Factors Influencing the Effectiveness of Problem-Solving Courts in Addressing Mental Health Issues within the Criminal Justice System

The National Alliance on Mental Health (NAMI) has raised concern about the state of mental health in the United States (US) and the nations role in perpetuating the criminalization of people with mental illness. Recent data from NAMI indicates that 1 in every 5 adults in the US (representing 21 percent of the population) suffered from mental illness in 2020 (NAMI, 2021). Of these, 27 percent (translating to 14.2 million people) suffered from serious mental illness (NAMI, 2021). Unfortunately, people with mental illness are overrepresented in the criminal justice system. Around 2 million people with serious mental illness are booked into American jails every year, and 2 in every 5 people who are incarcerated in the US report having a history of mental illness (NAMI, 2021).

The National Commission on Correctional Healthcare reports that between 13 and 18 percent of inmates in American prisons have major depression, between 2 and 4 percent have bipolar disorder, and around 3.9 percent suffer from schizophrenia and other psychotic diseases (Agency for Healthcare Research and Quality, 2012). Unfortunately, only 45 percent of people with serious mental illness in local jails and 37 percent of those in federal and state prisons receive treatment while in jail (NAMI, 2021). In the juvenile system, an estimated 70 percent of offenders suffer from a mental health condition, with data indicating that juveniles in detention are ten times more likely than the general youth population to suffer from psychosis (NAMI, 2021).

Prisons and jails are not structured or financed to offer effective mental health services. Hence, offenders with mental illness are more likely to be held in solitary confinement and more likely to commit suicide while in prison (NAMI, 2021). Further, untreated mental illness increases ones risk of recidivism upon release (Zgoba et al., 2022). This warrants solutions aimed at enhancing the criminal justice systems support for offenders with mental illness.

An intervention that has emerged as an innovative effort in supporting mental health in the criminal justice system (CJS) is problem-solving courts, which focus on using therapeutic techniques to address mental health and substance use disorders among offenders. This research analyzes the factors influencing the effectiveness of problem-solving courts in instilling positive behaviour and minimizing the risk of recidivism among at-risk offenders.

Definition of Terms and Abbreviations

i) Mental illness a condition affecting a persons mood, behaviour, or thinking, which affects their ability to relate effectively with others and interferes with daily living (NAMI, 2021b).

ii) In-jail mental health treatment programs the range of psychological and pharmacological interventions offered to offenders during incarceration to treat mental illness and help them transition into the community.

iii) Problem-solving court a court within the judicial system that uses therapeutic techniques to reduce the risk of recidivism among offenders with mental health and substance abuse disorders.

iv) BJS Bureau of Justice Statistics

v) CJS criminal justice system

vi) ICPSR - Inter-University Consortium for Political and Social Research

Purpose of the Study

Studies have shown that mentally-ill offenders are at a higher risk of reoffending, failure to comply with parole requirements, and re-incarceration upon release from prison (Zgoba et al., 2022). At the same time, evidence shows that offenders who received treatment for their mental illness while incarcerated were less likely to commit serious crimes upon re-entry into the community (Zgoba et al., 2022). One of the roles of the criminal justice system is to facilitate the successful reintegration of offenders into the community (Zgoba et al., 2022). Untreated or poorly-managed mental illness increases the risk of recidivism, thus interfering with this role. This study seeks to assess the effectiveness of problem-solving courts as a mental health intervention in the US criminal justice system. It is guided by three research questions:

i) What is the relationship between access to inpatient mental health treatment and behavioral change among mentally-ill inmates in problem-solving courts in the US?

ii) What is the relationship between outpatient mental health treatment and behavioral change among mentally-ill inmates in problem-solving courts in the US?

iii) What is the relationship between the frequency of court sessions and behavioral change among mentally-ill inmates in problem-solving courts in the US?

Literature Review

Mental Health Concerns in the CJS

In their study, Bandara et al (2018) measured the attitudes of community mental health providers toward clients involved with the CJS. They issued a survey to 627 mental health clinical providers from psychiatric rehabilitation programs in Maryland, US. Measures evaluated how well-versed clinicians were in dealing with, valuing, and seeing similarities among their clients with significant mental illness. The authors used Chi-square test analysis to measure these results with the results of providers who did not work with clients from the clinical justce system.

Compared to clients without such participation in the criminal justice system, providers indicated less respect for such clients. They had lower respect for criminal clients (79% lower for non-criminal and 95% lower for criminal). When asked to offer their opinion about similarity with clients, under 50% suggested they were similar to the criminal justice-embedded clients.

At the same time, the criminal justice system is comprised of individuals who have a higher prevalence of mental health issues (Bandara et al, 2018). Compared to those without major mental disorders, those with serious mental illnesses have disproportionately high rates of participation in the criminal judicial system. Between the years 2008 and 2014, about 25 27% of those with mental illness had reported at least one arrest during their lifetime, while without mental illness, the rate was between 17% and 18%.

Lamberti (2020) suggests this is problematic, considering that optimized and planned mental health treatment programs in prison can reduce rates of recidivism. There are various strategies that experts already utilize. Criminal justice cooperation was seen as a step-by-step process that integrates the best practices from each profession in Lamberti's (2020) article. Some strategies simply maintain jail diversion, which means they are formally implemented and can include parole and probation, mental health court, diversion and conditional release programs. However, studies have shown that these are relatively ineffective for criminals with severe mental illness (Lamberti, 2020). Strategies relying on compliance and surveillance, such as parole and home detention, are typically ineffective. The authors suggest a collaborative process that involves engagement, assessment, planning and treatment, monitoring, problem-solving and transition.

Furthermore, a study by Timmer & Nowotny (2021) suggests there are multiple factors to consider when working with CJ (criminal justice) clients with mental health issues. A conceptual model considers features like predisposing and vulnerability-increasing factors, such as history of arrest, probation, or supervision post-release and negative enabling factors, like employment status, government programs, coverage and poverty. CJ systems must also inpatient/outpatient treatment or medication (Timmer & Nowotny, 2021). The authors assert that an optimal mental health care program in a CJ facility would stress the need for several social institutions (welfare, research, community mental health, etc.) to work together to serve vulnerable clients.

One of the issues with mental health services in general is that there may be low knowledge among regular mental health providers about CJ clients or offenders. At the same time, Hean et al (2015) note that joint training and interprofessional, interdisciplinary education in healthcare education is missing. It also rarely occurs in professional development circles for criminal justice. At the same time, approximately 7 to 9 out of 10 people in the CJ system have a psychological disorder. CJ clients fall on a spectrum between MHS (Mental Health Services) and CJS (Criminal Justice Services) (Hean et al, 2015), which sparks debate about increasing both capacity and awareness.

One strategy proposed by the authors is to increase collaboration between MHS and CJS. Professionals from the legal and mental health fields must possess interprofessional collaboration skills in order to work together successfully to achieve the liaison and diversion agenda and to meet the requirements of mentally ill criminals. For instance, a common complaint is that police officers lack knowledge about mental health. Participants from the authors interviews suggested it was a good idea to bring people together from across a wide geographical area to compare different and good practice (Hean et al, 2015, p. 10). In other words, raising awareness about collaborative approaches is instrumental for securing good practice.

Another key area that will become important for the study is differentiating between mental health in the CJ system and regular mental health care. According to Ghiasi et al (2022), ASPD (Antisocial Personality Disorder) is frequently diagnosed in the prisoner population (Yousefi & Talib, 2022). However, it is important not to equate mental illness with criminal activity. Clinicians must make sure that diagnoses are used only when certain qualities are present in order to prevent offenders from using mental disorders as an excuse to avoid punishment. Yousefi & Talib (2022) note Major Depressive Disorder, ASPD and Borderline are also quite common, based on a study in Iran. It is thus important for mental health professionals working in CJ to identify which disorders are more common among the incarcerated population than among the non-incarcerated population.

A lot of literature exists on the area of mental health in the CJS. However, studies focused specifically on problem-solving courts are limited. The study will fill a gap in literature because it will offer policymakers crucial insights on how to improve the effectiveness of problem-solving courts as a form of intervention for offenders with mental health issues. I believe that this will go a long way towards enhancing these programs cost-effectiveness. This is especially important considering the current debates about defunding police, or more accurately, channeling funding into mental health resources and services.

Methodology

The study uses quantitative secondary data obtained from the Census of Problem-Solving Courts that was commissioned by the Bureau of Justice Statistics in 2012. This chapter presents the sampling techniques, research instrument, and data collection processes.

Sampling Techniques

The target population for this study is staff working in problem-solving courts in 2012. The study analyses secondary data collected from the 2012 Census of Problem-Solving Courts, which is the latest...…BY TOTAL EXITS, CATEGORIZED

No exits (0 divided by 0)

58

34

92

No successful exits

105

47

152

1-25% of exits successful

89

35

124

26-50% o exits successful

480

178

658

51-75% of exits successful

520

202

722

76-99% of exits successful

291

89

380

100% successful exits

135

46

181

Total

1678

631

2309

Chi-Square Tests

Value

df

Asymp. Sig. (2-sided)

Pearson Chi-Square

8.766a

6

.187

Likelihood Ratio

8.583

6

.198

Linear-by-Linear Association

6.777

1

.009

N of Valid Cases

2309

a. 0 cells (0.0%) have expected count less than 5. The minimum expected count is 25.14.

The case processing summary indicates a total of 2,309 valid responses and 1,324 missing responses. The null hypothesis and alternative hypotheses are as stated below:

Ho: there is no significant association between access to inpatient mental health treatment and successful exit in problem-solving courts

Ha: There is a significant association between access to inpatient mental health treatment and successful exit in problem-solving courts

The Pearson chi-square value of 8.766 shows that the two variables are positively correlated. However, the p-value (p = 0.187) is greater than the 0.05 significance level, indicating that the correlation is not significant. Hence, we accept the null hypothesis and conclude that although access to inpatient mental health increases the likelihood of successful exit, the association between the two variables is weak.

Table 4: Relationship between Access to Outpatient Mental Health Treatment and Behavioral Change as Measured by Successful Exits

ORIGINAL_OUTPATIENT MENTAL HEALTH TREATMENT: TYPES OF SERVICES COMMONLY USED BY ACTIVE PARTICIPANTS IN YOUR COURT * SUCCESSFUL EXITS DIVIDED BY TOTAL EXITS, CATEGORIZED Crosstabulation

Count

ORIGINAL_OUTPATIENT MENTAL HEALTH TREATMENT: TYPES OF SERVICES COMMONLY USED BY ACTIVE PARTICIPANTS IN YOUR COURT

Total

No

Yes

SUCCESSFUL EXITS DIVIDED BY TOTAL EXITS, CATEGORIZED

No exits (0 divided by 0)

26

66

92

No successful exits

52

100

152

1-25% of exits successful

42

82

124

26-50% of exits successful

243

415

658

51-75% of exits successful

297

425

722

76-99% of exits successful

192

188

380

100% successful exits

88

93

181

Total

940

1369

2309

Chi-Square Tests

Value

df

Asymp. Sig. (2-sided)

Pearson Chi-Square

34.780a

6

.000

Likelihood Ratio

34.852

6

.000

Linear-by-Linear Association

20.070

1

.000

N of Valid Cases

2309

a. 0 cells (0.0%) have expected count less than 5. The minimum expected count is 37.45.

The null and alternative hypotheses are as stated below:

Ho: there is no significant association between access to outpatient mental health treatment and successful exit in problem-solving courts

Ha: There is a significant association between access to outpatient mental health treatment and successful exit in problem-solving courts

The Pearson chi-square value of 34.780 shows a strong positive correlation between the two variables. The p-value (p = 0.000) is less than the 0.05 alpha level, indicating that the correlation is significant. Thus, we reject the null hypothesis and conclude that access to outpatient mental health treatment and successful exit are positively and significantly associated. This implies that courts with greater access to outpatient mental health treatment are likely to report higher rates of successful exits than those with less access. From the crosstabs table, courts with access to outpatient mental health treatment services are more likely to report 100% successful exists from their programs. Results of the chi-square test indicate that outpatient mental health treatment in problem-solving courts is a stronger influencer of successful outcomes than inpatient mental health treatment.

Table 5: Relationship between Frequency of Court Sessions and Behavioral Change as Measured by Successful Exits

O_HOW FREQUENTLY IS COURT IN SESSION * SUCCESSFUL EXITS DIVIDED BY TOTAL EXITS, CATEGORIZED Crosstabulation

Count

O_HOW FREQUENTLY IS COURT IN SESSION

Total

Daily

More than once a week but less than daily

Weekly

More than once a month but less than weekly

Monthly

Other

SUCCESSFUL EXITS DIVIDED BY TOTAL EXITS, CATEGORIZED

No exits (0 divided by 0)

0

1

49

18

13

11

92

No successful exits

3

7

81

40

6

15

152

1-25% of exits successful

6

5

70

31

4

8

124

26-50% of exits successful

15

41

375

132

29

67

659

51-75% of exits successful

19

51

402

177

28

45

722

76-99% of exits successful

13

21

164

120

32

31

381

100% successful exits

3

7

87

44

26

14

181

Total

59

133

1228

562

138

191

2311

Chi-Square Tests

Value

df

Asymp. Sig. (2-sided)

Pearson Chi-Square

95.312a

30

.000

Likelihood Ratio

91.232

30

.000

Linear-by-Linear Association

2.968

1

.085

N of Valid Cases

2311

a. 4 cells (9.5%) have expected count less than 5. The minimum expected count is 2.35.

The null and alternative hypotheses are as stated below:

Ho: there is no significant association between frequency of court sessions and successful exit in problem-solving courts

Ha: There is a significant association between frequency of court sessions and successful exit in problem-solving courts

The Pearson chi-square value of 95.312 shows a strong positive correlation between the two variables. The p-value (p = 0.000) is less than the 0.05 alpha level, indicating that the correlation is significant. Thus, we reject the null hypothesis and conclude that the frequency of court sessions and successful exit are positively and significantly associated. This implies that courts with more frequent sessions are likely to report higher rates of successful exits than those with less frequent sessions. From the crosstabs table, courts with weekly sessions report higher rates of 100% successful exits than those that meet less than weekly and those that meet monthly.

At the same time, daily sessions and sessions held more than once weekly result in lower success rates, which could be attributed to feelings of lack of autonomy among participants that increase the risk of early exit from the program. Studies have shown that majority of people with mental health issues desire and realize more gains in treatment if they perceive autonomy (Wright-Berryman & Kim, 2016). The authors posit that mental illness inhibits an individuals capacities to live a meaningful life. Perceptions of autonomy in treatment bring meaning to patients lives as they demonstrate that the health provider values the patients individual preferences and trusts them (Wright-Berryman & Kim, 2016). This would explain why daily sessions and multiple sessions in one week are associated with lower rates of success among participants in problem-solving courts. The crosstab…