The Classification of Violence Risk.

(Reprinted with permission from 24: 721-730, 2006).

Revising the paradigm for jail diversion for people with mental and substance use disorders: Intercept 0.

A conceptual model for community-based strategic planning to address the criminalization of adults with mental and substance use disorders, the Sequential Intercept Model has provided jurisdictions with a framework that overcomes traditional boundaries between the agencies within the criminal justice and behavioral health systems. This article presents a new paradigm, Intercept 0, for expanding the utility of the Sequential Intercept Model at the front end of the criminal justice system. Intercept 0 encompasses the early intervention points for people with mental and substance use disorders before they are placed under arrest by law enforcement.

Police Responses to Persons With Mental Illness: Going Beyond CIT Training.

Since 1988, a major development to reduce lethal encounters between police and persons displaying signs of mental illness has been the adoption by many police departments of crisis intervention teams (CITs). Created in Memphis, Tennessee, CIT programs incorporate deescalation training, police-friendly drop-off centers, and linkage to community treatment programs. The authors summarize issues discussed at a recent Substance Abuse and Mental Health Services Administration workshop at which participants highlighted the importance of going beyond CIT training to most effectively include police in a crisis care continuum model.

Gun Violence and Victimization of Strangers by Persons With a Mental Illness: Data From the MacArthur Violence Risk Assessment Study.

Objective: Highly publicized incidents in which people with apparent mental illnesses use guns to victimize strangers have important implications for public views of people with mental illnesses and the formation of mental health and gun policy. The study aimed to provide more data about this topic.

Methods: MacArthur Violence Risk Assessment Study data were analyzed to determine the prevalence of violence by 951 patients after discharge from a psychiatric hospital, including gun violence, violence toward strangers, and gun violence toward strangers.

Applicability of the Risk-Need-Responsivity Model to Persons With Mental Illness Involved in the Criminal Justice System.

Objective: National efforts to improve responses to persons with mental illness involved with the criminal justice system have traditionally focused on providing mental health services under court supervision. However, a new policy emphasis has emerged that focuses on providing correctional treatment services consistent with the risk-need-responsivity (RNR) model to reduce recidivism. The objective of this review was to evaluate empirical support for following the RNR model (developed with general offenders) with this group and to pose major questions that the field needs to address.

Best practices for increasing access to SSI and SSDI on exit from criminal justice settings.

Transitioning from jail or prison to community living frequently results in homelessness and recidivism. Access to benefits such as Supplemental Security Income (SSI) and Medicaid can increase access to housing and treatment and reduce recidivism. The authors review best practices for prerelease access to these benefits by using examples from five jails and four state prison systems.

Criminal justice and behavioral health care costs of mental health court participants: a six-year study.

Objective: This study examined whether there were differences in costs for mental health court (MHC) participants and a matched comparison group for three years after a target arrest.

Methods: Data from the MacArthur Mental Health Court Study, the first multisite study of MHCs, were used to compare behavioral health treatment and criminal justice costs for MHC participants and a matched group (using coarsened exact matching) of jail detainees who were not enrolled in an MHC but who received jail-based psychiatric services in the same cities. Cost data for three years before and after a target arrest were calculated separately for each year and for each participant at three sites of the multisite study-296 MHC participants and 386 matched jail detainees.

Transitional case management for reducing recidivism of individuals with mental disorders and multiple misdemeanors.

Objective: The purpose of this study was to measure the impact of a transitional case management (TCM) program targeted to individuals with mental disorders and multiple arrests for misdemeanor offenses.

Methods: The sample included 178 individuals who were diverted from jail at arraignment (N=125) or who voluntarily enrolled in TCM (N=53). Number of arrests and case management sessions attended were compared.

The cost of assisted outpatient treatment: can it save states money?

Objective: The authors assessed a state's net costs for assisted outpatient treatment, a controversial court-ordered program of community-based mental health services designed to improve outcomes for persons with serious mental illness and a history of repeated hospitalizations attributable to nonadherence with outpatient treatment.

Method: A comprehensive cost analysis was conducted using 36 months of observational data for 634 assisted outpatient treatment participants and 255 voluntary recipients of intensive community-based treatment in New York City and in five counties elsewhere in New York State. Administrative, budgetary, and service claims data were used to calculate and summarize costs for program administration, legal and court services, mental health and other medical treatment, and criminal justice involvement.

PTSD as a mediator between lifetime sexual abuse and substance use among jail diversion participants.

Objective: Many of the individuals with serious mental illness involved in the criminal justice system have experienced interpersonal victimization, such as sexual abuse, and have high rates of alcohol and drug use disorders. Little attention has been paid to the prevalence of posttraumatic stress disorder (PTSD) and its potential role in the substance misuse of offenders with mental illness.

Methods: The study used a path analytic framework to test the hypothesis that PTSD mediates the relationship between sexual abuse and level of alcohol and drug use among individuals (N=386) with mental illness enrolled in a multisite (N=7) jail diversion project.

Law & psychiatry: what can we say about mental health courts today?

Mental health courts (MHCs) are a popular type of problem-solving court, and there is ample evidence that they reduce recidivism and increase participation in community-based treatment. The authors summarize evidence for the effectiveness of MHCs and present findings from a study in which they identified and characterized 346 adult and 51 juvenile MHCs currently operating in the United States. The continued growth of MHCs will be based in large part on funding for services.

A multi-site study of the use of sanctions and incentives in mental health courts.

Mental health courts (MHCs) have become widespread in the United States as a form of diversion for justice-involved individuals with mental illness. Sanctions and incentives are considered crucial to the functioning of MHCs and drug courts, yet with little empirical guidance to support or refute their use, and there are no definitions of what they are. The use of sanctions and to a lesser degree incentives is the focus of this article, with particular emphasis on jail sanctions.

Exploring Racial Disparities in The Brief Jail Mental Health Screen.

The authors analyzed validation data from the Brief Jail Mental Health Screen (BJMHS) to determine whether race predicted screening results and if such a prediction was driven by particular screen items. A total of 22,000 individuals entering five jails over two 8-month periods were screened. The authors constructed binary logistic regression models to assess the impact of race on screening positive and endorsing particular items.

A national survey of U.S. juvenile mental health courts.

Objective: The authors surveyed U.S. juvenile mental health courts (JMHCs).

Effect of mental health courts on arrests and jail days: a multisite study.

Context: Mental health courts are growing in popularity as a form of jail diversion for justice system-involved people with serious mental illness. This is the first prospective multisite study on mental health courts with treatment and control groups.

Objectives: To determine if participation in a mental health court is associated with more favorable criminal justice outcomes than processing through the regular criminal court system and to identify defendants for whom mental health courts produce the most favorable criminal justice outcomes.

Reductions in arrest under assisted outpatient treatment in New York.

Objective: Individuals with serious mental illness have a relatively high risk of criminal justice involvement. Assisted outpatient treatment (AOT) is a legal mechanism that mandates treatment for individuals with serious mental illness who are unlikely to live safely in the community without supervision and who are also unlikely to voluntarily participate in treatment. Under an alternative arrangement, some individuals for whom an AOT order is pursued sign a voluntary service agreement in lieu of a formal court order.

Assessing outcomes for consumers in New York's assisted outpatient treatment program.

Objective: This study examined whether New York State's assisted outpatient treatment (AOT) program, a form of involuntary outpatient commitment, improves a range of policy-relevant outcomes for court-ordered individuals.

Methods: Administrative data from New York State's Office of Mental Health and Medicaid claims between 1999 and 2007 were linked to examine whether consumers under a court order for AOT experienced reduced rates of hospitalization, shorter hospital stays, and improvements in other outcomes. Multivariable analyses controlling for relevant covariates were used to examine the likelihood that AOT produced these effects.

Assisted outpatient treatment in New York: regional differences in New York's assisted outpatient treatment program.

Objective: This study sought to describe the implementation of "Kendra's Law" in New York State and examine regional differences in the application of the program.

Methods: Between February 2007 and April 2008, interviews were conducted with 50 key informants across New York State. Key informants included assisted outpatient treatment (AOT) county coordinators, county directors of community services, judges, attorneys from the Mental Hygiene Legal Service (MHLS), psychiatrists, treatment providers, peer advocates, family members, and other referred individuals.

Perceived coercion among jail diversion participants in a multisite study.

Objective: Although jail diversion is considered an appropriate and humane response to the disproportionately high volume of people with mental illness who are incarcerated, little is known regarding the perceptions of jail diversion participants, the extent to which they feel coerced into participating, and whether perceived coercion reduces involvement in mental health services. This study addressed perceived coercion among participants in postbooking jail diversion programs in a multisite study and examined characteristics associated with the perception of coercion.

Methods: Data collected in interviews with 905 jail diversion participants from 2003 to 2005 were analyzed with random-effects proportional odds models.

The use of mental health court appearances in supervision.

A defining feature of mental health courts (MHCs) is the requirement that enrollees appear periodically for status review hearings before the MHC judge. Although the research base on these specialty courts is growing, MHC appearances have yet to be examined. In the present study, the authors followed more than 400 MHC clients from four courts.

Who succeeds in jail diversion programs for persons with mental illness? A multi-site study.

This study examined how the characteristics of people with mental illness who are participants in post-booking jail diversion programs affect recidivism and time spent incarcerated. The study employed data from a multi-site, federally funded jail diversion initiative. A pre-post comparison design was used to compare experiences of arrest and days spent in jail of diverted individuals for the 12 months following enrollment with the 12 months prior to enrollment.

Prevalence of serious mental illness among jail inmates.

Objective: This study estimated current prevalence rates of serious mental illness among adult male and female inmates in five jails during two time periods (four jails in each period).

Methods: During two data collection phases (2002-2003 and 2005-2006), recently admitted inmates at two jails in Maryland and three jails in New York were selected to receive the Structured Clinical Interview for DSM-IV (SCID). Selection was based on systematic sampling of data from a brief screen for symptoms of mental illness that was used at admission for all inmates.