Countywide implementation of crisis intervention teams: Multiple methods, measures and sustained outcomes.

The crisis intervention team (CIT) is a tool that can be used to foster pre-booking diversion of individuals with mental illness from the criminal justice system and into community treatment services. Although CIT is often implemented solely as the training of law enforcement officers, the model stipulates that CIT is a vehicle for collaboration with community stakeholders who share a similar philosophy, as well as expanded mental health services offering a 24 hour-seven days per week drop-off option for law enforcement officers. This case study presents the countywide implementation of CIT and expands previous findings on the prevalence of officer interaction with persons with mental health issues and CIT training outcomes, including changes in officer perception of individuals with mental health issues. Furthermore, analysis of the disposition of calls for officer assistance coded as mental health or suicide found significant increases in officer drop-offs to the mental health crisis center post-CIT training. Interrupted time series analysis determined that this change has been sustained over time, perhaps owing to the unique communication between county law enforcement and mental health staff. Implications for policy and practice are discussed.

Cost analysis of long-term outcomes of an urban mental health court.

Multiple studies have demonstrated decreased recidivism and increased treatment engagement for individuals with serious mental illness involved in Mental Health Courts (MHC). However, the limited availability of social and fiscal resources requires an analysis of the relationship between a program's effectiveness and its costs. Outcome costs associated with a sample of 105 participants discharged for more than 1 year - and grouped by completion status - were compared to an eligible sample not enrolled (n=45). Transactional costs analysis (TCA) was used to calculate outcomes associated with treatment, arrest, and confinement in the 12-month post-MHC. Total outcome costs for the Successful Group ($16,964) significantly differed from the Unsuccessful ($32,258) and Compare Groups ($39,870). Costs associated with the higher number of arrests for those in the Compare Group created the largest differences. Total cost savings between Successful and Compare (M=$22,906) equated to $916,240 and savings between Unsuccessful and Compare (M=$7612) were $494,708. The total combined cost savings for participants in the 12-month post-MHC period was $1,411,020. While it is important to understand that MHCs and the individuals that they serve vary and these results are for a felony-level court, policy makers and researchers can use these results to guide their decision-making.

Short- and Long-Term Outcomes of Mental Health Court Participants by Psychiatric Diagnosis.

OBJECTIVE: The goal of mental health courts (MHCs) is to decrease incarceration and recidivism while increasing continuity of mental health treatment. Although previous research has found positive outcomes, questions remain unanswered regarding the population for which MHCs work best. No studies have assessed potential differences in MHC outcomes by psychiatric diagnosis. This study filled the gap by addressing the following research question: Are there differences in short-term program outcomes and in long-term recidivism and mental health engagement outcomes by psychiatric diagnosis? METHODS: The study was a cross-site evaluation of eight MHCs in a single state. To assess long-term outcomes, this study analyzed data from participants who had been discharged from an MHC for at least one year (N=234). Four diagnostic categories were used: bipolar disorder, depressive disorder, schizophrenia, and "other" disorder. Demographic, programmatic, recidivism, and mental health treatment data for each individual were collected from state administrative agencies. RESULTS: The findings suggest no differences by diagnosis in short-term outcomes or recidivism; however, significant reductions in use of high-intensity mental health services were noted for individuals with schizophrenia. CONCLUSIONS: Findings support inclusive eligibility for MHC participation across diagnostic categories and should inform policy and practice in regard to MHC development and operation. Future research should examine other key characteristics to determine ways in which resources can be best utilized.

Mental health court outcomes by offense type at admission.

Using a statewide database of mental health court (MHC) defendants, this study examines criminal justice outcomes by target arrest offense type. Findings suggest that defendants with a felony are less likely to complete MHC but those who do are at no greater risk of recidivism post-exit than those with a misdemeanor. In terms of jail days, both completers and noncompleters with a felony had reductions in jail days; however, misdemeanor defendants, especially those who did not complete MHC, had increases. We discuss why MHC supervision may sometimes have a negative effect and offer recommendations on how courts might modify supervision.

Assessing the feasibility and fidelity of an intervention for women with violent offenses.

Women convicted of assaultive or violent offenses represent a small but important subpopulation of adults involved in the criminal justice system. The limited treatment and rehabilitation programs that are available for these women are usually developed for male offenders and do not consider factors that are especially relevant to women, such as higher rates of mental health and substance use disorders as well as their likely histories of interpersonal violence. Moreover, women's trajectories into violent behavior - as well as their trajectories out - may differ from their male counterparts. Due to the absence of programs available for this unique population, a new gender-specific and trauma informed intervention, Beyond Violence, was developed. This paper describes a pilot study with a mixed-methods approach that assesses the feasibility and fidelity of the intervention within a state prison for women. Overall, various components of feasibility (i.e. engaging the target population, gaining institutional support, and finding skilled treatment staff), were realized, as were fidelity elements such as adherence to the intervention material, and high attendance and satisfaction by participants. The positive results of this pilot study increase the likelihood of dissemination of the intervention and a randomized control trial is currently underway.