تکرار جنایت طولانی مدت متهمان دادگاه بهداشت روانی

The first MHC was established in 1997 and now, over 15 years later, there are over 300 mental health courts in the United States. In a relatively short time these courts have become an established criminal justice intervention for persons with a mental illness. However, few studies have looked at the long-term outcomes of MHCs on criminal recidivism. Of the studies evaluating the impact of MHCs on criminal recidivism, most follow defendants after entry into the court during their participation, and only a few have followed defendants after court exit for periods of one or two years. This study follows MHC defendants for a minimum of five years to examine recidivism post-exit with particular attention to MHC completion's effect. Findings show that 53.9% of all MHC defendants were rearrested in the follow-up and averaged 15 months to rearrest. Defendants who completed MHC were significantly less likely to be rearrested (39.6% vs. 74.8%), and went longer before recidivating (17.15 months vs. 12.27 months) than those who did not complete. This study suggests that MHCs can reduce criminal recidivism among offenders with mental illness and that this effect is sustained for several years after defendants are no longer under the court's supervision.

Given the large numbers of persons with serious mental illness in the criminal justice system (Abram, Teplin and McClelland, 2003, Abram, Teplin, McClelland and Dulcan, 2003, Steadman et al., 2009, Teplin, 1990, Teplin et al., 1996 and Trestman et al., 2007) and the fact that many of these individuals repeatedly cycle through the system, local US jurisdictions have implemented various diversionary programs for mentally ill offenders. One such program is the mental health court (hereafter MHC), which is a type of problem-solving court that attempts to divert persons with mental illness out of the cycle of arrest, incarceration, release and rearrest, by requiring and motivating them to connect with treatment and services and to change their behaviors (Almquist & Dodd, 2009). The MHC uses case management and enhanced judicial supervision to monitor a defendant's progress. Judges, probation officers, social workers, community corrections, and treatment service professionals work together as part of the MHC team to develop treatment plans for each defendant and monitor defendants' progress (or lack thereof) while under court supervision. Individualized treatment plans may include requirements like attending a treatment program, meeting with a mental health professional, submitting to drug screenings, complying with a medication regimen, and offering some form of restitution. Some defendants complete the court process meaning they were compliant with court mandates for a continuous period of time and received a full “dose” of the court's treatment, services, structure, supervision and encouragement (Moore & Hiday, 2006). Other defendants who are persistently noncompliant are terminated from the process, receive only a part of their individualized plans, and eventually have their charges sent back to traditional court. Some opt out, choosing to return to traditional court for processing of their cases. These two groups are the MHC noncompleters. The majority of empirical research on MHCs has focused on criminal recidivism and has found that defendants who participate in a MHC have lower rates of reoffending than before entering the MHC (Burns et al., 2013, Christy et al., 2003, Dirks-Linhorst and Linhorst, 2012, Frailing, 2010, Herinckx et al., 2005, Moore and Hiday, 2006, Palermo, 2010, Steadman et al., 2011 and Trupin and Richards, 2003). When compared to defendants with a mental illness in a traditional criminal court, MHC defendants are no more likely to reoffend (Christy et al., 2005, Cosden et al., 2003, Dirks-Linhorst and Linhorst, 2012, Frailing, 2010, Hiday et al., 2013, McNiel and Binder, 2007, Moore and Hiday, 2006, Steadman et al., 2011 and Trupin and Richards, 2003). Some of these studies had comparison groups that consisted of defendants who were not referred to MHC or did not opt into MHC after referral (Dirks-Linhorst and Linhorst, 2012, Frailing, 2010, Hiday et al., 2013, McNiel and Binder, 2007, Moore and Hiday, 2006, Steadman et al., 2011 and Trupin and Richards, 2003), while others had no comparison group and looked at recidivism between MHC completers and noncompleters (Burns et al., 2013, Herinckx et al., 2005, Hiday and Ray, 2010 and Palermo, 2010). Although there are now over 300 MHCs throughout the United States (Almquist & Dodd, 2009)—and this number continues to grow—most of the studies have examined recidivism after MHC entry with follow-up over the time defendants are still in the MHC. Only a few studies have looked at the impact of the MHC on offending behavior post MHC exit (Burns et al., 2013, Dirks-Linhorst and Linhorst, 2012, Hiday and Ray, 2010, Hiday et al., 2013 and McNiel and Binder, 2007). By examining offending behavior post MHC exit, researchers are able to determine whether the MHC program that is expected to impact recidivism does so for a sustained period of time when defendants are no longer under the court's monitoring and receiving its treatment and services. Moreover, many MHC teams acknowledge that they are trying to change long-standing patterns of criminal behavior and accept that defendants often make mistakes early on in the MHC process and may be re-arrested (Ray et al., 2011 and Redlich et al., 2010). In such cases, the team can decide to add the additional charges to the original ones on the MHC docket. Looking at offending after MHC entry would count these arrests as recidivism when in fact technically these additional charges are disposed of along with the original charges if the defendant successfully completes the MHC. Of the post-exit studies, the longest follow-up period has been two years (Burns et al., 2013 and Hiday and Ray, 2010). Longer-term follow-up studies allow researchers to examine how long MHCs reduce offending and whether they help reintegrate defendants back into the community as law-abiding citizens. Given the spread of MHCs in the United States, it is important that policy decision makers are provided with information on the longer-term criminal justice outcomes of offenders with serious mental illness when considering the effectiveness of MHCs. Until recently such evidence has been hard to assemble as MHCs have not been around long enough for evaluators to complete studies with long-term outcomes. The present study examines post MHC exit arrests for a minimum of five years of all defendants who participated in one MHC in its first six years, 2000 to 2006. In doing so the study also investigates differences between completers and noncompleters of the court. MHC studies consistently suggest that completers are less likely to recidivate than noncompleters because they receive a full “dose” of MHC supervision, treatment, case management, services, and support. Unlike MHC studies that have examined noncompleters' recidivism, this study accurately assesses the risk period of rearrest for noncompleters by considering traditional court disposition and jail time dates. Using survival analysis to examine the likelihood of criminal recidivism and the length of time post MHC exit until defendants recidivate, this study addresses whether MHC participation and completion leads to compliance with the law in the years following MHC exit. In multivariate analyses, it controls those factors shown by previous empirical research to be significant in predicting recidivism and desistance over time.

Few studies have used a post-exit design in which the risk period for potential recidivism begins after MHC exit (Burns et al., 2013, Dirks-Linhorst and Linhorst, 2012, Hiday and Ray, 2010, Hiday et al., 2013 and McNiel and Binder, 2007) rather than after MHC entry. By examining offending behavior post MHC exit researchers are able to determine whether the MHC's program that is expected to impact recidivism does so for a sustained period after the time when defendants are no longer under the court's monitoring and receiving its treatment and services. With a minimum of five years follow-up and a maximum of ten years, this study is the longest follow-up of a MHC to date. During this longer period, 46.1% of MHC defendants still had not been rearrested. Most of those who did recidivate did so sooner rather than later. Among those who completed the MHC, 60.4% did not recidivate in the five or more years post-exit. Noncompleters recidivated sooner, usually in the first year, while completers recidivated in the second or third year post-exit. Defendant's age, criminal behavior and exit status were predictors of the time to recidivism.