Piloting a Measure of the Mental Health Court Judge-Participant Relationship

Purpose: Increased numbers of individuals with serious mental illness recycling through the criminal justice system has encouraged the development of jail diversion programs, including mental health courts (MHCs). MHCs are effective in reducing recidivism and increasing access to treatment (Sarteschi, Vaughn, & Kim, 2011). While MHC personnel and participants often credit positive outcomes to the judge-participant relationship (Redlich et al., 2010), no research to date has assessed this belief. The purpose of this research was to pilot test a measure of the MHC judge-participant relationship (MoJA) and to evaluate the relationship between its scores and program retention and recidivism.

Method: Study participants included 90 adult MHC participants who were diagnosed with schizophrenia, bipolar disorder, or major depression, were legally competent, and provided informed consent. Each participant completed a Measure of Judicial Alliance ([MoJA] author redacted, 2011) as part of an in-person structured interview. Based on the specialized mental health probation/probationer Dual-Role Relationship Inventory – Revised ([DRI-R] Skeem et al., 2007), the MoJA was designed to measure the quality of the MHC judge-participant relationship including factors related to alliance (i.e., acceptance, support, and trust), partnership (i.e., effort and collaborative work), fairness, respect, flexible consistency, commitment, and investment in the helping. The 30-item MoJA asks question such as "I feel safe enough to be open and honest with Judge Jones" or "Judge Jones puts me down when I've done something wrong" that are each rated on a 7-point Likert scale ranging from 1 - "never" to 7 - "always," resulting in possible scores extending from 30 to 210, with higher scores indicative of a stronger relationship. Data analysis included an exploratory factor analysis, interitem correlations, and internal consistency of the MoJA. Additionally, logistic regression analyses were utilized to assess MoJA scores as predictors of program retention and recidivism.

Results: The adequacy of the available sample for conducting an exploratory factor analysis was assessed using a Kaiser-Meyer-Olkin analysis (KMO = .881, p < .001). The results of a varimax rotation solution yielded a five-factor structure. The 30-item MoJA had excellent internal consistency (α = .96) for the full-scale, with subscales ranging from good (α = .77) to excellent (α = .96). Significant interitem correlations were moderate both for the overall scale (r = .44), as well as in the caring/fairness (r = .52), toughness (r = .40), and trust (r = .44) subscales. Results of regression analyses revealed that MoJA scores were a significant predictor of participants’ retention but not recidivism.

Conclusion: This was the first pilot test of the MoJA as a potential measure of the MHC judge-participant relationship. In Because of the measure’s reliability and participants’ scores that were predictive of program retention, training judges and other MHC actors on developing and maintaining a therapeutic relationship with court participants to encourage retention is suggested. Recommendations for future study include comprehensive psychometric testing of the MoJA in larger and representative samples over longer follow-up periods and to further assess the impact of relationship in MHC outcomes.