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Articles   |    
Stopping the Revolving Door: Effectiveness of Mental Health Court in Reducing Recidivism by Mentally Ill Offenders
Joye C. Anestis, Ph.D.; Joyce L. Carbonell, Ph.D.
Psychiatric Services 2014; doi: 10.1176/appi.ps.201300305
View Author and Article Information

Dr. Anestis is with the Department of Psychology, University of Southern Mississippi, Hattiesburg, Mississippi (e-mail: joye.anestis@usm.edu). Dr. Carbonell is with the Department of Psychology, Florida State University, Tallahassee.

Copyright © 2014 by the American Psychiatric Association

Abstract

Objectives  This study compared recidivism outcomes among criminal offenders with mental illness who were assigned to a mental health court (MHC) or a traditional criminal court. It also explored potential differences in outcomes between subgroups of offenders, including felony and misdemeanor offenders and violent and nonviolent offenders.

Methods  Data were obtained from court databases. Offenders in the MHC (N=198) and the traditional criminal court (N=198) were matched by propensity scores and followed for 12 months after the index offense. Data for the 12 months preceding the index offense were obtained for MHC participants. Intent-to-treat analyses were conducted, using both between-group and within-subjects designs.

Results  After control for covariates, logistic and Cox regressions indicated that MHC assignment predicted a lower overall rate of recidivism and longer time to rearrest for a new charge compared with assignment to traditional court. The groups did not significantly differ on the severity of the offense associated with rearrest. The findings largely held for felony, misdemeanor, violent, and nonviolent offenders, with the exception of analyses involving time to rearrest for violent offenders. Within-subjects analyses suggested that after MHC participation, there were improvements in occurrence of rearrest and time to rearrest but a tendency for rearrest to be associated with more severe offenses. Within the MHC group, recidivism outcomes did not significantly differ by class of offense.

Conclusions  The results suggest that an MHC can be effective in reducing recidivism among offenders with mental illness and also indicate that persons who commit more severe offenses may be appropriate candidates for MHC.

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Figure 1 Time to rearrest among criminal offenders with mental illness assigned to a mental health court (MHC) or a traditional criminal court (control), by type of offensea

a The cumulative survival function represents the proportion of offenders who survived (were not rearrested) in each group by the length of time (in months) from index offense. Survival functions were calculated by using the Kaplan-Meier estimator. For both groups, the follow-up period was 12 months following index offense.

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Table 1Characteristics of criminal offenders with mental illness assigned to mental health court (MHC group) or traditional criminal court (control group)a
Table Footer Note

a The two groups were matched by propensity scores to control for nonrandom assignment of participants.

Table Footer Note

b Severity of offense was determined by a scale from 1 to 13, with 1 indicating noncriminal violations; 2, second-degree misdemeanors; 3, first-degree misdemeanors, and 4–13, felony offenses. Classification of felony offenses was based on the felony sentencing guidelines of the State of Florida (32).

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Table 2Rearrest outcomes during the 12 months after the index offense among offenders assigned to mental health court (MHC) or traditional criminal court (control)a
Table Footer Note

a The MHC and control group each consisted of 198 offenders with a mental illness. Means were compared by t tests. Proportions were compared by chi square tests.

Table Footer Note

b Severity of offense was determined by a scale from 1 to 13, with 1 indicating noncriminal violations; 2, second-degree misdemeanors; 3, first-degree misdemeanors, and 4–13, felony offenses. Classification of felony offenses was based on the felony sentencing guidelines of the State of Florida (32).

Table Footer Note

c Nontransformed means are reported, but transformed means were used for t tests.

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Table 3Odds of rearrest in the 12 months after the index offense predicted by participation in mental health or traditional criminal court, by index offensea
Table Footer Note

a The data represent step 2 of five logistic regressions. All covariates were entered in step 1, and court membership was entered in step 2. Only data for the independent variable are displayed. The change in chi square indicates the change from step 1 to step 2 (df=1).

Table Footer Note

b –2LL, –2 log likelihood

Table Footer Note

c To aid in interpretation, negative odds ratios (<1.00) were converted to positive odds ratios (>1.00).

Table Footer Note

*p<.05, **p<.01, ***p<.001

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Table 4Length of time to rearrest in the 12 months after the index offense predicted by participation in mental health or traditional criminal court, by index offensea
Table Footer Note

a The data represent step 2 of five logistic regressions. All covariates were entered in step 1, and court membership was entered in step 2. Only data for the independent variable are displayed. The change in chi square indicates the change from step 1 to step 2 (df=1).

Table Footer Note

b –2LL, 2 log likelihood

Table Footer Note

c To aid in interpretation, negative odds ratios (<1.00) were converted to positive odds ratios (>1.00).

Table Footer Note

*p<.05, **p<.001

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