How consistent are mental health courts in selecting clients?
Our data indicate that there is general consistency among mental health courts in the stages used to identify, screen, and select clients for mental health courts.
What kind of cases are allowed in mental health courts?
Speaking in general, mental health courts only allow cases with non-violent, misdemeanor charges (Wolff, 2002; Wolff & Pogorzelski, 2005). Half of the mental health courts in our sample considered cases with felony convictions.
How are clients identified and recruited for mental health cases?
How these cases are identified, screened, and recruited is less clear. Potential clients could be referred to the mental health court by a prosecutor, defense attorney, family member, treatment provider, judge, jail personnel, police officer, and so forth.
Are mental health courts a model of intervention?
It has been argued that mental health courts as a model of intervention are idiosyncratic in their design and implementation (Goldkamp & Irons-Guynn, 2000; Wolff & Pogorzelski, 2005).
Who makes the unilateral selection decisions in a mental health court?
The proxy decision maker, typically the clinical coordinator, supervisor, or director, has the delegated authority to makes unilateral selection decisions on behalf of the mental health court team. All of these case review approaches include clinical staff making a recommendation for or against admission.
Why is not knowing the source of improved outcomes attributed to mental health courts important?
Not knowing the source of the improved outcomes attributed to mental health courts compromises the transportability of the intervention and its effectiveness to other settings. If performance outcomes are driven by (idiosyncratic) case selection processes , then the mental health court intervention can only be expected to work for a specific class of defendants with mental illnesses, not the general class of defendants with mental illnesses. This is especially problematic when the special class of defendants is small relative to the general class (suggesting weak penetration into the target population), or the decision rule process generating the special class of defendants cannot be readily replicated because it relies on hard-to-measure factors (e.g., “treatability”).
What are the eligibility criteria for mental health courts?
The eligibility criteria for mental health courts typically require that defendants have a mental illness, which may or may not be defined as serious, chronic, or persistent, and criminal charges that are non-violent in nature and most often classified as a mis demeanor (Wolff, 2002; Wolff & Pogorzelski, 2005), although some mental health courts accept violent charges and felonies (Goldkamp & Irons-Guynn, 2000; Redlich, Steadman, Monahan, Robbins, & Petrila, 2006). How these cases are identified, screened, and recruited is less clear. Potential clients could be referred to the mental health court by a prosecutor, defense attorney, family member, treatment provider, judge, jail personnel, police officer, and so forth. They may be screened formally by the court team or a case coordinator with mental health training, with or without the assistance of mental health staff. The information used to determine eligibility may be formalized in a screening protocol, or it may be more informal and specific to a team or individual. Even when found eligible for the court, issues of treatability, motivation, convictability, and support from victims and the defense attorney may independently impact selection and recruitment of clients.
What is initial screening in mental health court?
Second, they perform an initial eligibility screening function that considers whether referred potential clients are sufficiently appropriate for the court. In general, initial screening compares the potential client’s charges and criminal history, as well as evidence of mental illness to the mental health court’s formal eligibility criteria. At this stage of review, prosecutors as filtering agents typically consult with victims, as well as defense attorneys, on their willingness to have the case referred to a mental health court. Mental health court coordinators/directors/supervisors as filtering agents may also consult with prosecutors and defense attorneys on these issues. This varies, however, by court. In our sample, Court Four had a clinical supervisor who unilaterally decided initial eligibility for the court. This person collected clinical and criminal history evidence and rendered a decision without consulting the prosecutor or the mental health team. By contrast, the initial mental health court coordinators for the other courts variably consulted with prosecutors and the judge during Stage 1 screening.
What are the stages of mental health court selection?
The selection of clients for mental health courts was characterized by three stages: initial screening; assessment screening, and evaluation screening. The terminology here reflects the screening language of the American Psychiatric Association’s framework for Psychiatric Services in Jails and Prisons(2000). Initial screening originates with one of the two filtering agents: the district attorney or the mental health court coordinator/supervisor/director. The outcome of this process is the sample of clients enrolled in a mental health court. For ease of exposition, we will refer to candidates for mental health court as “clients.”
What is selection bias in drug trials?
Selection bias limits the “penetration” of diversion interventions into the target population. For example, in drug court and treatment diversion programs, it is typical for only about one-third of eligible offenders to be admitted to the programs, with one-third being rejected at some point in the recruitment process and one-third refusing to participate (Belenko, 2002; Lang & Belenko, 2000). Random assignment does not guarantee representativeness (Wolff, 2000). Candidates for inclusion ultimately self-select to participate in many randomized clinical trials, and as such they may not be representative of the general target population, resulting in poor external validity and low generalizability (Brown et al., 2009; Grimshaw & Eccles, 2004; Tucker & Roth, 2006). In part, this may explain why it can be difficult to replicate significant effects when interventions are brought to scale or implemented in different sites under less rigorous experimental controls.
How many stages of client screening are there?
Three stages of client screening were identified for mental health courts. Each stage will be described in turn.
Methods
This study drew on data from 20 grantees funded in 2002, 2003, and 2004 through the Targeted Capacity Expansion (TCE) Jail Diversion Initiative of the Substance Abuse and Mental Health Services Administration (SAMHSA).
Results
There were 42,518 jail diversion program activities—that is, screenings, assessments, and evaluations—during the study period, which resulted in 32,917 program decisions with an outcome of either rejection (N=30,916, or 93.9%) or recommendation for diversion (N=2,001, or 6.1%).
Discussion
A major finding of this study is the previously undocumented large number of program activities that precede enrollment in a jail diversion program. Jail diversion programs engage in a large number of activities to enroll a relatively small number of people.
Conclusions
One major finding of this study is the extremely large number of activities required to divert a small number of individuals into jail diversion programs for people with mental illness. Beyond this, our analyses highlight that factors other than formal criteria influence jail diversion decision making throughout the program determination process.
Acknowledgments and disclosures
This article is based on work supported by grant 1-H79-SM54722-01 from the Center for Mental Health Services, Substance Abuse and Mental Health Services Administration (SAMHSA). The contents are solely the responsibility of the authors and do not necessarily represent the official views of SAMHSA or the other participants.