The Role of Mental Health Courts in Mitigating Family Violence.

Mental health courts are one potential means to mitigate violence against family members by people with mental illness. This study identified the rate at which cases of family violence come before a mental health court and the success of defendants charged with assaulting family members. In a sample of 1,456 defendants eligible to participate in a mental health court, descriptive statistics were used to report rates of admission of defendants charged with assaulting family members and their characteristics; a static group design was used to compare post-program rearrests among defendants who assaulted family members who successfully completed the program, who did not complete the program, and who did not participate despite being eligible; and logistic regression was used to determine the effect of participation on rearrest when controlling for demographic and clinical factors. The study found that family violence occurred in 24.7% of admitted cases. Most eligible defendants who assaulted family members (75.8%) participated in the court program, and among those who did, 72.2% successfully completed the program. Defendants who assaulted family members and had a positive program termination had a much lower rate of rearrest post-program completion compared with those who did not complete the program or did not participate despite being eligible, a finding that held when controlling for other factors. This study suggests that mental health courts can be an effective option for mitigating family violence committed by people with mental illness.

Trends in Substance Use by Gender Among Participants in a Jail-Based Substance Use Disorder Treatment Program: 1998-2016.

Understanding trends in substance use by gender among jail-based treatment program participants can inform policies and programs tailored to this population. Preprogram assessment data from 3509 individuals entering a jail-based substance use disorder treatment program in Missouri between 1998 and 2016 were analyzed. Primary outcome was program participants' strongly preferred substances. Demographic covariates and drug preferences were compared between males and females. Average yearly trends in preferred substances were calculated. While 25.8% of the sample preferred heroin, it was more strongly preferred by women (36.4%) than men (22.0%, p < 0.0001). Alcohol and marijuana were preferred more by males. Overall, preferences for heroin and methamphetamine increased over time while alcohol, marijuana, and other stimulants decreased. Women being more likely to prefer heroin and the increasing preference for heroin over time are consistent with national trends. Offering evidence-based treatment like pharmacotherapy and gender-sensitive approaches can help address the needs of this vulnerable population.

Characteristics and Outcomes of People With Intellectual and Developmental Disabilities Participating in a Mental Health Court.

This study compares characteristics and outcomes of 70 defendants with and 1,122 without intellectual and developmental disabilities (IDD) participating in a mental health court. Demographic and clinical characteristics differed, but criminal justice or program characteristics did not. Age, race, marital status, living situation, court location, health insurance status, and likelihood of mental illness or substance abuse diagnosis differed between the two groups. When controlling for other factors, a diagnosis of IDD did not affect the odds of negative termination from the court but did reduce the odds of rearrest within 1 year of leaving the court. Some mental health courts exclude people with IDD; the study concludes inclusion is appropriate.

Statewide implementation of recovery support groups for people with serious mental illness: a multidimensional evaluation.

This study evaluated a statewide demonstration project to implement a group-based intervention called Procovery in selected inpatient and community mental health centers. Procovery is a facilitated mutual support group designed to build hope and a sense of social inclusion by raising consciousness and helping people develop an understanding of the ways one can move toward recovery in their own lives. This evaluation sought to determine both consumer outcomes and perceptions of the program and implementation efforts held by consumers and the facilitators of the intervention. A multidimensional approach was used, including a quasi-experimental design with consumers, questionnaires and focus groups with the intervention facilitators, and individual interviews with administrators. The Procovery model was shown to have a positive impact on consumers' recoveries and was viewed favorably by consumers, facilitators, and administrators. Several barriers to effective implementation were identified. These findings and their implications for future practice and research are discussed.

Harm reduction in community mental health settings.

Harm reduction is a conceptual framework and set of practices that focus on the minimization of the physical, social, and legal harms substance users do to themselves and to society as a whole. Its application to community mental health settings is relatively new, and can create controversies and ethical dilemmas if not properly designed, implemented, and evaluated. Building on the harm reduction literature, the community mental health literature, and the authors' experiences with a community mental health program that uses a harm reduction approach, the authors offer five guidelines for its successful implementation. The authors conclude that when properly integrated with other recovery-based services, and when appropriately applied to the individual client's stage of change, harm reduction can effectively be used, and should be used, in community mental health settings with clients with co-occurring substance use and psychiatric disorders.

Implementing the essential elements of a mental health court: the experiences of a large multijurisdictional suburban county.

Mental health courts developed in the USA in the late 1990s as one means to reduce the involvement of people with mental illness in the criminal justice system. In response to the growth in number of mental health courts, the Council of State Governments led an initiative to identify essential elements of mental health courts to guide their development and implementation. This paper applies these essential elements to a municipal mental health court in a multijurisdictional, suburban county. While this court met most essential elements, they faced a number of challenges. The primary ones included not being able to advance from hearing municipal cases only to state misdemeanor and felonies, not having the resources to expand program capacity for municipal cases, and participants not being able to always access needed mental health treatment, rehabilitation, and support services. The paper concludes with implications for behavioral health administrators and direct service staff in implementing the essential elements of mental health courts.

The use of logistic regression to enhance risk assessment and decision making by mental health administrators.

Development of policies and procedures to contend with the risks presented by elopement, aggression, and suicidal behaviors are long-standing challenges for mental health administrators. Guidance in making such judgments can be obtained through the use of a multivariate statistical technique known as logistic regression. This procedure can be used to develop a predictive equation that is mathematically formulated to use the best combination of predictors, rather than considering just one factor at a time. This paper presents an overview of logistic regression and its utility in mental health administrative decision making. A case example of its application is presented using data on elopements from Missouri's long-term state psychiatric hospitals. Ultimately, the use of statistical prediction analyses tempered with differential qualitative weighting of classification errors can augment decision-making processes in a manner that provides guidance and flexibility while wrestling with the complex problem of risk assessment and decision making.

Drug courts and mental health courts: implications for social work.

In recent years communities across the United States have instituted specialized criminal courts for defendants with substance abuse disorders and mental illness. These specialized courts seek to prevent incarceration and facilitate community-based treatment for offenders, while at the same time protecting public safety. The authors describe two types of specialized courts: drug courts and mental health courts. They critically examine the strengths and weaknesses of these courts and conclude with implications for social work education, practice, research, and advocacy.

Promoting participation in organizational decision making by clients with severe mental illness.

This qualitative study assessed clients' participation in organizational decision making in a public long-term psychiatric hospital. Numerous examples were found in which clients meaningfully participated in the decision-making process and achieved favorable policy changes. Three means of involving clients were found to be especially useful: (1) using a consumer council, (2) involving clients in the formal policy review process, and (3) including clients in the hospital's performance improvement system. The authors offer guidelines for mental health organizations wishing to promote client participation in organizational decision making. Implications for social work are discussed.

Assaultive behavior in state psychiatric hospitals: differences between forensic and nonforensic patients.

Forensic patients are occupying an increasingly large number of beds in state psychiatric hospitals. The presence of these mentally ill offenders has raised concerns about the risk they present to nonforensic patients. This study compared the rate of assaults and factors associated with assaultive behavior among 308 nonforensic patients and two groups of forensic patients including 469 patients found not guilty by reason of insanity and 76 pretrial patients. Consistent with other studies, nonforensic patients had higher rates of assaults than either group of forensic patients. However, being a forensic patient did not affect the odds of assault when controlling for the effects of demographic and clinical variables in a multivariate logistic regression analysis. Factors associated with assaults in each of the three patient groups were identified using multivariate analyses. Implications are presented for treatment of assaultive behavior, mixing of forensic and nonforensic patients within state hospitals, forensic release policies, and future research.

Recidivism among offenders with developmental disabilities participating in a case management program.

This study examined recidivism, defined as arrests, among 252 clients who were accepted into a case management program for offenders with developmental disabilities. Overall, 40% of clients were arrested while participating in the program, and 34% were arrested within 6 months after case closure. The crimes for which clients were arrested tended to be minor: 21% were for probation or parole violations not associated with new criminal acts, 39% were for misdemeanors, 27% were nonviolent felonies, and 12% were for felonies against persons. Clients who completed the program (N=115) were less likely to be arrested after case closure than those who dropped out of the program (N=112), 25 and 43%, respectively. Other factors associated with arrests after case closure included having a developmental disability other than mental retardation, living in an urban area, being referred to the program by a criminal justice agency or through a private referral rather than a social service agency, and being arrested while in the program. Implications are discussed for service provision and evaluation of programs that work with offenders with developmental disabilities.

Opportunities and barriers to empowering people with severe mental illness through participation in treatment planning.

Participation in treatment planning can be one means of empowering clients. However, significant barriers exist to empowering people with severe mental illness through treatment planning. This qualitative study reviewed documents and conducted focus groups with clients and staff of a public psychiatric hospital to identify barriers to empowerment and the conditions that must be present for client empowerment to occur through treatment planning. The conditions for empowerment were based on both psychological and organizational factors. For empowerment to occur, clients need psychiatric stability and decision-making skills. Organizations promote empowerment by ensuring that clinical staff have the time to involve clients in treatment planning, promoting staff attitudes that are respectful of clients' ability to participate in treatment planning, providing clients with a range of treatment options, designing programs that have a strong philosophical commitment to client empowerment, and implementing programs properly.

Involving people with severe mental illness in evaluation and performance improvement.

This article argues for the increased involvement of people with severe mental illness and consumers of other health and mental health services in evaluation and performance improvement in the organizations from which they receive services. Among other reasons, consumers can bring a different perspective to the selection of areas to evaluate, such involvement is consistent with some models of program evaluation, and the process of participation itself can be empowering to consumers. Based on a review of the literature and the experiences of a public psychiatric hospital in involving consumers in evaluation and performance improvement, the authors exemplify how mental health consumers can participate in each stage of the evaluation process, ranging from the initial stage of posing evaluation questions to the final stage of acting on evaluation findings. Next, challenges to consumer involvement are described. Guidelines are then offered for involving consumers of health and mental health services in evaluation and performance improvement.

Federalism and social justice: implications for social work.

Federalism is a system of government that divides power between two or more levels of government. During the current conservative political climate in the United States, power has shifted increasingly from the federal government to states, a move that has implications for the achievement of social justice. Consequently, it is now necessary for social workers to engage in political activity at the state and local levels, in addition to the federal level, to promote social justice. Implications for social work policy practice, research, and education for advancing social justice within the federal system of government are explored.

Development and implementation of a program for offenders with developmental disabilities.

The need for a comprehensive range of services for persons with mental retardation and other developmental disabilities who enter the criminal justice system has been well-established. However, such services are unavailable to most offenders with developmental disabilities. Here we describe the services of one agency devoted to this population. Established in 1990, this agency has provided education and training to over 1,500 professionals, answered over 1,000 information and referral questions, and provided direct services to over 600 offenders with developmental disabilities. Recommendations for developing and implementing similar programs are offered. Areas addressed include assessing need, funding, composition of boards of directors, program philosophy, selection of program services, staffing, the referral process, and program evaluation.