Disabilities newsletter publicizes results of 2013 panel on mental health courts

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From State Bar Disabilities Project Newsletter

The State Bar of Michigan (SBM) Disabilities Project Newsletter, Volume 9, Issue 1, for February 2014 (prepared by the Committee on Justice Initiatives and Equal Access Initiative Disabilities Project), offered a summary of a session at the 2013 SBM annual meeting, held in Grand Rapids last September. The session covered mental health courts, and incorporated the results of the study of pilot projects in 2011.Below is the summary of the presentation, followed by the excerpt from that study.

SBM supplies the following information regarding reprinting of such material: “The information is provided ‘AS IS,’ without warranty of any kind, express or implied, and should not be construed as formal legal advice or as forming an attorney/client relationship.     Any statements in these materials are those of the author(s) and do not necessarily reflect the views of the State Bar of Michigan or any of its sections or committees.”

At the 2013 SBM Annual Meeting the Equal Access Initiative in conjunction with the Criminal Law Section and Prisons and Corrections Section offered programming on problem solving courts. The program explored the follow-up assessment of pilot projects across Michigan and discussed the matter of people with mental health care needs encountering the legal system. Across the spectrum of the system, from law enforcement to courts to corrections, people with special needs face unique barriers to overcome in order to be appropriately served.

A two-panel discussion looked at the issues from multiple views in an effort to identify solutions to support access to justice for every individual. Below is the excerpt from the Michigan Department of Community Health’s Statewide Mental Health Court Outcome Evaluation Aggregate Report as compiled by Dr. Sheryl Kubiak, one of the authors of the report. The entire Annual Meeting presentation at http://www.michbar.

org/programs/equalaccess.cfm as well as find the full report.

**EXCERPT**

Statewide Mental Health Court Outcome Evaluation Aggregate Report 

September 2012        

Prepared for: Michigan Department of Community Health

Prepared by: Michigan State University

Sheryl Kubiak, Ph.D.

Liz Tillander, LMSW

Erin Comartin, Ph.D.

Bradley R. Ray, Ph.D.       

This project was supported by Byrne JAG grant #2009-SU-B9-0017, awarded by the Bureau of Justice Assistance, Office of Justice Programs, U.S. Department of Justice (DOJ) and administered by the Michigan State Police.  Points of view or opinions contained within this document  do not necessarily represent the official position or policies of the DOJ.

EXECUTIVE SUMMARY  Nationally, the number of people with serious mental illness (SMI) in jails ranges from 6 to 36 percent. Some refer to jails as the last mental health hospital as individuals with SMI revolve in and out of jails. As one solution to this social problem, jurisdictions are finding ways to divert such individuals from prosecution or sentencing by engaging them in treatment services. The mental health court (MHC) offers an alternative to traditional criminal court processing; it is post-booking diversion program that utilizes treatment and services available in a given community to stem the frequency of mentally ill offenders’ contact with the criminal justice system. Studies of MHCs have consistently found that they can be successful in reducing re-offending and increasing treatment utilization. 

In 2008, the Michigan Department of Community Health (MDCH) and the State Court Administrative Office (SCAO) developed the Michigan Mental Health Court Grant Program as a mechanism to jointly fund a statewide MHC pilot program during fiscal year 2009. In 2011, MDCH contracted an external evaluation of the pilot program encompassing eight MHCs: Berrien (Unified Trial Court); Genesee (25th Probate Court); Grand Traverse (86th District Court); Jackson (4th Circuit and 12th District Courts); Livingston (53rd District Court); Oakland (6th Circuit Court); St. Clair (72nd District Court); and Wayne (3rd Circuit Court).   

The evaluation encompasses the three-year pilot period of January 2009 to December 2011 and relies on multiple sources of data to assess the processes and outcomes of each court.  Questions related to court processes were: How are courts similar to and different from each other? What are mechanisms for referral and admission? How strong is the collaboration or integration between the court and mental health staff? Did participants successfully complete? Data used to assess these process-related questions included surveys, site visits, interviews, and court observation. Based on site visit and interview data, the research team created a process map illustrating each court’s screening, admission, and decision-making processes. The process map and a report based on the data collection was submitted to each MHC for verification. Questions related to outcomes included: Did MHC reduce recidivism (i.e. time in jail, new arrests)? Did MHC increase participation in mental health treatment? Did high-intensity treatment such as hospitalization decrease as a result of MHC? Did specific individual or system level factors affect outcomes? Data collected to assess these outcomes came from five primary sources: MDCH-CMH Encounter/Service Data; SCAO – MHC database; jail data from each county; MDCH – Bureau of Substance Abuse and Addiction Services treatment data; and Michigan State Police – arrest and conviction data. To assess long-term outcomes, a comparison of three time periods was considered: 1) one year prior to MHC admission; 2) the period of involvement in MHC; and 3) one year following MHC discharge. 

Using the Council of State Governments Justice Center list of ten essential elements of MHC as a guide, MHCs across Michigan were found to vary widely in terms of organization, policies, and practices. Differences between courts should not be construed as a ‘right’ or ‘wrong’ way of operating. Rather, each court is responsive to the needs of the particular county and uses the resources available to the best of its abilities. Because each MHC is unique, it is not possible to draw direct comparisons between courts. The intent of this evaluation is to illuminate the variety of MHC structures and processes across the state and utilize individual- and system-level factors, other than county of origin, to assess variations in outcomes.  There were 678 individuals admitted into the eight MHCs prior to December 31, 2011. The average age at admission was 35 years (range 18 to 64). Nearly two thirds of participants (63%) were males and 67% identified as Caucasian. The overwhelming majority of participants were unemployed (91%) at admission, and nearly 20% were homeless. Nearly 40% were admitted into MHC with a primary diagnosis of bipolar disorder, followed by depression (29%), schizophrenic/psychotic or delusional  disorders (21%), and 12% representing other diagnoses such as developmental or personality disorders. Although 60% were identified as having a ‘current substance abuse’, other evidence shows that as many as 79% were substance involved. Participants were most likely to enter MHC on a felony offense (48%), while 43% were admitted on a misdemeanor, and 8% on civil cases.  

The average length of stay in MHC was 276 days; among all 678 participants who were admitted, there were 187,043 MHC program days since 2009. Of the 450 participants discharged, 43% successfully completed all requirements of the MHC – a proportion within range of national averages. Age and offense type were the strongest predictors of success: Successful completers were more likely to be older than average (39 years) and have a misdemeanor/civil offense. 

Treatment outcomes. Participants received the greatest number of services during MHC, and these were primarily low-intensity services (e.g., med reviews, case management). The proportion of participants requiring a high intensity service (e.g., hospitalization) declined from 31% pre-MHC to 15% post-MHC. Time to first mental health treatment after MHC admission averaged 16 days; upon discharge into the community the average was 41 days. While 95% of participants received mental health treatment during MHC, 72% of those discharged greater than one year received such services. Substance abuse treatment within the CMH system increased during MHC as compared to pre-MHC (45% compared to 53%) but declined post-MHC (28% of those discharged).   

Recidivism outcomes. A primary indicator of MHC is recidivism, measured nationally by new arrests. Since admission into MHC, only 14% of participants were arrested and charged with a new offense – a much lower rate than national averages – particularly, since time between admission to MHC and one year post-MHC may have been as long as 2-years. Prior to MHC, 81% of participants spent time in jail, averaging 39 days. During MHC, 54% of participants spent time in jail, averaging 24 days. This represents a statewide saving of 10,074 jail bed days. To date, a reduction of 15,991 jail bed days is seen when comparing the pre-MHC to post-MHC periods for the 450 participants discharged. Among participants discharged one-year (n=236), long-term outcomes indicate 43% spent time in jail post-MHC and 4% were incarcerated in state prisons. Successful program completion strongly predicts the absence of recidivism.

Individual Factors Influencing Outcomes. Mental health diagnosis was found to have no effect on completion, treatment attainment or recidivism. However, the presence of COD predicted less favorable completion, more time in jail during MHC and higher proportion of new arrests/convictions. Similarly, those with felony offenses were less likely to complete, and when they did, they spent more time in MHC. Interestingly, those with felony offenses had significant reductions in jail days when comparing pre- and post-MHC periods regardless of completion status. Importantly, there was no difference in new arrest/convictions between those who entered with a felony versus a misdemeanor. 

System-level Factors Influencing Outcomes. Outcome variations related to court type (felony, misdemeanor/civil, or mixed) were similar to those above, with courts focused on felony cases having the greatest reduction in jail days. Examining the level of integration between the courts and treatment staff (high vs. low), high integration courts had lower lengths of stay and less time to treatment. Although those in low integration courts were more likely to complete MHC, those in high integration courts were more likely to experience greater reductions in jail days and higher treatment participation.  

Implementation and piloting of MHCs across Michigan has been successful, and many quantitative indicators as well as personal stories demonstrate positive outcomes. Based upon the body of knowledge amassed in this report, the following are areas for future consideration that may expand positive outcomes: 1) Enhance the level of integration between courts and treatment; 2) Consider matching risk level with length or intensity of court supervision; 3) Extend use of rewards to encourage longer length of stays and positive completion; 4) Increase attention to COD, integration of mental health and substance abuse treatment, and continuity of care post-MHC to support ongoing recovery.

The excerpt, which can also be found at the SBM website link above, goes on to make recommendations.

Past issues of The Disa-

bilities Project Newsletter, which can be accessed there as well, offer studies on such topics as “Child Welfare Cases Involving Parents With Disabilities,” and “Using the Best Interests Test to Protect the Cognitively Impaired From Intrusive Interventions at the End of Life.” The article “Accommodating the Deaf or Hard of Hearing Client in the Law Office Setting” was reprinted in a previous Grand Rapids Legal News.