Individual factors associated with recidivism among mental health court program clients
Introduction
Mental health court programs (MHC) were created to help individuals who are arrested and have a mental illness that is a significant contributing factor to their arrest (Desmond & Lenz, 2010). There are three components that MHC diversion programs offer that are not offered by traditional courts: screening, assessment, and negotiation between mental health specialists and criminal justice staff (H. J. Steadman, Barbera, & Dennis, 1994; H. J. Steadman, Davidson, & Brown, 2001). Screening involves identifying defendants who are suspected of having a mental illness while assessment involves the evaluation of identified defendants by a mental health professional. The last component involves court diversion staff negotiating with prosecutors, defence attorneys, the courts, and community-based mental health providers to have charges reduced or waived (H. J. Steadman et al., 1994; H. J. Steadman et al., 2001). Although there is growing evidence that diversion to a MHC can reduce recidivism rates and improve the quality of life of clients (Anestis & Carbonell, 2014; Broner, Lattimore, Cowell, & Schlenger, 2004; Broner, Mayrl, & Gerald, 2005; B. Burns, 2013; M. Cosden, Ellens, Schnell, & Yamini-Diouf, 2005; Merith Cosden, Ellens, Schnell, Yamini-Diouf, & Wolfe, 2003; Dirks-Linhorst & Linhorst, 2012; Frisman et al., 2006; Han & Redlich, 2016; Herinckx, Swart, Ama, Dolezal, & King, 2005; V. A. Hiday, Ray, & Wales, 2016; Virginia Aldige Hiday, Wales, & Ray, 2013; Hoff, Baranosky, Buchanan, Zonana, & Rosenheck, 1999; H. R. Lamb, Weinberger, & Reston-Parham, 1996; Lamberti et al., 2001; Lim & Day, 2014; Loong, Bonato, Barnsley, & Dewa, 2019; McNiel & Binder, 2007; Moore & Hiday, 2006; Naples & Steadman, 2003; Shafer, Arthur, & Franczak, 2004; Henry J. Steadman, Redlich, Callahan, Robbins, & Vesselinov, 2011; Trupin & Richards, 2003), there is little information on the client characteristics associated with recidivism outcomes of MHC clients (Ryan, Brown, & Watanabe-Galloway, 2010; Verhaaff & Scott, 2015). The absence of this type of information makes it difficult to target programs and to improve the effectiveness of programs.
For example, among MHC clients, it is not clear as to whether sex and age are significant factors that are associated with the risk of rearrest (B. Burns, 2013; Herinckx et al., 2005; V. A. Hiday et al., 2016; Virginia Aldige Hiday et al., 2013; Lim & Day, 2014; Moore & Hiday, 2006). Research within the general prison population have consistently found females to be less likely to be rearrested compared to men across a variety of settings (Gendreau, Little, & Goggin, 1996; Piquero, Jennings, Diamond, & Reingle, 2015). When it comes to age, it has been found that antisocial and criminal activity increases rapidly and peaks in adolescence, followed by a continual decline throughout adulthood (Farrington, 1986; Farrington, Piquero, & Jennings, 2013; Hirschi & Gottfredson, 1983; Moffitt, 1993; Piquero et al., 2003, Piquero et al., 2007; Sweeten, Piquero, & Steinberg, 2013). Thus, with increasing age, there is decreasing likelihood of recidivism.
There is also a disproportionate number of individuals with mental illness in the criminal justice system (Markowitz, 2006). Studies have found suspects with a mental illness are more likely to be arrested than those without (H. R. Lamb & Weinberger, 1998; H. R. Lamb, Weinberger, & DeCuir Jr., 2002; Steury, 1991; Teplin, 1990). Having a mental illness has been associated with lower functional status and greater disability (Mauksch et al., 2001). In the face of limited clinical options, police who encounter disruptive behavior resulting from mental illness often resort to arrests as a means to get suspects into mental health treatment and maintain their authority in conflict situations (Markowitz, 2006).
Whether homelessness is a risk factor for rearrest among MHC clients is also not known. In the general population, homelessness was found to be an important pathway to incarceration (H.R. Lamb, Lamb, & Weinberger, 2001). Surveys of inmates found offenders with mental illness to be more likely than other inmates to be homeless either at the time of, or the year before arrest (DeLisi, 2000; Ditton, 1999; McCarthy & Hagan, 1991). Being homeless has also been associated with a greater number of arrests (Gelberg, Linn, & Leake, 1988; H. R. Lamb & Weinberger, 1998; Leal, Galanter, Dermatis, & Westreich, 1999; Markowitz, 2006; Roy, Crocker, Nicholls, Latimer, & Ayllon, 2014; Wenzel et al., 1996).
In terms of the effects of having a criminal history, studies on MHC offenders found those with a prior criminal history were more likely to be rearrested compared to first time offenders (V. A. Hiday & Ray, 2010; Virginia Aldige Hiday et al., 2013; Moore & Hiday, 2006; Reich, Pichard-Fritsche, Lebron, & Hahn, 2015; Henry J. Steadman et al., 2011).
Overall, the literature suggests that sex, age, functional status, homelessness, and criminal history may be individual factors that are linked to recidivism among offenders with mental illnesses (Farrington, 1986; Farrington et al., 2013; Gelberg et al., 1988; Gendreau et al., 1996; V. A. Hiday & Ray, 2010; Virginia Aldige Hiday et al., 2013; Hirschi & Gottfredson, 1983; H.R. Lamb et al., 2001; H. R. Lamb & Weinberger, 1998; Leal et al., 1999; Link, Monahan, Stueve, & Cullen, 1999; Markowitz, 2006; Moffitt, 1993; Moore & Hiday, 2006; Piquero et al., 2003, Piquero et al., 2007; Piquero et al., 2015; Reich et al., 2015; Roy et al., 2014; Henry J. Steadman et al., 2011; Swanson et al., 1998; Sweeten et al., 2013; Wenzel et al., 1996). Of these factors, only criminal history has been well studied in the MHC population; and to date, there is no consensus on the effect of sex and age – while functional status and homelessness have not been studied. As a result, this study seeks to answer, “What individual factors are associated with recidivism among MHC program clients?”
Section snippets
Description of the dataset
This secondary data analysis uses a subset of the Matryoshka Project dataset that focuses on MHC clients. The Matryoshka Project was a 4-year study that looked at two types of specialized community mental health programs in the province of Ontario, Canada: Early Intervention Programs (EIP) and Court Support Programs (CSP) (Dewa, Trojanowski, Cheng, & Loong, 2012; Dewa, Trojanowski, Cheng, & Sirotich, 2012). The purpose of the project was to examine the effects of the Government of Ontario's
Description of the study population
Of the 155 CSP clients that were successfully interviewed, one client did not consent to collect further data from their case manager. Given recidivism is the primary outcome of interest and this information was collected from case managers, only 154 individuals were included in the analysis (Table 2). On average, clients were 37 ± 12 years of age and the majority were male (73%, n = 113). Thirty-six percent of clients were found to have low functional status and less than 5% of clients
Discussion
The purpose of this secondary analysis was to address the question, “What individual factors are associated with recidivism among MHC program clients?”. This analysis specifically explored the association of sex, age, low functional ability, homelessness, court site, and criminal history with recidivism. Our results found less than 20% of our sample recidivated. Those who did were younger, had low functional ability, and a criminal history. When considered together, our multiple logistic
Conclusion
The purpose of this secondary analysis was to examine “What individual factors are associated with recidivism among MHC program clients?” This analysis specifically explored the association of sex, age, low functional ability, homelessness, court site, and criminal history. Among these, only age and criminal history were found to be significantly associated with the likelihood of recidivism. MHC clients were found to be less likely to reoffend with increasing age; while those with a prior
Ethics approval and consent to participate
Research ethics approval was received from the Centre for Addiction and Mental Health and the University of Toronto.
Consent for publication
Not applicable.
Funding
This project was funded by the Ontario Mental Health Foundation. Any views expressed or errors are the sole responsibility of the authors and do not reflect the views of any of the funders.
Author contributions
DL and CSD led the conception, design, data acquisition, analysis and interpretation of the data. JB and TA collaborated on the analysis and interpretation of the data. All authors read and approved the final manuscript.
Funding information
This project was funded by the Ontario Mental Health Foundation. Any views expressed or errors are the sole responsibility of the authors and do not reflect the views of any of the funders.
Declaration of Competing Interest
The authors declare that they have no competing interests.
Acknowledgements
The authors would like to thank Dr. Whitney Berta for comments that greatly improved the manuscript.
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