FROM PSYCHIATRIC SERVICES

Participation in mental health courts appears to reduce some measures of recidivism among adults with mental illness – but the impact is modest, according to a meta-analysis conducted by Evan M. Lowder, PhD, and his associates.

“Our findings inform the overall effectiveness of [mental health courts] as a judicial strategy to reduce the number of adults with mental illnesses who are returning to the criminal justice system,” wrote Dr. Lowder, formerly with the department of psychology at North Carolina State University, Raleigh, and now with the school of public and environmental affairs at Indiana University, Indianapolis (Psychiatr Serv. 2017 Aug 15. doi: 10.1176/appi.ps.201700107 ).

The growing numbers of adults with mental illnesses in the U.S. criminal justice system led to the development of mental health courts in the 1990s. Mental health courts allow defendants to agree on a voluntary basis to mental health treatment in the community, “often in exchange for a reduced or dismissed index charge upon successful completion,” the investigators wrote. Previous research has shown that graduation from mental health courts, rather than participation, is tied to better outcomes ( Law Hum Behav. 2016 Apr;40[2]:118-27 ) and ( Int J Psychiatry. 2014 Sep-Oct;37[5]:448-54 ).

To explore the effectiveness of participating in these courts in reducing recidivism, Dr. Lowder and his associates searched three databases and found 17 relevant studies (n = 16,129) published between 2004 and 2015. Recidivism outcomes of defendants who experienced traditional criminal processing were compared with those who participated in mental health courts across the country over a 12-month period. The investigators looked at four measures of recidivism outcomes – arrest, jail time, charge, and conviction.

Overall, the meta-analysis showed a “significant, negative, and small effect of mental health court participation on recidivism” (d, –.20; 95% confidence interval, –2.9 to –.10; P less than .001), compared with traditional processing, Dr. Lowder and his associates reported. Specifically, they found that participation lowered two measures of recidivism: charge and jail time. But the impact of participation on the measures of arrest and conviction were not significantly affected. When they looked at the subset of studies that were based on defendants who completed their mental health court participation, however, the impact proved broader, and included lower rates of arrest and conviction.

“Given the already high rates of reoffending in this population, it may not be realistic to expect complete distance from criminal activity among [mental health court] participants,” the researchers wrote. “Rather, [mental health court] participation may be a means to mitigate the severity of future offending (that is, jail time associated with a new offense).”

Dr. Lowder and his associates cited several limitations related to the data they chose to include and how those numbers were analyzed. “These are important directions for future research,” they wrote. They added that future research should look at components of mental health courts that are associated with better outcomes in participation.

The investigators reported no financial disclosures.

acruz@frontlinemedcom.com

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