Assessing Program Completion and Recidivism Outcomes Among Individuals with Serious Mental Illnesses in the Community: A Case Study of the Cook County Adult Probation Department

Background: Probation comprises the largest segment of the U.S. criminal legal system and a significant number of people under probation supervision have been diagnosed with serious mental illnesses (SMI), such as Schizophrenia, Bipolar Disorder, and Major Depressive Disorder. Within the context of probation programming, work on legal-system involved persons with SMI has resulted in the use of two prevailing court-based models: 1. Mental Health Courts and 2. Specialized Mental Health Probation Caseloads. However, experts in the field have called for more careful and thorough evaluations of both models.

Methods: The current study analyzes secondary data to examine the Cook County Adult Probation Department’s various approaches to supervising adult probationers with SMI. Administrative data from individuals with SMI (N=864) who exited Mental Health Court (n=78), Mental Health Unit (n=700), or Standard Caseload Supervision (n=86) in 2008 or 2009, were analyzed to better understand those factors associated with successful program completion and time to rearrest through 2014.

Results: Propensity score matching was used to reduce confounding due to non-randomization of probation program assignment and results suggest that assignment to Mental Health Court may result in improved program outcomes compared to those assigned to Mental Health Unit or Standard Caseload Supervision. However, survival analysis results did not indicate any significant reductions in time to rearrest among those who successfully completed Mental Health Court for the five years following successful program completion.

Conclusion: Current efforts to transform the criminal legal system have focused on policing reforms, progressive prosecution practices, and the reduced use of incarceration. However, these conversations should also include enacting changes to probation, where the bulk of individuals involved in the legal system are supervised. Findings from this study have potential implications for the refinement of mental health probation programming and results suggest that several factors should be considered by policy makers when developing and implementing mental health programming initiatives. Local jurisdictions could also explore the possibility of co-locating treatment programming, counseling services, and other commonly needed supports directly within the probation setting given the large volume of probation clients with mental health treatment needs.