the regular criminal court system? • Does participation in a MHC produce higher rates of treatment participation than processing through the regular criminal court system? • Do high sanctioning MHCs have higher rates of treatment participation than low sanctioning MHCs?(enforcement) • Is higher treatment participation associated with more favorable mental health and criminal justice outcomes than lower treatment participation? • For what type of defendants do MHCs produce the most favorable mental health and criminal justice outcomes?

10. 4 - Site Design

11. Subject Recruitment: All Sites BL =1047 6M=747 (71%)

12. Study Design:Data Collection Types • Self Report • Baseline (BL) • 6 Month (6M) • 12 Month (12M - San Francisco only) • Objective Records • Criminal Justice: 18M Pre- & Post-Entry • Treatment: 12M Post-Entry • MHC Appearances/Compliance: 12M Post-Entry

13. MHC Client Theoretical Framework Individual Factors Behavioral Health Outcomes Treatment Participation Public Safety Outcomes Enforcement

14. Study Findings [Data being finalized and will be published by the end of the summer]

15. What courts can do to collect data • Use participants as their own control group • Collect descriptive information • Pay attention to referrals, not just acceptances

16. What courts can do to collect data Look at… • Breakdown of charges and diagnoses accepted • How long it takes to connect people with treatment once they are accepted into the MHC • Length of time people stay in the program, what percentage graduate, and why participants are removed

17. Developing a MHC Database • Justice Center worked with Ohio MHCs to develop a basic Microsoft Access data entry system • Data system now being used as the model for a statewide web-based system in Illinois • Access data system and accompanying documents will be available on the Justice Center website

21. How do we know if Mental Health Courts “Work”? • What are the goals of MHCs? • What are the priority outcomes of MHCs? • How do we measure “success” of programs & MHC participants?

22. How to Use Data • Start collecting data as early as possible • Avoid collecting TOO much data • Shape expectations for policymakers • Keep in mind the bigger picture, how your MHC affects the overall system

23. Thank you For further information & conference presentations please visit www.consensusproject.org This material was developed by presenters for the July 2009 event: “Smart Responses in Tough Times: Achieving Better Outcomes for People with Mental Illnesses Involved in the Criminal Justice System.” Presentations are not externally reviewed for form or content and as such, the statements within reflect the views of the authors and should not be considered the official position of the Bureau of Justice Assistance, Justice Center, the members of the Council of State Governments, or funding agencies supporting the work.