A Second Chance: Negative Terminations in Mental Health Courts and Subsequent Readmissions for Persons with Severe Mental Illnesses

Background/purpose:  The criminalization of person with severe mental illness (SMI) is an ever increasing concern for the community mental health system and criminal justice system (CJS). According to the sequential intercept model (SIM), a continuum of interventions/contact points, starting with effective mental health services, proceeding first contact with the CJS, and eventually to post incarceration programs, have been designed to “capture” persons with SMI with the goal moving consumers from the CJS and in to treatment as-soon-as-possible (Munetz & Griffin, 2006). Mental Health Courts (MHC) are a point along this continuum. Research suggests MHCs reduced recidivism and increased treatment involvement/adherence (Trawver, 2011). In theory, participating in a MHC and having a positive termination would link persons with needed treatment resources and keep them from future criminal justice system involvement, including reappearing before a MHC. An unanswered question remains. Does type of termination from a MHC effect the likelihood that a person would be readmitted to the same MHC?

Methods:  Data were collected from a MHC in one urban Midwestern county over a period of 9 years. MHC case managers collected data for all persons referred to the MHC (n =  921). The dependent variables were readmission to MHC and time to readmission to MHC. The primary independent variable was first admission outcome, which included three levels – positive termination, negative termination and non-participation. In addition, the researchers included variables in the model measuring demographics, psychiatric factors, length of participation in first MHC, and arrests while under supervision. The researchers used logistic regression to model readmission to MHC and Cox regression to model time to readmission.

Results:  The researchers first examined the model of the effects of final disposition of the first MHC experience on readmission. The model was a significant predictor of readmission (χ² =236.24, df=30, p<.01) and explained about 48% of readmissions. Having a negative termination was a significant predicator of readmissions (b= 1.1, df = 1, p<.01).  Persons with a negative termination were 198 percent more likely than persons with a positive termination to be readmitted to the MHC. The model predicting time to readmission was significant (χ² =236.24, df=30, p<.01). A negative termination from the first mental health court was associated with time to readmission in to the second court (b= 1.05, df = 1, p<.01). The hazard rate of having a negative termination on readmission was 286 percent greater than having a positive termination.

Conclusions/Implications:  The findings suggest that persons who have a negative termination from MHCs are more likely to be readmitted to MHC and at a faster rate than are persons with a positive termination or who chose not to participate. The development of new interventions and the implementation of already existing interventions, such as police crisis intervention teams, may be one way to “capture” individuals who fail at MHC earlier in the SIM process. In addition, developing in MHC interventions to help consumers have a positive outcome may reduce second admissions and move participants in to mental health care.