A Randomized Controlled Trial of a Specialized Approach to Probation for Adults with Severe Mental Illnesses

Background: The large and growing number of persons with mental illness in jails, prisons and community supervision arrangements present significant challenges to the criminal justice system, especially for probation officers who are tasked with supervising this high-risk, high-need population. State and local agencies have implemented specialty mental health probation (SMHP) to address high rates of probation violations and recidivism among probationers with mental illnesses; however, there is a lack of rigorous empirical evidence to support the efficacy of SMHP. To address this gap, we conducted a randomized trial to answer the following questions: (a) Does SMHP enhance mental health service engagement among probationers with severe mental illnesses? and (b) Does SMHP reduce probation violations among probationers with severe mental illnesses?

Methods: We randomly assigned 91 probationers with severe mental illnesses to standard probation (n=49) or specialty mental health probation (n=42). Probationers who were at high-risk for recidivism and had a diagnosis of major depression, bipolar disorder, psychotic disorder or post-traumatic stress disorder volunteered to participate in the study. Outcomes included the initiation of mental health action steps by probation officers (e.g., referring a probationer to receive mental health services), completion of a mental health action step by a probationer (e.g., meet with a mental health provider), and technical violations (i.e., failure to meet probation requirements).  Randomization successfully balanced treatment and control groups on all baseline covariates. To examine differences between treatment and control groups, we conducted chi square and independent samples t-tests, two-tailed, with alpha set a .05.

Results: SMHP officers were more likely to have initiated a mental health actions step (e.g., referral to mental health services; 54.76%, n=23) compared to standard probation officers (14.29%, n=7; x² = 16.77, df = 1, p<0.001, OR=7.26). Compared to probationers who received standard supervision, a greater percentage of probationers who received SMHP completed one or more mental health action steps (e.g., meet with mental health provider; 71.43% vs. 95.65%, respectively), although this difference was not statistically significant (p=.06). Further, compared to those on SMHP caseloads, a higher percentage of participants on standard probation (61.22%, n=30) had at least one technical violation (e.g., failure to meet probation requirements; 50.00% n=21), more absconding violations (e.g., intentionally avoiding supervision) and more violations of any type; however, these results were not statistically significant.

Conclusions and Implications: This small-scale RCT study addresses a significant methodological limitation in the literature and our results suggest differences between SMHP officers and standard probation officers in terms of their focus on probationers’ mental health service connection. In addition, the study suggests that SMHP officer efforts may also result in higher rates of accessing mental health services. Further, although not statistically significant, the lower rates of probation violations among individuals on SMHP is promising. More research is needed to further establish the evidence for specialty mental health probation as a strategy for supervising probationers with severe mental illnesses.