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Alysson Gatens  |  Updated: April 23, 2019
Mental Health Disorders and the Criminal Justice System: A Continuum of Evidence-Informed Practices

Mental health disorders (MHD) are between three and six times more common among individuals involved in the criminal justice system compared to the general population.[1] In the United States, 24 percent of individuals who are incarcerated reported receiving a clinical diagnosis or treatment for a MHD within the past year and 49 percent reported experiencing symptoms of a MHD.[2] Research estimates 1 million individuals with a MHD are on probation or parole in the United States.[3]

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Despite the disproportionately high prevalence of MHDs in the criminal justice system, many individuals do not receive treatment while incarcerated.[4] Nationally, sixty-three percent of individuals with a history of a MHD received treatment in prison from 2011 to 2012, and only 45 percent of those jailed received treatment.[5] In addition, individuals with a MHD spend significantly more time in jail compared to those without a MHD.[6]

Upon release from prison, individuals with a MHD on parole are nearly twice as likely to be reincarcerated within one year of release than those without mental health disorders.[7] This creates a problematic cycle where individuals with MHDs are released into the community, only to likely be returned to the justice system in the future.[8] These issues, among others, have led to the development of interventions targeted to justice-involved individuals with a MHD.

A very small proportion of the crimes committed by individuals with mental health disorders are a direct result of their mental health symptoms; researchers estimate about 1 in 10 arrested individuals with a MHD are involved with the justice system due to mental health symptoms.[9] Moreover, the idea that MHDs are a primary cause of criminality does not align with the fact that the vast majority of individuals with a MHD (treated or untreated) do not commit crimes.[10] This flaw in the rationale for providing interventions that mainly emphasize provision of mental health treatment may in part explain why such programs and practices have failed to reduce the overrepresentation of individuals with MHDs in the criminal justice system.[11] Research has shown individuals with MHDs have largely the same predictors and risk factors for criminal justice involvement as individuals without MHDs.[12]

Evidence-based practices or programs (EBPs) have demonstrated consistently positive outcomes through empirical research and evaluation. Promising programs and practices are associated with positive outcomes but need further research to support them as EBPs.[13] There are many EBPs for treating MHDs and there are several EBPs for preventing/reducing criminality. However, EBPs addressing mental health outcomes often have little to no impact on public safety outcomes.[14] There is markedly little empirical research on EBPs from the mental health field tailored for the justice-involved population or on criminal justice practices adapted to the abilities of individuals with a MHD.[15] More research is needed to gauge outcomes from adapted models relative to the expected outcomes from an EBP implemented with high levels of fidelity.[16]

This continuum was created to present the current state of research regarding programs and practices targeted to individuals with mental health disorders at various stages of the criminal justice system following the sequential intercept model (SIM). The SIM is a way to conceptualize points throughout the criminal justice system where individuals with MHD can be diverted to mental health treatment; or if the individual is already in the criminal justice system, programs and practices aim to help individuals avoid future involvement with the justice system (e.g. reentry).[17] Interventions at each intercept can be evaluated on measures in the following domains:

  • Criminal justice outcomes.
  • Mental health (clinical) outcomes.
  • Costs and savings.
  • Client and staff perceptions and satisfaction.[18]
References

  1. Note: Mental Health Disorders (MHDs) are diagnosed by clinicians using the criteria in the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5).Blandford, A. & Osher, F. (2012). A checklist for implementing evidence-based practices and programs (EBPs) for justice-involved adults with behavioral health disorders. Delmar, NY: SAMHSA’s GAINS Center for Behavioral Health and Justice Transformation.

  2. James, D. J., & Glaze, L. E. (2006). Mental health problems of prison and jail inmates (Bureau of Justice Statistics Report NCJ-213600). Washington, DC: U.S. Department of Justice, Office of Justice Programs. Retrieved from https://www.bjs.gov/content/pub/pdf/mhppji.pdf

  3. Louden, J. E., Manchak, S., O’Connor, M., & Skeem, J. L. (2015). Applying the sequential intercept model to reduce recidivism among probationers and parolees with mental illness. In P.A. Griffin, K. Heilbrun, E.P. Mulvey, D. DeMatteo, & C.A. Schubert (Eds.). The sequential intercept model and criminal justice: Promoting community alternatives for individuals with serious mental illness (pp. 118-136). USA: Oxford University Press.

  4. Note: There are limited data available on the proportion of probationers and parolees that receive mental health treatment while under community supervision; this is due, in part, to the more decentralized system of community mental health services, relative to the provision of treatment while incarcerated.DeMatteo, D., LaDuke, C., Locklair, B. R., & Heilbrun, K. (2013). Community-based alternatives for justice-involved individuals with severe mental illness: Diversion, problem-solving courts, and reentry. Journal of Criminal Justice, 41(2), 64-71.

  5. Bronson, J., & Berzofsky, M. (2017). Indicators of mental health problems reported by prisoners and jail inmates, 2011-12. (Bureau of Justice Statistics Report NCJ-250612). Washington, DC: U.S. Department of Justice, Office of Justice Programs. Retrieved from https://www.bjs.gov/content/pub/pdf/imhprpji1112.pdf

  6. Haneberg, R., & Watts, K. “Stepping Up” to beat the mental health crisis in U.S. jails. Criminal Justice/Corrections. New York, NY: Council of State Governments Justice Center. Retrieved from http://knowledgecenter.csg.org/kc/system/files/Haneberg Watts 2016.pdf

  7. Eno Louden, J., & Skeem, J. (2011). Parolees with mental disorder: Toward evidence-based practice. Bulletin of the Center for Evidence-Based Corrections, 7(1), 1-9.

  8. Baillargeon, J., Binswanger, I. A., Penn, J. V., Williams, B. A., & Murray, O. J. (2009). Psychiatric disorders and repeat incarcerations: The revolving prison door. American Journal of Psychiatry, 166(1), 103-109.

  9. Skeem, J. L., Manchak, S., & Peterson, J. K. (2011). Correctional policy for offenders with mental illness: Creating a new paradigm for recidivism reduction. Law and Human Behavior, 35(2), 110-126.

  10. Louden, J. E., Manchak, S., O’Connor, M., & Skeem, J. L. (2015). Applying the sequential intercept model to reduce recidivism among probationers and parolees with mental illness. In P.A. Griffin, K. Heilbrun, E.P. Mulvey, D. DeMatteo, & C.A. Schubert (Eds.). The sequential intercept model and criminal justice: Promoting community alternatives for individuals with serious mental illness (pp. 118-136). USA: Oxford University Press.

  11. Epperson, M. W., Wolff, N., Morgan, R. D., Fisher, W. H., Frueh, B. C., & Huening, J. (2014). Envisioning the next generation of behavioral health and criminal justice interventions. International Journal of Law and Psychiatry, 37(5), 427-438.; Osher, F. C., & Steadman, H. J. (2007). Adapting evidence-based practices for persons with mental illness involved with the criminal justice system. Psychiatric Services, 58(11), 1472-1478.

  12. Bonta, J., Law, M., & Hanson, K. (1998). The prediction of criminal and violent recidivism among mentally disordered offenders: a meta-analysis. Psychological Bulletin, 123(2), 123.; Epperson, M. W., Wolff, N., Morgan, R. D., Fisher, W. H., Frueh, B. C., & Huening, J. (2014). Envisioning the next generation of behavioral health and criminal justice interventions. International Journal of Law and Psychiatry, 37(5), 427-438.

  13. Blandford, A., & Osher, F. (2012). A checklist for implementing evidence-based practices and programs (EBPs) for justice-involved adults with behavioral health disorders. Delmar, NY: SAMHSA’s GAINS Center for Behavioral Health and Justice Transformation.

  14. Osher, F. C., & Steadman, H. J. (2007). Adapting evidence-based practices for persons with mental illness involved with the criminal justice system. Psychiatric Services, 58(11), 1472-1478.

  15. Heilbrun, K., DeMatteo, D., Yasuhara, K., Brooks-Holliday, S., Shah, S., King, C., ... & Laduke, C. (2012). Community-based alternatives for justice-involved individuals with severe mental illness: Review of the relevant research. Criminal Justice and Behavior, 39(4), 351-419.

  16. Heilbrun, K., DeMatteo, D., Yasuhara, K., Brooks-Holliday, S., Shah, S., King, C., ... & Laduke, C. (2012). Community-based alternatives for justice-involved individuals with severe mental illness: Review of the relevant research. Criminal Justice and Behavior, 39(4), 351-419.

  17. Munetz, M. R., & Griffin, P. A. (2006). Use of the sequential intercept model as an approach to decriminalization of people with serious mental illness. Psychiatric Services, 57(4), 544-549.

  18. DeMatteo, D., LaDuke, C., Locklair, B. R., & Heilbrun, K. (2013). Community-based alternatives for justice-involved individuals with severe mental illness: Diversion, problem-solving courts, and reentry. Journal of Criminal Justice, 41(2), 64-71.

Points to Consider
  1. What is included under the term “mental health disorders” (MHDs) is defined differently by many programs, policies, and in various research studies.[1] Clinical diagnostic criteria for specific disorders are available in in the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5).[2]
  2. Individuals with MHDs have largely the same predictors and risk factors for criminal justice involvement as individuals without MHDs.[3]
  3. Individuals with MHDs in the justice system share many of the same treatment needs as individuals with MHDs who are not involved in the justice system.[4]
  4. The criminal justice system has the primary goal of promoting public safety, whereas the primary goal of the mental health system is to improve mental health symptoms.[5]
  5. A number of evaluations of programs and practices found no association between criminal justice outcomes and mental health outcomes (i.e. many interventions impact one group of factors but not the other).[6]
  6. The availability and capacity of mental health resources in a community may impact the ways in which the criminal justice system and the mental health system are able to collaborate.[7]
  7. Mental health treatment and services should be provided by a practitioner with appropriate training, and in some cases, the necessary professional licenses.[8]
  8. Receipt of mental health treatment in the community may be impacted by the consumer’s insurance status or ability to pay out of pocket.[9] In Cook County, individuals are screened for Medicaid eligibility and offered assistance with the application for enrollment during the jail intake process.[10] For more information on facilitating access to publicly funded behavioral healthcare benefits for justice-involved individuals, see Critical Connections: Getting People Leaving Prison and Jail the Mental Health Care and Substance Use Treatment They Need.
  9. Illinois state law and federal law require that insurance plans provide equal coverage for behavioral health and physical health benefits; under the Affordable Care Act, mental health and substance use disorder treatment are categorized as essential health benefits, which requires at least a minimum level of coverage in these areas for many employer-sponsored plans.[11] For more information, see Mental Health and Addiction Parity in Illinois.
  10. If an individual is receiving mental health treatment in the community, involvement with the criminal justice system has the potential to interrupt receipt of care, with possible negative effects.[12]
  11. Strict criteria for voluntary or involuntary psychiatric hospitalization may lead to arrests or revocations of supervision with the intention of providing access to treatment.[13]
  12. Any change (or lack of change) in future outcomes due to treatment is dependent in part on the quality of mental health treatment services received, which is often beyond the control of the justice system.[14]
  13. Involvement with the criminal justice system as well as having an MHD can cause an individual to feel stigmatized, which can impact their willingness to seek services, including mental health treatment.[15]
  14. Participants may view treatment mandated by the criminal justice system as coercive, which has the potential to impact the effectiveness of the treatment.[16]
  15. Studies should control for a participant’s level of risk for recidivism when evaluating interventions.[17]
  16. Individuals with co-occurring disorders can also benefit from EBPs for substance use disorders. For more information, see Reducing Substance Use Disorders and Related Offending: A Continuum of Evidence-Informed Practices in the Criminal Justice System.
  17. Community-based providers tend to employ more evidence-based practices compared to practices used in institutional settings.[18]
  18. Improvements in technology have increased the use of “telemedicine” which allows mental health professionals to provide treatment remotely; this practice has been beneficial in increasing access to mental health treatment for individuals in correctional facilities, while eliminating some issues that arise from either transporting individuals or bringing mental health professionals into secure facilities for consultation.[19] In some departments, law enforcement officers are also able to consult with mental health professionals regarding crisis incidents while in the field.[20]
  19. Information about an individual’s mental health may be subject to the protections of HIPAA and should be treated with all necessary protections to confidentiality.[21] For more information, see Information Sharing in Criminal Justice-Mental Health Collaborations: Working with HIPAA and Other Privacy Laws.[22]
  20. The Substance Abuse and Mental Health Services Administration’s working definition of recovery from MHDs is “a process of change through which individuals improve their health and wellness, live a self-directed life, and strive to reach their full potential.”[23] Recovery support can be offered through long-term services that aim to promote improved individual functioning and reductions in symptoms through ongoing treatment and community-based programming.[24]

Additional Resources

Principles of Community-based Behavioral Health Services for Justice-involved Individiuals: A Research-based Guide

Sheriffs Addressing the Mental Health Crisis in the Community and in the Jails

References

  1. Cross, B. (2011). Mental health courts effectiveness in reducing recidivism and improving clinical outcomes: A meta-analysis (Doctoral disseration). Retrieved from University of South Florida, Graduate School Theses and Dissertations.http://scholarcommons.usf.edu/cgi/viewcontent.cgi?article=4247&context=etd

  2. American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). Arlington, VA: Author.

  3. Bonta, J., Law, M., & Hanson, K. (1998). The prediction of criminal and violent recidivism among mentally disordered offenders: a meta-analysis. Psychological Bulletin, 123(2), 123.; Epperson, M. W., Wolff, N., Morgan, R. D., Fisher, W. H., Frueh, B. C., & Huening, J. (2014). Envisioning the next generation of behavioral health and criminal justice interventions. International Journal of Law and Psychiatry, 37(5), 427-438.

  4. Rotter, M., & Carr, A. (2013). Reducing criminal recidivism for justice-involved persons with mental illness: Risk/needs/responsivity and cognitive-behavioral interventions. Delmar, NY: SAMHSA’s GAINS Center for Behavioral Health and Justice Transformation. Retrieved from http://forensiccounselor.org/images/file/ReduceCrimRecidMIRiskNeedsResponCogBehavInter.pdf; Osher, F. C., & Steadman, H. J. (2007). Adapting evidence-based practices for persons with mental illness involved with the criminal justice system. Psychiatric Services, 58(11), 1472-1478.

  5. DeMatteo, D., LaDuke, C., Locklair, B. R., & Heilbrun, K. (2013). Community-based alternatives for justice-involved individuals with severe mental illness: Diversion, problem-solving courts, and reentry. Journal of Criminal Justice, 41(2), 64-71.; Osher, F. C., D’Amora, D. A., Plotkin, M., Jarrett, N., & Eggleston, A. (2012). Adults with behavioral health needs under correctional supervision: A shared framework for reducing recidivism and promoting recovery. New York, NY: Council of State Governments Justice Center. Retrieved from https://www.ncjrs.gov/App/Publications/abstract.aspx?ID=261662; Skeem, J. L., Manchak, S., & Peterson, J. K. (2011). Correctional policy for offenders with mental illness: Creating a new paradigm for recidivism reduction. Law and Human Behavior, 35(2), 110-126.

  6. Epperson, M. W., Wolff, N., Morgan, R. D., Fisher, W. H., Frueh, B. C., & Huening, J. (2014). Envisioning the next generation of behavioral health and criminal justice interventions. International Journal of Law and Psychiatry, 37(5), 427-438.

  7. Lamberti, J. S. (2016). Preventing criminal recidivism through mental health and criminal justice collaboration. Psychiatric Services, 67(11), 1206-1212.; Council of State Governments. (2002). Criminal justice/mental health consensus project. New York, NY: Author. Retrieved from https://csgjusticecenter.org/wp-content/uploads/2013/03/consensus-project-full-report.pdf

  8. Lurigio, A. J., & Swartz, J. A. (2000). Changing the contours of the criminal justice system to meet the needs of persons with serious mental illness. In J. Horney (Ed.) Criminal justice 2000 (Vol. 3) policies, processes, and decisions of the criminal justice system (pp. 45-108). Washington, D.C.: U.S. Department of Justice, National Institute of Justice.; Mental Health America. (n.d.) Types of mental health professionals. Retrieved from http://www.mentalhealthamerica.net/types-mental-health-professionals

  9. Boutwell, A. E., & Freedman, J. (2014). Coverage expansion and the criminal justice–involved population: Implications for plans and service connectivity. Health Affairs, 33(3), 482-486.; Slate, R. N., & Usher, L. (2014). Health coverage for people in the justice system: The potential impact of Obamacare. Federal Probation, 78, 19.; Winkelman, T. N., Kieffer, E. C., Goold, S. D., Morenoff, J. D., Cross, K., & Ayanian, J. Z. (2016). Health insurance trends and access to behavioral healthcare among justice-involved individuals—United States, 2008–2014. Journal of General Internal Medicine, 31(12), 1523-1529.

  10. National Association of Counties. (2015). Addressing mental illness and medical conditions in county jails. NACo Why Counties Matter Series. Washington, DC: Author. Retrieved from https://www.naco.org/sites/default/files/documents/09.16.15_Cook County - Healthcare and Jails Case Study.pdf

  11. The Kennedy Forum Illinois. (2015). Mental health and addiction parity in Illinois. Chicago, IL: Author. Retrieved from http://thekennedyforumillinois.org/wp-content/uploads/2015/12/Summary-of-HB-1-Parity-Provisions.pdf

  12. Heilbrun, K., DeMatteo, D., Brooks-Holliday, S., & Griffin, P.A. (2015). Intercept 2: Initial detention and initial hearings. In P.A. Griffin, K. Heilbrun, E.P. Mulvey, D. DeMatteo, & C.A. Schubert (Eds.). The sequential intercept model and criminal justice: Promoting community alternatives for individuals with serious mental illness (pp. 57-77). USA: Oxford University Press.

  13. Skeem, J. L., Manchak, S., & Peterson, J. K. (2011). Correctional policy for offenders with mental illness: Creating a new paradigm for recidivism reduction. Law and Human Behavior, 35(2), 110-126.; Solomon, P., Draine, J., & Marcus, S. C. (2002). Predicting incarceration of clients of a psychiatric probation and parole service. Psychiatric Services, 53(1), 50-56.

  14. Skeem, J. L., Manchak, S., & Peterson, J. K. (2011). Correctional policy for offenders with mental illness: Creating a new paradigm for recidivism reduction. Law and Human Behavior, 35(2), 110-126.

  15. Lamb, H. R., Weinberger, L. E., & Gross, B. H. (2004). Mentally ill persons in the criminal justice system: Some perspectives. Psychiatric Quarterly, 75(2), 107-126.; Lamb, H. R., & Weinberger, L. E. (1998). Persons with severe mental illness in jails and prisons: A review. Psychiatric Services, 49(4), 483-492.; Phan, S. V. (2012). Mental illness and the criminal justice system: Where are we now?. Mental Health Clinician, 1(8), 180-181.

  16. Osher, F. C., & Steadman, H. J. (2007). Adapting evidence-based practices for persons with mental illness involved with the criminal justice system. Psychiatric Services, 58(11), 1472-1478.

  17. Blandford, A. & Osher, F. (2012). A checklist for implementing evidence-based practices and programs (EBPs) for justice-involved adults with behavioral health disorders. Delmar, NY: SAMHSA’s GAINS Center for Behavioral Health and Justice Transformation.

  18. Friedmann, P. D., Taxman, F. S., & Henderson, C. E. (2007). Evidence-based treatment practices for drug-involved adults in the criminal justice system. Journal of Substance Abuse Treatment, 32(3), 267-277.

  19. Morgan, R. D., Patrick, A. R., & Magaletta, P. R. (2008). Does the use of telemental health alter the treatment experience? Inmates' perceptions of telemental health versus face-to-face treatment modalities. Journal of Consulting and Clinical Psychology, 76(1), 158.; Kip, H., Bouman, Y. H., Kelders, S. M., & van Gemert-Pijnen, L. J. (2018). eHealth in treatment of offenders in forensic mental health: A review of the current state. Frontiers in Psychiatry, 9, 42.

  20. Gatens, A. (2018). Law enforcement response to mental health crisis incidents: A survey of Illinois police and sheriff’s departments. Chicago, IL: Illinois Criminal Justice Information Authority.

  21. Coffey, R. M., Buck, J. A., Kassed, C. A., Dilonardo, J., Forhan, C., Marder, W. D., & Vandivort-Warren, R. (2008). Transforming mental health and substance abuse data systems in the United States. Psychiatric Services, 59(11), 1257-1263.; Petrila, J. (2007). Dispelling the myths about information sharing between the mental health and criminal justice systems. CMHS National GAINS Center for Systemic Change for Justice-Involved People with Mental Illness. Tampa, FL: Department of Mental Health Law & Policy, University of South Florida.

  22. Petrila, J., & Fader-Towe, H. (2010). Information sharing in criminal justice-mental health collaborations: Working with HIPAA and other privacy laws. New York, NY: Council of State Governments Justice Center.

  23. Substance Abuse and Mental Health Services Administration. (2012). SAMHSA’s working definition of recovery. Rockville, MD: Author. Retrieved from https://store.samhsa.gov/product/SAMHSA-s-Working-Definition-of-Recovery/PEP12-RECDEF

  24. Osher, F. C., D’Amora, D. A., Plotkin, M., Jarrett, N., & Eggleston, A. (2012). Adults with behavioral health needs under correctional supervision: A shared framework for reducing recidivism and promoting recovery. New York, NY: Council of State Governments Justice Center. Retrieved from https://www.ncjrs.gov/App/Publications/abstract.aspx?ID=261662; Substance Abuse and Mental Health Services Administration. (2018). Recovery and recovery support. Rockville, MD: Author. Retrieved from https://www.samhsa.gov/recovery.

Intercept 1: Pre-arrest: Law Enforcement and Emergency Services

Police officers are often called on to respond to incidents in which an individual is experiencing a mental health crisis. Many police departments have developed specialized responses for the incidents to divert individuals away from the criminal justice system and connect them to mental health treatment. Two common specialized response models are:

  • The crisis intervention team (CIT) model involves specialized training for officers and partnerships with mental health service providers in the community.
  • The co-responder model utilizes mental health professionals in the field with officers to assist in de-escalating crisis situations and facilitate access to treatment.[1]

Departments may incorporate mental health services in other ways for crisis incidents. However, empirical research is limited outside of the CIT and co-responder models.[2]

Goals:

  • Reduce unnecessary involvement with the criminal justice system.[3]
  • Increase access to mental health treatment.[4]
  • Reduce injuries to individuals in crisis.[5]
  • Reduce injuries to officers.[6]
  • More efficient disposition of mental health calls for service.[7]

Eligibility:

Officers have significant discretion when determining the disposition of a call for service, and eligibility for pre-arrest diversion following a mental health crisis incident is also often dependent on officer discretion.[8] Examples of eligibility criteria for pre-arrest diversion include:

  • Exhibiting psychiatric symptoms.
  • Nonviolent alleged offense.[9]

Note: Emergency communications personnel should be trained to identify calls for service related to individuals experiencing a mental health crisis and trained to dispatch a CIT officer or a co-responder team.[10]

Research Evidence:

Despite widespread adoption of the CIT model in police departments across the country, there is a dearth of rigorous research evaluating these programs. CIT can be considered evidence-based with respect to the outcome of improved officer knowledge and attitudes toward individuals with MHDs.[11] More research is required before CIT can be considered evidence-based in achieving other outcomes. Research findings related to CIT outcomes include the following:

  • CIT-trained officers have greater knowledge of MHDs and more positive attitudes toward individuals with MHDs.[12]
  • Officers with CIT training are more likely to facilitate access to mental health treatment and services.[13]
  • There is no evidence to suggest CIT officers are less likely to arrest individuals with MHDs.[14]
  • At least one study suggests CIT-trained officers are less likely to use force in response to mental health crisis incidents.[15]
  • There is no evidence to suggest individuals receiving a specialized response are less likely to reoffend.[16]

The Washington State Institute for Public Policy (WSIPP) examines programs to analyze the ratio of benefits to costs in monetary values. After examining pre-arrest diversion programs that follow the CIT model, WSIPP reported that the benefit-to-cost ratio was a loss of $2.94 for every $1 spent.[17] The group also noted that there was only a 1-percent chance that this type of program would produce benefits greater than the total cost.[18]

Co-responder programs have been less frequently researched; however, emerging evidence suggests that this model has potential to be effective in achieving the desired outcomes of pre-arrest diversion for individuals experiencing a mental health crisis. A review of co-responder programs found the model to be successful in:

  • Connecting individuals in crisis with community mental health services.
  • Reducing police department resources expended on mental health crisis incidents.[19]

There is a small amount of evidence regarding the co-responder model’s impact on other outcomes, showing:

  • Police attitudes toward individuals with MHDs improved.[20]
  • The number of individuals admitted to mental health facilities decreased.[21]
  • More positive perceptions were created of both the police response and the mental health system for officers and consumers alike.[22]

Examples in the Field:

Police departments across the nation are adopting the CIT program model at a fast pace.[23] Programs that have been evaluated thoroughly include:

While co-responder programs are less common, well-established programs include:

Additional Resources:

Police-Mental Health Collaboration Toolkit: Bureau of Justice Assistance, U.S. Department of Justice & Council of State Governments

Police-Mental Health Collaborations - A Framework for Implementing Effective Law Enforcement Responses for People Who Have Mental Health Needs: Bureau of Justice Assistance, U.S. Department of Justice & Council of State Governments

References

  1. Gatens, A. (2018). Responding to individuals experiencing mental health crises: Police-involved programs. Chicago, IL: Illinois Criminal Justice Information Authority.

  2. Gatens, A. (2018). Responding to individuals experiencing mental health crises: Police-involved programs. Chicago, IL: Illinois Criminal Justice Information Authority.

  3. Canada, K. E., Angell, B., & Watson, A. C. (2010). Crisis intervention teams in Chicago: Successes on the ground. Journal of Police Crisis Negotiations, 10(1-2), 86-100.; Cross, A. B., Mulvey, E. P., Schubert, C. A., Griffin, P. A., Filone, S., Winckworth-Prejsnar, K., …, & Heilbrun, K. (2014). An agenda for advancing research on crisis intervention teams for mental health emergencies. Psychiatric Services, 65(4), 530-536.

  4. Canada, K. E., Angell, B., & Watson, A. C. (2010). Crisis intervention teams in Chicago: Successes on the ground. Journal of Police Crisis Negotiations, 10(1-2), 86-100.; Cross, A. B., Mulvey, E. P., Schubert, C. A., Griffin, P. A., Filone, S., Winckworth-Prejsnar, K., …, & Heilbrun, K. (2014). An agenda for advancing research on crisis intervention teams for mental health emergencies. Psychiatric Services, 65(4), 530-536.

  5. Canada, K. E., Angell, B., & Watson, A. C. (2010). Crisis intervention teams in Chicago: Successes on the ground. Journal of Police Crisis Negotiations, 10(1-2), 86-100.; Cross, A. B., Mulvey, E. P., Schubert, C. A., Griffin, P. A., Filone, S., Winckworth-Prejsnar, K., …, & Heilbrun, K. (2014). An agenda for advancing research on crisis intervention teams for mental health emergencies. Psychiatric Services, 65(4), 530-536.

  6. Canada, K. E., Angell, B., & Watson, A. C. (2010). Crisis intervention teams in Chicago: Successes on the ground. Journal of Police Crisis Negotiations, 10(1-2), 86-100.; Cross, A. B., Mulvey, E. P., Schubert, C. A., Griffin, P. A., Filone, S., Winckworth-Prejsnar, K., …, & Heilbrun, K. (2014). An agenda for advancing research on crisis intervention teams for mental health emergencies. Psychiatric Services, 65(4), 530-536.

  7. Canada, K. E., Angell, B., & Watson, A. C. (2010). Crisis intervention teams in Chicago: Successes on the ground. Journal of Police Crisis Negotiations, 10(1-2), 86-100.; Cross, A. B., Mulvey, E. P., Schubert, C. A., Griffin, P. A., Filone, S., Winckworth-Prejsnar, K., …, & Heilbrun, K. (2014). An agenda for advancing research on crisis intervention teams for mental health emergencies. Psychiatric Services, 65(4), 530-536.

  8. Munetz, M. R., & Griffin, P. A. (2006). Use of the sequential intercept model as an approach to decriminalization of people with serious mental illness. Psychiatric Services, 57(4), 544-549.

  9. Broner, N., Lattimore, P. K., Cowell, A. J., & Schlenger, W. E. (2004). Effects of diversion on adults with co‐occurring mental illness and substance use: Outcomes from a national multi‐site study. Behavioral Sciences & the Law, 22(4), 519-541.

  10. Dupont, R., Cochran, S., & Pillsbury, S. (2007). Crisis intervention team core elements. Memphis, TN: University of Memphis.

  11. Watson, A. C., Compton, M. T., & Draine, J. N. (2017). The crisis intervention team (CIT) model: An evidence‐based policing practice?. Behavioral Sciences & the Law, 35(5-6), 431-441.

  12. Compton, M. T., Esterberg, M. L., McGee, R., Kotwicki, R. J., & Oliva, J. R. (2006). Crisis intervention team training: Changes in knowledge, attitudes, and stigma related to schizophrenia. Psychiatric Services, 57(8), 1199-1202.; Ellis, H. A. (2014). Effects of a Crisis Intervention Team (CIT) training program upon police officers before and after Crisis Intervention Team training. Archives of Psychiatric Nursing, 28, 10–16. doi:10.1016/j.apnu.2013.10.003

  13. Steadman, H. J., Deane, M. W., Borum, R., & Morrissey, J. P. (2000). Comparing outcomes of major models of police responses to mental health emergencies. Psychiatric Services, 51(5), 645-649.

  14. Watson, A. C., Ottati, V. C., Morabito, M., Draine, J., Kerr, A. N., & Angell, B. (2010). Outcomes of police contacts with persons with mental illness: The impact of CIT. Administration and Policy in Mental Health and Mental Health Services Research, 37(4), 302-317.

  15. Bower, D. L., & Pettit, W. (2001). The Albuquerque police department’s crisis intervention team: A report card. FBI Law Enforcement Bulletin, 70, 1.

  16. Cowell, A. J., Broner, N., & Dupont, R. (2004). The cost-effectiveness of criminal justice diversion programs for people with serious mental illness co-occurring with substance abuse: Four case studies. Journal of Contemporary Criminal Justice, 20(3), 292-314.

  17. Washington State Institute for Public Policy. (2017). Police diversion for individuals with mental illness (pre-arrest). Benefit-cost results. Retrieved from http://www.wsipp.wa.gov/BenefitCost/Program/738

  18. Washington State Institute for Public Policy. (2017). Police diversion for individuals with mental illness (pre-arrest). Benefit-cost results. Retrieved from http://www.wsipp.wa.gov/BenefitCost/Program/738

  19. Shapiro, G. K., Cusi, A., Kirst, M., O’Campo, P., Nakhost, A., & Stergiopoulos, V. (2015). Co-responding police-mental health programs: a review. Administration and Policy in Mental Health and Mental Health Services Research, 42(5), 606-620.

  20. Shapiro, G. K., Cusi, A., Kirst, M., O’Campo, P., Nakhost, A., & Stergiopoulos, V. (2015). Co-responding police-mental health programs: a review. Administration and Policy in Mental Health and Mental Health Services Research, 42(5), 606-620.

  21. Puntis, S., Perfect, D., Kirubarajan, A., Bolton, S., Davies, F., Hayes, A., ... & Molodynski, A. (2018). A systematic review of co-responder models of police mental health ‘street’ triage. BMC Psychiatry, 18(1), 256.

  22. Shapiro, G. K., Cusi, A., Kirst, M., O’Campo, P., Nakhost, A., & Stergiopoulos, V. (2015). Co-responding police-mental health programs: a review. Administration and Policy in Mental Health and Mental Health Services Research, 42(5), 606-620.

  23. Cross, A. B., Mulvey, E. P., Schubert, C. A., Griffin, P. A., Filone, S., Winckworth-Prejsnar, K., …, & Heilbrun, K. (2014). An agenda for advancing research on crisis intervention teams for mental health emergencies. Psychiatric Services, 65(4), 530-536.

  24. Shapiro, G. K., Cusi, A., Kirst, M., O’Campo, P., Nakhost, A., & Stergiopoulos, V. (2015). Co-responding police-mental health programs: a review. Administration and Policy in Mental Health and Mental Health Services Research, 42(5), 606-620.

Intercept 2: Post-arrest: Initial Detention and Initial Hearings

Individuals with mental health disorders (MHDs) are less likely to be able to afford monetary bail, and more likely to remain in custody for longer periods of time if not diverted.[1] In addition to negative consequences that all individuals face due to time spent in jail, such as disruption to routine and potential loss of employment or housing, even a short jail stay can be detrimental to an individual with a mental health condition if mental health treatment or access to medication is interrupted.[2]

Following arrest, defendants with MHDs may be eligible for diversion from standard criminal justice processing and linked to mental health treatment in the community. Typically, a prosecutor or judge must give approval to pursue a diversion option. Diversion to treatment may be in lieu of prosecution or incarceration. Participation is usually voluntary.[3] The specific characteristics of a post-arrest diversion model can be adapted to the needs and resources of the implementing jurisdiction. For example, diversion programs can be administered through the court system or through the jail. Jail-based diversion is typically carried out by pretrial services staff or specialized jail staff, whereas court-based diversion often employs a mental health professional.[4]

While there may be some variation in court system and jail-based program implementation, post-arrest diversion is generally characterized by three main components:[5]

  • Screening of all individuals detained in jail to identify possible MHDs. The Brief Jail Mental Health Screen is a validated screening tool developed by Policy Research Associates, Inc., and is available at no cost.[6] The screening can be completed by jail staff at intake and qualifying individuals should be referred for further mental health assessment.
  • Assessment of an individual’s symptoms by mental health professionals during initial jail detention to provide a recommendation to the court.[7] Jurisdictions that do not employ mental health professionals at this stage may task pre-trial services or defense counsel with conducting a mental health assessment.[8]
  • Negotiation between criminal justice personnel and diversion staff (e.g. specialized jail staff or mental health professionals) to agree on a plan for community-based treatment and supervision.[9]

The screening and identification processes are most efficient when conducted in the first 24 to 72 hours following arrest. This reduces pre-trial detention time for those with MHDs and provides access to needed mental health treatment.[10] Some jurisdictions have created information sharing pathways from jails and courts to the local mental health system to streamline the eligibility determinations.[11] In Illinois, the Department of Human Services, Division of Mental Health operates the Jail Data Link System, which helps identify individuals involved in both the criminal justice and mental health systems.

Charges may be dismissed by the court upon successful completion of a mental health treatment plan (deferred prosecution).[12] Mental health treatment staff ensure the confidentiality of information about an individual’s MHD; they only provide information on what the treatment plan is and whether the individual has complied with their treatment plan.[13] If participants fail to comply with the conditions of diversion, the case may be returned to court for traditional criminal justice processing.[14]

Goals:

  • Increase access to mental health treatment.[15]
  • Reduce further involvement in the criminal justice system.[16]
  • Reduce use of pretrial detention and lessen jail overcrowding.[17]
  • Decrease costs to the criminal justice system.[18]

Eligibility:

Eligibility decisions for post-arrest diversion typically take into the account the circumstances and crime surrounding the individual’s arrest. Examples of different possible eligible offense types include:

  • Non-violent offense.
  • Low-level offense.
  • Offenses directly related to a mental health condition.[19]

A multi-site study of post-arrest diversion programs indicated no significant differences in outcomes between individuals arrested for a violent offense and those arrested for a non-violent offense.[20] This suggests diversion can be beneficial to individuals regardless of offense type.

Additionally, eligibility criteria may be based on the severity of mental health symptoms or type of diagnosis.[21] For example, a post-arrest diversion program in Florida examines the following factors when determining a defendant’s eligibility:

  • Severity of charges.
  • Criminal history.
  • Mental health history.[22]

Jurisdictions may be limited in offering post-arrest diversion to mental health treatment due to mandatory sentencing policies that do not allow for diversion options.[23] When diversion programs are limited to defendants facing very minor charges, potential participants may decline the opportunity for diversion because their sentences may be less burdensome than the requirements of a diversion program.[24] Some individuals may choose not to participate due to the fear that sharing their mental health information may negatively bias the court and sentencing.[25]

Research Evidence:

Studies typically compare the outcomes of those diverted to those who go through standard criminal justice processing. Researchers also use individuals reentering the community from incarceration as a control group for those who were diverted post-arrest.[26]

The findings of research on post-arrest diversion programs are mixed. Some research has shown post-arrest diversion programs may lead to:

  • Fewer days in jail.[27]
  • Reduced recidivism.[28]
  • More time in the community (e.g. not incarcerated or hospitalized in a psychiatric facility).[29]
  • More mental health treatment for those in need.[30]
  • Improvements in mental health symptoms/conditions.[31]

However, other research has shown potentially negative outcomes associated with post-arrest diversion, including increased use of emergency psychiatric services,[32] reduced likelihood of receiving mental health medication,[33] increased anxiety and psychiatric symptomology,[34] and no meaningful reductions in recidivism[35] or revocations of conditional release.[36]

The Washington State Institute for Public Policy review of potential costs and savings associated with post-arrest diversion suggests potential for a monetary benefit per participant ($734) and a 51 percent chance that the benefits of the program will exceed the overall costs.[37]

While potentially promising, these findings should be interpreted with caution due to the relatively small number of studies conducted and the wide variation in interventions employed by programs under the term “diversion.” Many positive outcomes may be more dependent on the treatment and services received, and less a result of the diversion event.[38]

Examples in the Field:

Additional Resources:

Effective Court Responses to Persons with Mental Disorders - National Center for State Courts (2018)

Improving Responses to People with Mental Illnesses at the Pretrial Stage: Essential Elements – Council for State Governments Justice Center (2015)

References

  1. Substance Abuse and Mental Health Services Administration. (2015). Municipal courts: An effective tool for diverting people with mental and substance use disorders from the criminal justice system. HHS Publication No. (SMA)-15-4929. Rockville, MD: Substance Abuse and Mental Health Services Administration.

  2. Substance Abuse and Mental Health Services Administration. (2015). Municipal courts: An effective tool for diverting people with mental and substance use disorders from the criminal justice system. HHS Publication No. (SMA)-15-4929. Rockville, MD: Substance Abuse and Mental Health Services Administration.

  3. Heilbrun, K., DeMatteo, D., Brooks-Holliday, S., & Griffin, P.A. (2015). Intercept 2: Initial detention and initial hearings. In P.A. Griffin, K. Heilbrun, E.P. Mulvey, D. DeMatteo, & C.A. Schubert (Eds.). The sequential intercept model and criminal justice: Promoting community alternatives for individuals with serious mental illness (pp. 57-77). USA: Oxford University Press.

  4. Sirotich, F. (2009). The criminal justice outcomes of jail diversion programs for persons with mental illness: a review of the evidence. Journal of the American Academy of Psychiatry and the Law Online, 37(4), 461-472.

  5. Steadman, H. J., Barbera, S. S., & Dennis, D. L. (1994). A national survey of jail diversion programs for mentally ill detainees. Psychiatric Services, 45(11), 1109-1113.

  6. Steadman, H. J., Scott, J. E., Osher, F., Agnese, T. K., & Robbins, P. C. (2005). Validation of the brief jail mental health screen. Psychiatric Services, 56(7), 816-822.

  7. Munetz, M. R., & Griffin, P. A. (2006). Use of the sequential intercept model as an approach to decriminalization of people with serious mental illness. Psychiatric Services, 57(4), 544-549.; DeMatteo, D., LaDuke, C., Locklair, B. R., & Heilbrun, K. (2013). Community-based alternatives for justice-involved individuals with severe mental illness: Diversion, problem-solving courts, and reentry. Journal of Criminal Justice, 41(2), 64-71.

  8. Substance Abuse and Mental Health Services Administration. (2015). Municipal courts: An effective tool for diverting people with mental and substance use disorders from the criminal justice system. HHS Publication No. (SMA)-15-4929. Rockville, MD: Substance Abuse and Mental Health Services Administration.

  9. Broner, N., Lattimore, P. K., Cowell, A. J., & Schlenger, W. E. (2004). Effects of diversion on adults with co‐occurring mental illness and substance use: Outcomes from a national multi‐site study. Behavioral Sciences & the Law, 22(4), 519-541.; Broner, N., Mayrl, D. W., & Landsberg, G. (2005). Outcomes of mandated and nonmandated New York City jail diversion for offenders with alcohol, drug, and mental disorders. The Prison Journal, 85(1), 18-49.

  10. Steadman, H. J., Morris, S. M., & Dennis, D. L. (1995). The diversion of mentally ill persons from jails to community-based services: A profile of programs. American Journal of Public Health, 85(12), 1630-1635.

  11. Note: In Arizona, this is a one-way path for information; information on individuals entering the mental health records system are not shared with jail officials.Raider, E., & Arthur, B. (1999). Using management information systems to locate people with serious mental illnesses and co-occurring substance abuse disorders in the criminal justice system for diversion: Maricopa County Data Link Project. Jail Suicide/Mental Health Update, 9(2), 6-9.

  12. Shafer, M. S., Arthur, B., & Franczak, M. J. (2004). An analysis of post‐booking jail diversion programming for persons with co‐occurring disorders. Behavioral Sciences and the Law, 22(6), 771-785.

  13. Frisman, L., Sturges, G. E., Baranoski, M. V., & Levinson, M. (2001). Connecticut’s criminal justice diversion program: A comprehensive community forensic mental health model. Community Mental Health Report, 3, 19-20, 25-26.

  14. Heilbrun, K., DeMatteo, D., Brooks-Holliday, S., & Griffin, P.A. (2015). Intercept 2: Initial detention and initial hearings. In P.A. Griffin, K. Heilbrun, E.P. Mulvey, D. DeMatteo, & C.A. Schubert (Eds.). The sequential intercept model and criminal justice: Promoting community alternatives for individuals with serious mental illness (pp. 57-77). USA: Oxford University Press.

  15. Perez, A., Leifman, S., & Estrada, A. (2003). Reversing the criminalization of mental illness. Crime & Delinquency, 49(1), 62-78.

  16. Sirotich, F. (2009). The criminal justice outcomes of jail diversion programs for persons with mental illness: a review of the evidence. Journal of the American Academy of Psychiatry and the Law Online, 37(4), 461-472.

  17. Heilbrun, K., DeMatteo, D., Brooks-Holliday, S., & Griffin, P.A. (2015). Intercept 2: Initial detention and initial hearings. In P.A. Griffin, K. Heilbrun, E.P. Mulvey, D. DeMatteo, & C.A. Schubert (Eds.). The sequential intercept model and criminal justice: Promoting community alternatives for individuals with serious mental illness (pp. 57-77). USA: Oxford University Press.

  18. Heilbrun, K., DeMatteo, D., Brooks-Holliday, S., & Griffin, P.A. (2015). Intercept 2: Initial detention and initial hearings. In P.A. Griffin, K. Heilbrun, E.P. Mulvey, D. DeMatteo, & C.A. Schubert (Eds.). The sequential intercept model and criminal justice: Promoting community alternatives for individuals with serious mental illness (pp. 57-77). USA: Oxford University Press.

  19. Munetz, M. R., & Griffin, P. A. (2006). Use of the sequential intercept model as an approach to decriminalization of people with serious mental illness. Psychiatric Services, 57(4), 544-549.

  20. Naples, M., & Steadman, H. J. (2003). Can persons with co-occurring disorders and violent charges be successfully diverted?. International Journal of Forensic Mental Health, 2(2), 137-143.

  21. Heilbrun, K., DeMatteo, D., Brooks-Holliday, S., & Griffin, P.A. (2015). Intercept 2: Initial detention and initial hearings. In P.A. Griffin, K. Heilbrun, E.P. Mulvey, D. DeMatteo, & C.A. Schubert (Eds.). The sequential intercept model and criminal justice: Promoting community alternatives for individuals with serious mental illness (pp. 57-77). USA: Oxford University Press.

  22. Perez, A., Leifman, S., & Estrada, A. (2003). Reversing the criminalization of mental illness. Crime & Delinquency, 49(1), 62-78.

  23. DeMatteo, D., LaDuke, C., Locklair, B. R., & Heilbrun, K. (2013). Community-based alternatives for justice-involved individuals with severe mental illness: Diversion, problem-solving courts, and reentry. Journal of Criminal Justice, 41(2), 64-71.

  24. Substance Abuse and Mental Health Services Administration. (2015). Municipal courts: An effective tool for diverting people with mental and substance use disorders from the criminal justice system. HHS Publication No. (SMA)-15-4929. Rockville, MD: Substance Abuse and Mental Health Services Administration.

  25. Substance Abuse and Mental Health Services Administration. (2015). Municipal courts: An effective tool for diverting people with mental and substance use disorders from the criminal justice system. HHS Publication No. (SMA)-15-4929. Rockville, MD: Substance Abuse and Mental Health Services Administration.

  26. Heilbrun, K., DeMatteo, D., Yasuhara, K., Brooks-Holliday, S., Shah, S., King, C., Dicarlo, A. B., Hamilton, D., & Laduke, C. (2012). Community-based alternatives for justice-involved individuals with severe mental illness: Review of the relevant research. Criminal Justice and Behavior, 39(4), 351-419.

  27. Hoff, R. A., Baranosky, M. V., Buchanan, J., Zonana, H., & Rosenheck, R. A. (1999). The effects of a jail diversion program on incarceration: A retrospective cohort study. Journal of the American Academy of Psychiatry and the Law Online, 27(3), 377-386.; Lamberti, J. S., Weisman, R. L., Schwarzkopf, S. B., Price, N., Ashton, R. M., & Trompeter, J. (2001). The mentally ill in jails and prisons: Towards an integrated model of prevention. Psychiatric Quarterly, 72(1), 63-77.

  28. Swanson, R. M., Ghokar, R., & Tolle, L. W. (2011). Arapahoe county diverts the mentally ill to treatment (ADMIT): A program evaluation. Corrections & Mental Health: An Update of the National Institute of Corrections, 1, 1-16.

  29. Broner, N., Mayrl, D. W., & Landsberg, G. (2005). Outcomes of mandated and nonmandated New York City jail diversion for offenders with alcohol, drug, and mental disorders. The Prison Journal, 85(1), 18-49.; Lamberti, J. S., Weisman, R. L., Schwarzkopf, S. B., Price, N., Ashton, R. M., & Trompeter, J. (2001). The mentally ill in jails and prisons: Towards an integrated model of prevention. Psychiatric Quarterly, 72(1), 63-77.

  30. Steadman, H. J., & Naples, M. (2005). Assessing the effectiveness of jail diversion programs for persons with serious mental illness and co‐occurring substance use disorders. Behavioral Sciences & the Law, 23(2), 163-170.

  31. Shafer, M. S., Arthur, B., & Franczak, M. J. (2004). An analysis of post‐booking jail diversion programming for persons with co‐occurring disorders. Behavioral Sciences & the Law, 22(6), 771-785.

  32. Shafer, M. S., Arthur, B., & Franczak, M. J. (2004). An analysis of post‐booking jail diversion programming for persons with co‐occurring disorders. Behavioral Sciences & the Law, 22(6), 771-785.; Steadman, H. J., & Naples, M. (2005). Assessing the effectiveness of jail diversion programs for persons with serious mental illness and co‐occurring substance use disorders. Behavioral Sciences & the Law, 23(2), 163-170.

  33. Broner, N., Lattimore, P. K., Cowell, A. J., & Schlenger, W. E. (2004). Effects of diversion on adults with co‐occurring mental illness and substance use: Outcomes from a national multi‐site study. Behavioral Sciences & the Law, 22(4), 519-541.

  34. Broner, N., Lattimore, P. K., Cowell, A. J., & Schlenger, W. E. (2004). Effects of diversion on adults with co‐occurring mental illness and substance use: Outcomes from a national multi‐site study. Behavioral Sciences & the Law, 22(4), 519-541.

  35. Sirotich, F. (2009). The criminal justice outcomes of jail diversion programs for persons with mental illness: a review of the evidence. Journal of the American Academy of Psychiatry and the Law Online, 37(4), 461-472.

  36. Bertman‐Pate, L. J., Burnett, D. M., Thompson, J. W., Calhoun, C. J., Deland, S., & Fryou, R. M. (2004). The New Orleans Forensic Aftercare Clinic: A seven year review of hospital discharged and jail diverted clients. Behavioral Sciences & the Law, 22(1), 159-169.

  37. Washington State Institute for Public Policy. (2017). Jail diversion for individuals with mental illness (post-arrest). Benefit-Cost Results. Retrieved from http://www.wsipp.wa.gov/BenefitCost/Program/498

  38. Broner, N., Lattimore, P. K., Cowell, A. J., & Schlenger, W. E. (2004). Effects of diversion on adults with co‐occurring mental illness and substance use: Outcomes from a national multi‐site study. Behavioral Sciences & the Law, 22(4), 519-541.

Intercept 3: Jail and Courts: Adult Mental Health Court

Mental health courts are problem-solving courts that provide alternative sanctions aimed at reducing behaviors that may lead to incarceration.[1] According to the Center for Court Innovation, problem-solving courts feature three core characteristics. They:

  1. Identify and address the underlying cause(s) of criminality for specific groups.
  2. Collaborate with members of the justice system, as well as members of the community.
  3. Offer accountability to increase compliance from court participants; ensure service providers offer necessary treatment; and require the court to monitor operations and outcomes.[2]

In mental health courts, individuals with mental health disorders (MHDs) are diverted from jail or prison and receive community-based treatment. Participants are required to comply with court conditions, with adherence monitored by a criminal justice agency and/or a mental health agency.[3] The first mental health court was established in Broward County, Fla., in 1997[4] and an estimated 350 mental health courts are now operating in the United States.[5]

Jail personnel, defense attorneys, and direct service providers typically make referrals to mental health court upon determination of eligibility via screenings and assessments.[6] The court proceedings of mental health courts are less adversarial than traditional criminal courts, with a greater focus on participant rehabilitation.[7] Many mental health courts promote a team approach in which the defense counsel, prosecutors, judges, and mental health service case managers work together to achieve successful participant outcomes.[8] However, critics argue that the less formal nature of proceedings may be detrimental to the defendant’s constitutional right to due process.[9]

Mental health courts can be offered either pre- or post-adjudication.

  • Pre-adjudication model. Upon successful completion of a mental health court program, initial charges may be dropped or reduced or the conviction may be vacated.[10]
  • Post-adjudication model. With this program model, the court may require a guilty plea and defer or suspend the sentence.[11] In addition, participation is a condition of probation.[12]

Failure to complete mental health court requirements may result in a variety of sanctions (e.g. more intense supervision, incarceration). Requiring a guilty plea in exchange for release from detention may be considered coercive.[13] There are mixed findings on the association between participants’ perception of coercion and the efficacy of mental health treatment mandated by the criminal justice system, including mental health courts.[14]

Individuals with more severe charges and/or lengthy criminal histories may be required to participate in mental health court for a longer duration.[15] Frequency of contact between the court and participants is often determined by court docket size and court resources.[16] Mental health court administrators should consider mental health treatment service capacity as they manage court caseloads.[17]

Goals:

Goals of mental health courts are to:

  • Reduce contact of individuals with MHDs and the justice system.
  • Connect individuals with MHDs to mental health treatment services.
  • Reduce recidivism of individuals with MHDs.[18]

Eligibility:

Mental health courts target offenders with MHDs, but additional eligibility criteria vary across jurisdictions.[19]

Eligibility criteria for mental health courts may include:

  • History of an MHD or mental health treatment, apparent mental health symptoms while in custody, or formal assessment with a diagnostic screening tool.[20]
  • Charges of a nonviolent misdemeanor; however, more courts are allowing participation by those who commit felonies or more serious types of crime.[21]
  • Voluntary participation in the court.[22]

Research Evidence:

Mental health courts are considered a promising practice, with additional rigorous research needed for the concept to be considered evidence-based.[23] Participation in mental health court may:

  • Reduce recidivism.[24] Individual studies have found mental health court participants:
    • Have fewer rearrests than those who receive “treatment as usual.”[25]
    • Spend more time in the community before receiving any new charges.[26]
    • Spend fewer days in jail than the control groups.[27]
    • Have a reduced risk of perpetrating violence in the year after participation.[28]
  • Increase access to mental health treatment. Research has found mental health court participants have:
    • Increased engagement with mental health treatment services.[29]
    • Fewer uses of crisis or emergency services, or costlier in-patient treatment services than a comparison group.[30]
    • Decreased symptoms of psychological distress.[31]

However, there are mixed findings on the results of the increased access to mental health treatment through mental health court participation. Some studies have found that mental health court participation is not associated with a reduction in clinical mental health symptoms;[32] this may be due to the quality of treatment services received, which is often beyond the control of the mental health court.[33] Further, a multi-site study of mental health courts did not find a significant relationship between receipt of treatment services and subsequent rearrests.[34]

A significant amount of research is available on process outcomes and administration of mental health courts. Researchers reported an average mental health court graduation rate of 52 percent.[35] Factors found to be associated with a failure to complete a mental health court program include:

  • Prior criminal behavior.
  • Multiple diagnoses.
  • Co-occurring substance use disorders.[36]

Conversely, factors that were associated with greater likelihood of court program completion included being prescribed psychiatric medication and receiving disability benefits.[37] Consistent findings on the impact of race and gender on mental health court completion are not available.[38]

There are mixed findings regarding the costs and savings associated with mental health courts. The Washington State Institute for Public Policy found mental health courts were associated with $5.62 in benefits for every dollar spent per participant and a 96 percent chance the benefits will exceed the costs of the program.[39] In contrast, a quasi-experimental multi-site study found mental health courts were costlier per participant than standard criminal justice processing of a matched comparison group of individuals who received mental health services in jail.[40] During court participation, there were slight savings in criminal justice costs for mental health court participants; however, three years after court participation, the increased cost of treatment eclipsed any funds saved.[41] Still other research demonstrated mental health courts offered cost savings after 18 months[42] and 24 months.[43]

When surveyed, 91 percent of participants in two mental health courts reported participation to be beneficial.[44] Researchers found that participants in mental health courts reported low levels of perceived coercion and felt high levels of respect, fairness, and freedom to express opinions, compared to individuals with mental health disorders in standard criminal justice processing.[45] An increased perception of procedural justice was associated with a decrease in symptoms during participation in the court.[46] However, one study found 27 percent of participants had clinically significant impairments which may call into question their legal competence or ability to fully comprehend the court’s processes and requirements.[47]

Examples in the Field:

Broward County Mental Health Court: Broward County, Fla.

Felony and Misdemeanor Jail Diversion Courts: Dallas County, Texas

San Francisco Behavioral Health Court : San Francisco, Calif.

Additional Resources:

Improving Responses to People with Mental Illnesses: The Essential Elements of a Mental Health Court – Bureau of Justice Assistance & Council of State Governments Justice Center

References

  1. Hughes, E., & Reichert, J. (2017). An overview of problem-solving courts and implications for practice. Chicago, IL: Illinois Criminal Justice Information Authority.

  2. Porter, R., Rempel, M., & Mansky, A. (2010). What makes a court problem-solving? Universal performance indicators for problem-solving justice. New York, NY: Center for Court Innovation.

  3. Thompson, M., Osher, F., & Tomasini-Joshi, D. (2008). Improving responses to people with mental illnesses: The essential elements of a mental health court. New York: Council of State Governments Justice Center Criminal Justice/Mental Health Consensus Project. Retrieved from https://csgjusticecenter.org/wp-content/uploads/2012/12/mhc-essential-elements.pdf

  4. Callahan, L., Steadman, H. J., Tillman, S., & Vesselinov, R. (2013). A multi-site study of the use of sanctions and incentives in mental health courts. Law and Human Behavior, 37(1), 1.

  5. Steadman, H. J., Callahan, L., Robbins, P. C., Vesselinov, R., McGuire, T. G., & Morrissey, J. P. (2014). Criminal justice and behavioral health care costs of mental health court participants: A six-year study. Psychiatric Services, 65(9), 1100-1104.

  6. Steadman, H. J., Redlich, A., Callahan, L., Robbins, P. C., & Vesselinov, R. (2011). Effect of mental health courts on arrests and jail days: A multisite study. Archives of General Psychiatry, 68(2), 167-172.

  7. Liu, S. & Redlich, A. D. (2015). Intercept 3: Jails and courts. In P.A. Griffin, K. Heilbrun, E.P. Mulvey, D. DeMatteo, & C.A. Schubert (Eds.). The sequential intercept model and criminal justice: Promoting community alternatives for individuals with serious mental illness (pp. 78-94). USA: Oxford University Press.

  8. Steadman, H. J., Davidson, S., & Brown, C. (2001). Mental health courts: Their promise and unanswered questions. Psychiatric Services, 52(4), 457-458.

  9. Note: The lack of procedural safeguards and the team approach of mental health courts may compromise the adversarial system employed in traditional courts, where defense and prosecution each make their case before an impartial judge. For more see Miller & Perelman (2009).Miller, S. L., & Perelman, A. M. (2009). Mental health courts: An overview and redefinition of tasks and goals. Law & Psychology Review, 33, 113.

  10. Liu, S. & Redlich, A. D. (2015). Intercept 3: Jails and courts. In P.A. Griffin, K. Heilbrun, E.P. Mulvey, D. DeMatteo, & C.A. Schubert (Eds.). The sequential intercept model and criminal justice: Promoting community alternatives for individuals with serious mental illness (pp. 78-94). USA: Oxford University Press.

  11. Griffin, P. A., Steadman, H. J., & Petrila, J. (2002). The use of criminal charges and sanctions in mental health courts. Psychiatric Services, 53(10), 1285-1289.

  12. Worwood, E.B., Sarver, C., Borgia, A. D., & Butters, R. P. (2015). Statewide evaluation of Utah mental health courts: Phase I report. Salt Lake City, Utah: Utah Criminal Justice Center, University of Utah. Retrieved from https://socialwork.utah.edu/_documents/Statewide-UT-MHC-Study_Part-1-Report.pdf

  13. Redlich, A. D., Hoover, S., Summers, A., & Steadman, H. J. (2010). Enrollment in mental health courts: Voluntariness, knowingness, and adjudicative competence. Law and Human Behavior, 34(2), 91-104.

  14. Lidz, C. W. (1998). Coercion in psychiatric care: What have we learned from research?. Journal of the American Academy of Psychiatry and the Law Online, 26(4), 631-637.; Newton-Howes, G., & Mullen, R. (2011). Coercion in psychiatric care: Systematic review of correlates and themes. Psychiatric Services, 62(5), 465-470.; Kisely, S. R., Campbell, L. A., & Preston, N. J. (2005). Compulsory community and involuntary outpatient treatment for people with severe mental disorders. Cochrane Database of Systematic Reviews, (3 Article No: CD004408), 1-25.; Poythress, N. G., Petrila, J., McGaha, A., & Boothroyd, R. (2002). Perceived coercion and procedural justice in the Broward mental health court. International Journal of Law and Psychiatry, 25(5), 517-533.

  15. Redlich, A. D., Hoover, S., Summers, A., & Steadman, H. J. (2010). Enrollment in mental health courts: Voluntariness, knowingness, and adjudicative competence. Law and Human Behavior, 34(2), 91-104.

  16. Note: The authors found that status review hearing frequency was a result of limitations on court resources, as opposed to an optimal standard for frequency of meetings. For more see Griffin et al. (2002).Griffin, P. A., Steadman, H. J., & Petrila, J. (2002). The use of criminal charges and sanctions in mental health courts. Psychiatric Services, 53(10), 1285-1289.

  17. Steadman, H. J., Davidson, S., & Brown, C. (2001). Mental health courts: Their promise and unanswered questions. Psychiatric Services, 52(4), 457-458.

  18. Casey, P. M., & Rottman, D. B. (2005). Problem-solving courts: Models and trends. Justice System Journal, 26(1), 35-56.

  19. Worwood, E.B., Sarver, C., Borgia, A. D., & Butters, R. P. (2015). Statewide evaluation of Utah mental health courts: Phase I report. Salt Lake City, Utah: Utah Criminal Justice Center, University of Utah. Retrieved from https://socialwork.utah.edu/_documents/Statewide-UT-MHC-Study_Part-1-Report.pdf

  20. Poythress, N. G., Petrila, J., McGaha, A., & Boothroyd, R. (2002). Perceived coercion and procedural justice in the Broward mental health court. International Journal of Law and Psychiatry, 25(5), 517-533.

  21. Griffin, P. A., Steadman, H. J., & Petrila, J. (2002). The use of criminal charges and sanctions in mental health courts. Psychiatric Services, 53(10), 1285-1289.; Redlich, A. D., Steadman, H. J., Monahan, J., Petrila, J., & Griffin, P. A. (2005). The second generation of mental health courts. Psychology, Public Policy, and Law, 11(4), 527.

  22. Liu, S. & Redlich, A. D. (2015). Intercept 3: Jails and courts. In P. A. Griffin, K. Heilbrun, E. P. Mulvey, D. DeMatteo, & C. A. Schubert (Eds.). The sequential intercept model and criminal justice: Promoting community alternatives for individuals with serious mental illness (pp. 78-94). USA: Oxford University Press.

  23. Liu, S. & Redlich, A. D. (2015). Intercept 3: Jails and courts. In P. A. Griffin, K. Heilbrun, E. P. Mulvey, D. DeMatteo, & C. A. Schubert (Eds.). The sequential intercept model and criminal justice: Promoting community alternatives for individuals with serious mental illness (pp. 78-94). USA: Oxford University Press.; Office of Justice Programs. (n.d.) Adult mental health courts. Retrieved from https://www.crimesolutions.gov/PracticeDetails.aspx?ID=34

  24. Sarteschi, C. M., Vaughn, M. G., & Kim, K. (2011). Assessing the effectiveness of mental health courts: A quantitative review. Journal of Criminal Justice, 39(1), 12-20.; Honegger, L. N. (2015). Does the evidence support the case for mental health courts? A review of the literature. Law and Human Behavior, 39(5), 478.

  25. Dirks-Linhorst, P. A., & Linhorst, D. M. (2012). Recidivism outcomes for suburban mental health court defendants. American Journal of Criminal Justice, 37(1), 76-91.; Moore, M. E., & Hiday, V. A. (2006). Mental health court outcomes: A comparison of re-arrest and re-arrest severity between mental health court and traditional court participants. Law and Human Behavior, 30(6), 659-674.; Steadman, H. J., Redlich, A., Callahan, L., Robbins, P. C., & Vesselinov, R. (2011). Effect of mental health courts on arrests and jail days: A multisite study. Archives of General Psychiatry, 68(2), 167-172.; Trupin, E., & Richards, H. (2003). Seattle's mental health courts: Early indicators of effectiveness. International Journal of Law and Psychiatry, 26(1), 33-53.

  26. McNiel, D. E., & Binder, R. L. (2007). Effectiveness of a mental health court in reducing criminal recidivism and violence. American Journal of Psychiatry, 164(9), 1395-1403.

  27. Christy, A., Poythress, N. G., Boothroyd, R. A., Petrila, J., & Mehra, S. (2005). Evaluating the efficiency and community safety goals of the Broward County mental health court. Behavioral Sciences & the Law, 23(2), 227-243.; Frailing, K. (2010). How mental health courts function: Outcomes and observations. International Journal of Law and Psychiatry, 33(4), 207-213.

  28. McNiel, D. E., Sadeh, N., Delucchi, K. L., & Binder, R. L. (2015). Prospective study of violence risk reduction by a mental health court. Psychiatric Services, 66(6), 598-603.

  29. Keator, K. J., Callahan, L., Steadman, H. J., & Vesselinov, R. (2013). The impact of treatment on the public safety outcomes of mental health court participants. American Behavioral Scientist, 57(2), 231-243.

  30. Boothroyd, R. A., Poythress, N. G., McGaha, A., & Petrila, J. (2003). The Broward mental health court: Process, outcomes, and service utilization. International Journal of Law and Psychiatry, 26(1), 55-71.

  31. Note: This was measured using the BASIS-32 self-report scale.Cosden, M., Ellens, J., Schnell, J., & Yamini‐Diouf, Y. (2005). Efficacy of a mental health treatment court with assertive community treatment. Behavioral Sciences & the Law, 23(2), 199-214.

  32. Cross, B. (2011). Mental Health Courts Effectiveness in Reducing Recidivism and Improving Clinical Outcomes: A Meta-Analysis. University of South Florida, Graduate School Theses and Dissertations.http://scholarcommons.usf.edu/cgi/viewcontent.cgi?article=4247&context=etd

  33. Boothroyd, R. A., Mercado, C. C., Poythress, N. G., Christy, A., & Petrila, J. (2005). Clinical outcomes of defendants in mental health court. Psychiatric Services, 56(7), 829-834.;

  34. Keator, K. J., Callahan, L., Steadman, H. J., & Vesselinov, R. (2013). The impact of treatment on the public safety outcomes of mental health court participants. American Behavioral Scientist, 57(2), 231-243.

  35. Hiday, V. A., Ray, B., & Wales, H. W. (2014). Predictors of mental health court graduation. Psychology, Public Policy, and Law, 20(2), 191.; Redlich, A. D., Steadman, H. J., Callahan, L., Robbins, P. C., Vessilinov, R., & Özdoğru, A. A. (2010). The use of mental health court appearances in supervision. International Journal of Law and Psychiatry, 33(4), 272-277.

  36. Burns, P. J., Hiday, V. A., & Ray, B. (2013). Effectiveness 2 years postexit of a recently established mental health court. American Behavioral Scientist, 57(2), 189-208.; Ray, B., & Dollar, C. B. (2013). Examining mental health court completion: A focal concerns perspective. The Sociological Quarterly, 54(4), 647-669.; Dirks-Linhorst, P. A., Kondrat, D., Linhorst, D. M., & Morani, N. (2013). Factors associated with mental health court nonparticipation and negative termination. Justice Quarterly, 30(4), 681-710.; Worwood, E.B., Sarver, C., Borgia, A. D., & Butters, R. P. (2015). Statewide evaluation of Utah mental health courts: Phase I report. Salt Lake City, Utah: Utah Criminal Justice Center, University of Utah. Retrieved from https://socialwork.utah.edu/_documents/Statewide-UT-MHC-Study_Part-1-Report.pdf

  37. Sarteschi, C. M., & Vaughn, M. G. (2013). Recent developments in mental health courts: What have we learned?. Journal of Forensic Social Work, 3(1), 34-55.

  38. Hiday, V. A., Ray, B., & Wales, H. W. (2014). Predictors of mental health court graduation. Psychology, Public Policy, and Law, 20(2), 191.

  39. Washington State Institute for Public Policy. (2017). Mental Health Courts. Benefit-Cost Results. Retrieved from http://www.wsipp.wa.gov/BenefitCost/Program/52

  40. Steadman, H. J., Callahan, L., Robbins, P. C., Vesselinov, R., McGuire, T. G., & Morrissey, J. P. (2014). Criminal justice and behavioral health care costs of mental health court participants: A six-year study. Psychiatric Services, 65(9), 1100-1104.

  41. Steadman, H. J., Callahan, L., Robbins, P. C., Vesselinov, R., McGuire, T. G., & Morrissey, J. P. (2014). Criminal justice and behavioral health care costs of mental health court participants: A six-year study. Psychiatric Services, 65(9), 1100-1104.

  42. Ridgely, M. S., Engberg, J., Greenberg, M. D., Turner, S., DeMartini, C., & Dembosky, J. W. (2007). Justice, treatment, and cost: An evaluation of the fiscal impact of Allegheny County mental health court. Santa Monica, CA: RAND.

  43. Lindberg, A. J. (2009). Examining the program costs and outcomes of San Francisco’s Behavioral Health Court: Predicting success. San Francisco, CA: Superior Court of California, Office of Collaborative Justice Programs.

  44. Redlich, A. D., Hoover, S., Summers, A., & Steadman, H. J. (2010). Enrollment in mental health courts: Voluntariness, knowingness, and adjudicative competence. Law and Human Behavior, 34(2), 91-104.

  45. Poythress, N. G., Petrila, J., McGaha, A., & Boothroyd, R. (2002). Perceived coercion and procedural justice in the Broward mental health court. International Journal of Law and Psychiatry, 25(5), 517-533.

  46. Kopelovich, S., Yanos, P., Pratt, C., & Koerner, J. (2013). Procedural justice in mental health courts: Judicial practices, participant perceptions, and outcomes related to mental health recovery. International Journal of Law and Psychiatry, 36(2), 113-120.

  47. Note: Clinically significant impairment is a standardized classification of legal competence measured with the “Understanding” and “Reasoning” sections of the MacArthur Competence Assessment Tool—Criminal Adjudication (MacCat-CA).Redlich, A. D., Hoover, S., Summers, A., & Steadman, H. J. (2010). Enrollment in mental health courts: Voluntariness, knowingness, and adjudicative competence. Law and Human Behavior, 34(2), 91-104.

Intercept 4: Reentry from Institutions: Jails, Prisons, and Forensic Hospitals

Reentry programs aim to improve the continuity of care for individuals as they exit a correctional facility or hospital to return to the community. During the first hours, days, and weeks following release, individuals may experience a heightened need for mental health services.[1] However, many find that other needs, such as shelter and income, must be prioritized over treatment.[2] A study in Washington state found that only half of individuals with mental health disorders (MHDs) received mental health services in the community during the year following release and only 16 percent received services in at least nine of the first 12 months after release.[3] In addition, individuals with MHDs reported more challenges with housing, employment, family support, and criminal behavior upon returning to the community, compared to those without MHDs.[4]

Correctional reentry programs ideally engage individuals in pre-release planning to address mental health needs during the transition back to the community and connecting with community-based providers for long-term treatment.[5] Participation in a reentry program for mental health may be voluntary or involuntary (i.e. a condition of parole supervision). A meta-analysis found interventions in a correctional facility or forensic hospital, followed by mental health services in the community, can decrease the likelihood of recidivism.[6]

Services for individuals with MHDs reentering the community should be individually tailored to achieve the optimum level of treatment and supervision. It is recommended that programs employ a structure of graduated sanctions and incentives to promote adherence to treatment plans.[7]

Goals:

Reentry programs that promote mental health treatment in the community seek to:

  • Provide continuous mental health care from the time of release.[8]
  • Reduce psychiatric hospitalizations.[9]
  • Prevent future involvement with the justice system.[10]

Eligibility:

Eligibility for reentry programs with an emphasis on mental health treatment varies, but some key factors include:

  • Referral from jail, prison, or a forensic hospital.[11]
  • Severity of mental health diagnosis.[12]
  • Incarceration for a nonviolent offense, or assessment of a low risk for violence upon release.[13]
  • Multiple prior arrests or incarcerations.[14]
  • Functional abilities below a certain threshold in areas such as employment, interpersonal relationships, reasoning, thought processes, and temperament.[15]

Program Models:

Reentry programs with a focus on MHDs often follow the models of:

  • Assertive Community Treatment (ACT), where a multidisciplinary team coordinates and provides services to a small caseload of clients with high levels of need for mental health treatment.
  • Intensive Case Management (ICM), where a case manager facilitates linkages to appropriate community mental health services.[16]

While the practices of ACT and ICM may be considered evidence-based for improving clinical mental health outcomes, research has found clients often experienced no significant difference in criminal justice outcomes (e.g. arrests, days in jail) compared to clients who received treatment as usual.[17] ACT is more expensive than ICM; however, both are less expensive than incarcerating an individual.[18]

ACT and ICM have been adapted for justice-involved individuals and are known as Forensic Assertive Community Treatment (FACT) and Forensic Intensive Case Management (FICM), respectively. The more narrow target population of FACT and FICM allows for the inclusion of criminal justice stakeholders to the case management process and have the primary aim of reducing recidivism.

Forensic Assertive Community Treatment (FACT)

Based on the ACT model, FACT programs serve the justice-involved population with the highest levels of mental health needs and greatest risk for negative behaviors (e.g. recidivism, self-harm).[19] A multidisciplinary treatment team that includes stakeholders like a parole officer, psychiatrist, and case manager is available 24/7 to proactively address or respond to participants’ needs, such as mental health and substance use disorder treatment, transportation assistance, and vocational support.[20] FACT specifically aims to reduce rearrests and reincarceration.[21] FACT also leverages criminal justice sanctions (e.g. technical violation of parole) to promote compliance with the treatment plan.[22]

The duration and intensity of FACT is based on the individual’s needs over time. This may create a potential risk of dependency on the intensive service provision and raise questions about long-term sustainability.[23] The reduction in jail days associated with one FACT program led to estimated annual savings in jail costs of more than $200,000 for a group of 30 clients.[24] However, due to high treatment costs per participant (estimated at $14,000 annually in 2013), the Washington State Institute for Public Policy estimated gains in estimated benefits of FACT would not surpass the program costs.[25]

While ACT is an evidence-based program model, FACT is still considered a promising program model.[26] The National Registry for Evidence-based Programs and Practices found the FACT program model to be promising in achieving the outcomes of both reduced criminal/delinquent behavior and increased mental health and/or substance use treatment.

Research Evidence:

Research indicates FACT may be able to:

  • Increase receipt of mental health treatment services.[27]
  • Decrease new jail bookings.[28]
  • Decrease jail days.[29]
  • Decrease psychiatric hospital days.[30]
  • Reduce costs from inpatient treatment and jail stays.[31]

Examples in the Field:

Forensic Intensive Case Management (FICM)

Based on ICM, the FICM model for justice-involved individuals is typically considered less intensive than FACT.[32] Case managers under this model have individual caseloads, are not available 24/7, and provide linkages to mental health treatment rather than directly providing treatment.[33] A case management approach should promote sustained communication between treatment providers and parole officers for individuals on supervision.[34]

Research Evidence:

Research indicates FICM may be able to:

  • Decrease rearrests.[35]
  • Increase time in the community (i.e. not in prison/jail or a forensic hospital).[36]
  • Increase medication compliance.[37]
  • Increase mental health counseling attendance.[38]

FICM is considered a promising program model to help participants reduce further contact with the criminal justice system and to improve symptoms of MHDs.[39]

Examples in the Field:

Additional Resources:

Adults with Behavioral Health Needs Under Correctional Supervision: A Shared Framework for Reducing Recidivism and Promoting Recovery – National Institute of Corrections, Council of State Governments Justice Center, and Bureau of Justice Assistance (2012)

References

  1. Blandford, A. M., &. Osher, F. C. (2013). Guidelines for the successful transition of individuals with behavioral health disorders from jail and prison. Delmar, NY: SAMHSA’s GAINS Center for Behavioral Health and Justice Transformation.

  2. Angell, B., Matthews, E., Barrenger, S., Watson, A. C., & Draine, J. (2014). Engagement processes in model programs for community reentry from prison for people with serious mental illness. International Journal of Law and Psychiatry, 37(5), 490-500.

  3. Lovell, D., Gagliardi, G. J., & Peterson, P. D. (2002). Recidivism and use of services among persons with mental illness after release from prison. Psychiatric Services, 53(10), 1290-1296.

  4. Mallik-Kane, K., & Visher, C. A. (2008). Health and prisoner reentry: How physical, mental and substance abuse conditions shape the process of reintegration. Washington, DC: The Urban Institute. Retrieved from http://www.cfgnh.org/Portals/0/Uploads/Documents/Understanding GNH/Third Party Reports/411617-Health-and-Prisoner-Reentry.PDF

  5. Jennings, J. L. (2009). Does assertive community treatment work with forensic populations? Review and recommendations. The Open Psychiatry Journal, 3(1).

  6. Morgan, R. D., Flora, D. B., Kroner, D. G., Mills, J. F., Varghese, F., & Steffan, J. S. (2012). Treating offenders with mental illness: A research synthesis. Law and Human Behavior, 36(1), 37.

  7. Blandford, A. M., &. Osher, F. C. (2013). Guidelines for the successful transition of individuals with behavioral health disorders from jail and prison. Delmar, NY: SAMHSA’s GAINS Center for Behavioral Health and Justice Transformation.

  8. Skeem, J. L., Manchak, S., & Peterson, J. K. (2011). Correctional policy for offenders with mental illness: Creating a new paradigm for recidivism reduction. Law and Human Behavior, 35(2), 110-126.

  9. Weisman, R. L., Lamberti, J. S., & Price, N. (2004). Integrating criminal justice, community healthcare, and support services for adults with severe mental disorders. Psychiatric Quarterly, 75(1), 71-85.

  10. Weisman, R. L., Lamberti, J. S., & Price, N. (2004). Integrating criminal justice, community healthcare, and support services for adults with severe mental disorders. Psychiatric Quarterly, 75(1), 71-85.

  11. Jennings, J. L. (2009). Does assertive community treatment work with forensic populations? Review and recommendations. The Open Psychiatry Journal, 3(1).; Lurigio, A. J., Rollins, A., & Fallon, J. (2004). The effects of serious mental illness on offender reentry. Federal Probation, 68, 45.; California Board of Corrections (2005). Mentally ill offender crime reduction grant program: Overview of statewide evaluation findings. Retrieved from http://sd15.senate.ca.gov/sites/sd15.senate.ca.gov/files/7b.pdf

  12. Jennings, J. L. (2009). Does assertive community treatment work with forensic populations? Review and recommendations. The Open Psychiatry Journal, 3(1).; Lurigio, A. J., Rollins, A., & Fallon, J. (2004). The effects of serious mental illness on offender reentry. Federal Probation, 68, 45.; California Board of Corrections (2005). Mentally ill offender crime reduction grant program: Overview of statewide evaluation findings. Retrieved from http://sd15.senate.ca.gov/sites/sd15.senate.ca.gov/files/7b.pdf

  13. Jennings, J. L. (2009). Does assertive community treatment work with forensic populations? Review and recommendations. The Open Psychiatry Journal, 3(1).; Lurigio, A. J., Rollins, A., & Fallon, J. (2004). The effects of serious mental illness on offender reentry. Federal Probation, 68, 45.; California Board of Corrections (2005). Mentally ill offender crime reduction grant program: Overview of statewide evaluation findings. Retrieved from http://sd15.senate.ca.gov/sites/sd15.senate.ca.gov/files/7b.pdf

  14. Jennings, J. L. (2009). Does assertive community treatment work with forensic populations? Review and recommendations. The Open Psychiatry Journal, 3(1).; Lurigio, A. J., Rollins, A., & Fallon, J. (2004). The effects of serious mental illness on offender reentry. Federal Probation, 68, 45.; California Board of Corrections (2005). Mentally ill offender crime reduction grant program: Overview of statewide evaluation findings. Retrieved from http://sd15.senate.ca.gov/sites/sd15.senate.ca.gov/files/7b.pdf

  15. Note: This study employed the Global Assessment of Functioning (GAF) score.Solomon, P., & Draine, J. (1995). One-year outcomes of a randomized trial of case management with seriously mentally ill clients leaving jail. Evaluation Review, 19(3), 256-273.

  16. Heilbrun, K., DeMatteo, D., Yasuhara, K., Brooks-Holliday, S., Shah, S., King, C., Dicarlo, A. B., Hamilton, D., & Laduke, C. (2012). Community-based alternatives for justice-involved individuals with severe mental illness: Review of the relevant research. C_riminal Justice and Behavior, 39_(4), 351-419.

  17. Mueser, K. T., Bond, G. R., Drake, R. E., & Resnick, S. G. (1998). Models of community care for severe mental illness: A review of research on case management. Schizophrenia Bulletin, 24(1), 37.

  18. Osher, F. & King, C. (2015). Intercept 4: Reentry from jail and prisons. In P.A. Griffin, K. Heilbrun, E.P. Mulvey, D. DeMatteo, & C.A. Schubert (Eds.). The sequential intercept model and criminal justice: Promoting community alternatives for individuals with serious mental illness (pp. 95-117). USA: Oxford University Press.

  19. Note: ACT has generally been ineffective at reducing involvement in the justice system, which prompted the development of a specialized program (FACT) to better address criminal justice-related outcomes.Bond, G. R., Drake, R. E., Mueser, K. T., & Latimer, E. (2001). Assertive community treatment for people with severe mental illness. Disease Management and Health Outcomes, 9(3), 141-159.

  20. Blandford, A., & Osher, F. (2012). A checklist for implementing evidence-based practices and programs (EBPs) for justice-involved adults with behavioral health disorders. Delmar, NY: SAMSHA’s GAINS Center for Behavioral Health and Justice Transformation.; Lamberti, J. S., Weisman, R., & Faden, D. I. (2004). Forensic assertive community treatment: Preventing incarceration of adults with severe mental illness. Psychiatric Services, 55(11), 1285-1293.; Solomon, P., & Draine, J. (1995). One-year outcomes of a randomized trial of case management with seriously mentally ill clients leaving jail. Evaluation Review, 19(3), 256-273.

  21. Weisman, R. L., Lamberti, J. S., & Price, N. (2004). Integrating criminal justice, community healthcare, and support services for adults with severe mental disorders. Psychiatric Quarterly, 75(1), 71-85.

  22. Angell, B., Matthews, E., Barrenger, S., Watson, A. C., & Draine, J. (2014). Engagement processes in model programs for community reentry from prison for people with serious mental illness. International Journal of Law and Psychiatry, 37(5), 490-500.

  23. Angell, B., Matthews, E., Barrenger, S., Watson, A. C., & Draine, J. (2014). Engagement processes in model programs for community reentry from prison for people with serious mental illness. International Journal of Law and Psychiatry, 37(5), 490-500.

  24. Lurigio, A. J., Fallon, J. R., & Dincin, J. (2000). Helping the mentally ill in jails adjust to community life: A description of a postrelease ACT program and its clients. International Journal of Offender Therapy and Comparative Criminology, 44(5), 532-548.

  25. Note: Benefits are estimated from changes to crime and psychiatric hospitalization.Washington State Institute for Public Policy. (2017). Forensic Assertive Community Treatment (FACT). Benefit-cost results. Retrieved from http://www.wsipp.wa.gov/BenefitCost/Program/308

  26. Blandford, A., & Osher, F. (2012). A checklist for implementing evidence-based practices and programs (EBPs) for justice-involved adults with behavioral health disorders. Delmar, NY: SAMSHA’s GAINS Center for Behavioral Health and Justice Transformation.

  27. Cusack, K. J., Morrissey, J. P., Cuddeback, G. S., Prins, A., & Williams, D. M. (2010). Criminal justice involvement, behavioral health service use, and costs of forensic assertive community treatment: A randomized trial. Community Mental Health Journal, 46(4), 356-363.

  28. Cusack, K. J., Morrissey, J. P., Cuddeback, G. S., Prins, A., & Williams, D. M. (2010). Criminal justice involvement, behavioral health service use, and costs of forensic assertive community treatment: A randomized trial. Community Mental Health Journal, 46(4), 356-363.

  29. Lamberti, J. S., Weisman, R. L., Schwarzkopf, S. B., Price, N., Ashton, R. M., & Trompeter, J. (2001). The mentally ill in jails and prisons: Towards an integrated model of prevention. Psychiatric Quarterly, 72(1), 63-77.; Thresholds State, County Collaborative Jail Linkage Project, Chicago. (2001). Gold award: Helping mentally ill people break the cycle of jail and homelessness. Psychiatric Services, 52(10), 1380-1382.; Cusack, K. J., Morrissey, J. P., Cuddeback, G. S., Prins, A., & Williams, D. M. (2010). Criminal justice involvement, behavioral health service use, and costs of forensic assertive community treatment: A randomized trial. Community Mental Health Journal, 46(4), 356-363.

  30. Thresholds State, County Collaborative Jail Linkage Project, Chicago. (2001). Gold award: Helping mentally ill people break the cycle of jail and homelessness. Psychiatric Services, 52(10), 1380-1382.; Cusack, K. J., Morrissey, J. P., Cuddeback, G. S., Prins, A., & Williams, D. M. (2010). Criminal justice involvement, behavioral health service use, and costs of forensic assertive community treatment: A randomized trial. Community Mental Health Journal, 46(4), 356-363.

  31. Cusack, K. J., Morrissey, J. P., Cuddeback, G. S., Prins, A., & Williams, D. M. (2010). Criminal justice involvement, behavioral health service use, and costs of forensic assertive community treatment: A randomized trial. Community Mental Health Journal, 46(4), 356-363.

  32. DeMatteo, D., LaDuke, C., Locklair, B. R., & Heilbrun, K. (2013). Community-based alternatives for justice-involved individuals with severe mental illness: Diversion, problem-solving courts, and reentry. Journal of Criminal Justice, 41(2), 64-71.

  33. Osher, F., & King, C. (2015). Intercept 4: Reentry from jail and prisons. In P.A. Griffin, K. Heilbrun, E.P. Mulvey, D. DeMatteo, & C.A. Schubert (Eds.). The sequential intercept model and criminal justice: Promoting community alternatives for individuals with serious mental illness (pp. 95-117). USA: Oxford University Press.

  34. Lurigio, A. J., Rollins, A., & Fallon, J. (2004). The effects of serious mental illness on offender reentry. Federal Probation, 68, 45.

  35. Ventura, L. A., Cassel, C. A., Jacoby, J. E., & Huang, B. (1998). Case management and recidivism of mentally ill persons released from jail. Psychiatric Services, 49(10), 1330-1337.

  36. Ventura, L. A., Cassel, C. A., Jacoby, J. E., & Huang, B. (1998). Case management and recidivism of mentally ill persons released from jail. Psychiatric Services, 49(10), 1330-1337.; Steadman, H. J., & Naples, M. (2005). Assessing the effectiveness of jail diversion programs for persons with serious mental illness and co‐occurring substance use disorders. Behavioral Sciences & the Law, 23(2), 163-170.

  37. Steadman, H. J., & Naples, M. (2005). Assessing the effectiveness of jail diversion programs for persons with serious mental illness and co‐occurring substance use disorders. Behavioral Sciences & the Law, 23(2), 163-170.

  38. Steadman, H. J., & Naples, M. (2005). Assessing the effectiveness of jail diversion programs for persons with serious mental illness and co‐occurring substance use disorders. Behavioral Sciences & the Law, 23(2), 163-170.

  39. Blandford, A., & Osher, F. (2012). A checklist for implementing evidence-based practices and programs (EBPs) for justice-involved adults with behavioral health disorders. Delmar, NY: SAMSHA’s GAINS Center for Behavioral Health and Justice Transformation.

Intercept 5: Community Corrections and Community Support

Individuals with mental health disorders (MHDs) under community supervision (probation or parole) by the criminal justice system are at higher risk for violating the terms of their supervision and are nearly twice as likely to have their probation or parole revoked than those without an MHD.[1] This may be due to:

  • Difficulty complying with conditions of their supervision such as maintaining employment.
  • Sentences with numerous additional supervision conditions such as attending frequent mental health or substance use disorder treatment.
  • Probation and parole officer biases resulting in closer supervision or a lower threshold for revocation.[2]

The Council for State Governments recommends the following to community corrections departments working with individuals with MHDs:

  • Tailor supervision conditions to the needs and abilities of individuals with MHDs.
  • Ensure government benefits for which individuals are eligible are reinstated immediately after release from custody.
  • Create specialty mental health caseloads for probation and parole officers and provide these officers training to work with individuals with MHDs.
  • Establish clear guidelines for probation and parole officers and clients on compliance with supervision conditions and consequences for violations of those conditions.[3]

Goals:

The goals of probation and parole programs that specialize in working with individuals with MHDs include:

  • Increase successful compliance with community supervision conditions.
  • Improve public safety by reducing the commission of new crimes.
  • Provide more/better access to mental health treatment and other supportive services in the community.

Program Models & Research Evidence:

Specialized Probation for Individuals with MHDs

Many probation departments designate specialty caseloads for clients with MHDs.[4] Probation officers assigned to these caseloads receive ongoing training on supervising individuals with MHDs, safety, psychiatric medications, and working with the mental health system.[5] These probation officers typically have smaller caseloads than standard probation, at 30 to 50 probationers versus an average of 130 probationers, as smaller caseloads result in improved outcomes compared to large specialty caseloads and traditional probation.[6]

Specialized probation often requires probationers to participate in treatment.[7] Compared to traditional probation, research indicates specialty probation may be able to:

  • Increase participant access to mental health services.[8]
  • Reduce participant probation violations and court appearances for noncompliance with treatment.[9]
  • Decrease number of new arrests of participants.[10]
  • Reduce participants’ days in jail.[11]

Research by Skeem and colleagues indicated the effect of specialty probation on rearrest is dependent on the quality of the relationship between the probation officer and probationer.[12] Specialty probation may be able to enhance the probation officer-client relationship by:

  • Maintaining frequent contact with probationers.[13]
  • Using problem-solving strategies in response to noncompliance.[14]
  • Avoiding a coercive relationship by applying a “firm but fair” supervision style.[15]
  • Employing graduated sanctions for violations.[16]

A 2014 study demonstrated specialty probationers were about two times less likely to receive a formal probation violation compared to those on traditional probation. In addition, improved relationship quality between probation officer and probationer reduced the likelihood of receiving a violation.[17]

An assessment of the type and quality of services received in mandated treatment is important when evaluating the program’s outcomes.[18] Future research should examine the specific mechanisms by which specialty probation programs can improve mental health symptoms and reduce involvement with the criminal justice system.

Example in the Field:

Connections: San Diego, Calif.

Specialized Parole for Individuals with MHDs

There has been minimal research conducted on the effectiveness of specialty parole for individuals with MHDs. The California Division of Adult Parole Operations’ Mental Health Services Continuum Program features small caseloads, intensive supervision, and outpatient mental health treatment services at clinics in parole offices.[19] Researchers found that program participants who attended at least one mental health treatment session were significantly less likely to be returned to custody.[20] However, program participants had higher rates of technical violations and new offenses than their counterparts without MHDs.[21] This program is rated “Promising” by crimesolutions.gov.

A study of parole in New Jersey found that individuals with MHDs were more likely than those without MHDs to receive disciplinary actions during incarceration, which made release to parole less likely for those individuals.[22] A study of a specialized parole program found parolees with psychiatric symptoms were more likely to violate conditions of parole but were not more likely to be rearrested for a new offense.[23] These findings support the idea that parole officers may supervise parolees with MHDs more closely, leading to increased detection of parole violations.

Example in the Field:

Mental Health Services Continuum Program: California

Forensic Assertive Community Treatment (FACT)

Based on the ACT model, FACT programs serve the justice-involved population with the highest levels of mental health needs and greatest risk for negative behaviors (e.g. recidivism, self-harm).[24] A multidisciplinary treatment team that includes stakeholders like a parole officer, psychiatrist, and case manager is available 24/7 to proactively address or respond to participants’ needs, such as mental health and substance use disorder treatment, transportation assistance, and vocational support.[25] FACT specifically aims to reduce rearrests and reincarceration.[26] FACT also leverages criminal justice sanctions (e.g. technical violation of parole) to promote compliance with the treatment plan.[27] See Intercept 4 for more information on FACT.

Additional Resources:

Adults with Behavioral Health Needs Under Correctional Supervision: A Shared Framework for Reducing Recidivism and Promoting Recovery – National Institute of Corrections, Council of State Governments Justice Center, and Bureau of Justice Assistance (2012)

Improving Responses to People with Mental Illnesses: The Essential Elements of Specialized Probation Initiatives – Council of State Governments Justice Center (2009)

Mental Health Probation Officers: Stopping Justice-Involvement before Incarceration – Policy Brief from Center for Behavioral Health Services & Criminal Justice Research (2010)

Monitoring Offenders with Mental Illness in the Community: Guidelines for Practice – P. Ann Dirks-Linhorst and Donald M. Linhorst (2012)

Parolees with Mental Disorder: Toward Evidence-Based Practice – University of California Irvine Center for Evidence-Based Corrections (2011)

References

  1. Louden, J., Manchak, S., O’Connor, M., & Skeem, J. L. (2015). Applying the sequential intercept model to reduce recidivism among probationers and parolees with mental illness. In P.A. Griffin, K. Heilbrun, E.P. Mulvey, D. DeMatteo, & C.A. Schubert (Eds.). The sequential intercept model and criminal justice: Promoting community alternatives for individuals with serious mental illness (pp. 118-136). USA: Oxford University Press.; Prins, S. J., & Osher, F. C. (2009). Improving responses to people with mental illnesses: The Essential elements of specialized probation initiatives. New York, NY: The Council of State Governments Justice Center. Retrieved from https://csgjusticecenter.org/cp/publications/improving-responses-to-people-with-mental-illnesses-the-essential-elements-of-specialized-probation-initiatives/; Skeem, J. L., Manchak, S., & Peterson, J. K. (2011). Correctional policy for offenders with mental illness: Creating a new paradigm for recidivism reduction. Law and Human Behavior, 35(2), 110-126.

  2. Note: Revocation of community supervision may occur due to a violation of a condition of supervision (including noncompliance with court-ordered mental health treatment) or due to the commission of a new crime. For more, see: Watson, C., & Billick, S. B. (2007). Revocation of Conditional Release of a Mentally Ill Prisoner. Journal of the American Academy of Psychiatry and the Law Online, 35(2), 271-273.; Skeem, J. L., Manchak, S., & Peterson, J. K. (2011). Correctional policy for offenders with mental illness: Creating a new paradigm for recidivism reduction. Law and Human Behavior 35_(2), 110-126.

  3. Council of State Governments Justice Center (2002). Policy statement 16: Modification of conditions of probation/supervised release. Criminal Justice/Mental Health Consensus Project Report. New York, NY: Council of State Governments. Retrieved from https://csgjusticecenter.org/wp-content/uploads/2013/03/consensus-project-full-report.pdf

  4. Manchak, S. M., Skeem, J. L., Kennealy, P. J., & Louden, J. E. (2014). High-fidelity specialty mental health probation improves officer practices, treatment access, and rule compliance. Law and Human Behavior, 38(5), 450.

  5. Skeem, J. L., & Louden, J. E. (2006). Toward evidence-based practice for probationers and parolees mandated to mental health treatment. Psychiatric Services, 57(3), 333-342.; Burke, C., & Keaton, S. (2004). San Diego County's connections program board of corrections final report. San Diego, CA: San Diego Association of Governments. Retrieved from http://sandiegohealth.org/sandag/sandag_pubs_2009-7-25/publicationid_1099_3391.pdf

  6. Skeem, J. L., Emke-Francis, P., & Louden, J. E. (2006). Probation, mental health, and mandated treatment: A national survey. Criminal Justice and Behavior, 33(2), 158-184.; Louden, J. E., Manchak, S., O’Connor, M., & Skeem, J. L. (2015). Applying the sequential intercept model to reduce recidivism among probationers and parolees with mental illness. In P.A. Griffin, K. Heilbrun, E.P. Mulvey, D. DeMatteo, & C.A. Schubert (Eds.). The sequential intercept model and criminal justice: Promoting community alternatives for individuals with serious mental illness (pp. 118-136). USA: Oxford University Press.

  7. Epperson, M. W., Wolff, N., Morgan, R. D., Fisher, W. H., Frueh, B. C., & Huening, J. (2014). Envisioning the next generation of behavioral health and criminal justice interventions. International Journal of Law and Psychiatry, 37(5), 427-438.

  8. Manchak, S. M., Skeem, J. L., Kennealy, P. J., & Louden, J. E. (2014). High-fidelity specialty mental health probation improves officer practices, treatment access, and rule compliance. Law and Human Behavior, 38(5), 450.

  9. DeMatteo, D., LaDuke, C., Locklair, B. R., & Heilbrun, K. (2013). Community-based alternatives for justice-involved individuals with severe mental illness: Diversion, problem-solving courts, and reentry. Journal of Criminal Justice, 41(2), 64-71.

  10. Burke, C., & Keaton, S. (2004). San Diego County's connections program board of corrections final report. San Diego, CA: San Diego Association of Governments. Retrieved from http://sandiegohealth.org/sandag/sandag_pubs_2009-7-25/publicationid_1099_3391.pdf; Skeem, J. L., Manchak, S., & Montoya, L. (2017). Comparing public safety outcomes for traditional probation vs specialty mental health probation. JAMA Psychiatry, 74(9), 942-948.

  11. Burke, C., & Keaton, S. (2004). San Diego County's connections program board of corrections final report. San Diego, CA: San Diego Association of Governments. Retrieved from http://sandiegohealth.org/sandag/sandag_pubs_2009-7-25/publicationid_1099_3391.pdf

  12. Skeem, J. & Manchak, S. (2010, October). Final outcomes of the longitudinal study: “What really works!” for probationers with serious mental illness. Paper presented at the final meeting of the Macarthur Research Network on Mandated Community Treatment, Tucson, AZ. Cited in Louden, J. E., Manchak, S., O’Connor, M., & Skeem, J. L. (2015). Applying the sequential intercept model to reduce recidivism among probationers and parolees with mental illness. In P.A. Griffin, K. Heilbrun, E.P. Mulvey, D. DeMatteo, & C.A. Schubert (Eds.). The sequential intercept model and criminal justice: Promoting community alternatives for individuals with serious mental illness (pp. 118-136). USA: Oxford University Press.

  13. Louden, J. E., Skeem, J. L., Camp, J., & Christensen, E. (2008). Supervising probationers with mental disorder: How do agencies respond to violations?. Criminal Justice and Behavior, 35(7), 832-847.

  14. Louden, J. E., Skeem, J. L., Camp, J., & Christensen, E. (2008). Supervising probationers with mental disorder: How do agencies respond to violations?. Criminal Justice and Behavior, 35(7), 832-847.

  15. Skeem, J. L., Encandela, J., & Louden, J. E. (2003). Perspectives on probation and mandated mental health treatment in specialized and traditional probation departments. Behavioral Sciences & the Law, 21(4), 429-458.

  16. Louden, J. E., Skeem, J. L., Camp, J., & Christensen, E. (2008). Supervising probationers with mental disorder: How do agencies respond to violations?. Criminal Justice and Behavior, 35(7), 832-847.

  17. Manchak, S. M., Skeem, J. L., Kennealy, P. J., & Louden, J. E. (2014). High-fidelity specialty mental health probation improves officer practices, treatment access, and rule compliance. Law and Human Behavior, 38(5), 450.

  18. Skeem, J. L., & Louden, J. E. (2006). Toward evidence-based practice for probationers and parolees mandated to mental health treatment. Psychiatric Services, 57(3), 333-342.

  19. Louden, J. E., Manchak, S., O’Connor, M., & Skeem, J. L. (2015). Applying the sequential intercept model to reduce recidivism among probationers and parolees with mental illness. In P.A. Griffin, K. Heilbrun, E.P. Mulvey, D. DeMatteo, & C.A. Schubert (Eds.). The sequential intercept model and criminal justice: Promoting community alternatives for individuals with serious mental illness (pp. 118-136). USA: Oxford University Press.

  20. Farabee, D., Bennett, D., Garcia, D., Warda, U., & Yang, J. (2006). Final Report on the Mental Health Services Continuum Program of the California Department of Corrections and Rehabilitation—Parole Division. Submitted to the California Department of Corrections and Rehabilitation, Division of Parole. Los Angeles, CA: UCLA Integrated Substance Abuse Program, Neuropsychiatric Institute.

  21. Louden, J. E., Manchak, S., O’Connor, M., & Skeem, J. L. (2015). Applying the sequential intercept model to reduce recidivism among probationers and parolees with mental illness. In P.A. Griffin, K. Heilbrun, E.P. Mulvey, D. DeMatteo, & C.A. Schubert (Eds.). The sequential intercept model and criminal justice: Promoting community alternatives for individuals with serious mental illness (pp. 118-136). USA: Oxford University Press.

  22. Matejkowski, J., Caplan, J. M., & Wiesel Cullen, S. (2010). The impact of severe mental illness on parole decisions: Social integration within a prison setting. Criminal Justice and Behavior, 37(9), 1005-1029.

  23. Skeem, J. L., Winter, E., Kennealy, P. J., Louden, J. E., Tatar, I. I., & Joseph, R. (2014). Offenders with mental illness have criminogenic needs, too: Toward recidivism reduction. Law and Human Behavior, 38(3), 212.

  24. Note: ACT has generally been ineffective at reducing involvement in the justice system, which prompted the development of a specialized program (FACT) to better address criminal justice-related outcomes.Bond, G. R., Drake, R. E., Mueser, K. T., & Latimer, E. (2001). Assertive community treatment for people with severe mental illness. Disease Management and Health Outcomes, 9(3), 141-159.

  25. Blandford, A., & Osher, F. (2012). A checklist for implementing evidence-based practices and programs (EBPs) for justice-involved adults with behavioral health disorders. Delmar, NY: SAMSHA’s GAINS Center for Behavioral Health and Justice Transformation.; Lamberti, J. S., Weisman, R., & Faden, D. I. (2004). Forensic assertive community treatment: Preventing incarceration of adults with severe mental illness. Psychiatric Services, 55(11), 1285-1293.; Solomon, P., & Draine, J. (1995). One-year outcomes of a randomized trial of case management with seriously mentally ill clients leaving jail. Evaluation Review, 19(3), 256-273.

  26. Weisman, R. L., Lamberti, J. S., & Price, N. (2004). Integrating criminal justice, community healthcare, and support services for adults with severe mental disorders. Psychiatric Quarterly, 75(1), 71-85.

  27. Angell, B., Matthews, E., Barrenger, S., Watson, A. C., & Draine, J. (2014). Engagement processes in model programs for community reentry from prison for people with serious mental illness. International Journal of Law and Psychiatry, 37(5), 490-500.

Intercepts 1-5: Additional Evidence-Based Practices

The following are evidence-based programs and practices (EPBs) for individuals with mental health disorders (MHDs) that span multiple intercepts.

Illness Management Recovery (IMR)

IMR aims to educate individuals with serious MHDs about their conditions and encourage them to take a proactive approach to setting treatment goals and managing symptoms.[1] Participants are taught strategies to avoid mental health symptom relapse and effectively cope with their MHDs. The program is offered weekly over three months.[2]

IMR is well-established as an EBP and may be able to:

  • Increase knowledge about MHDs.
  • Improve medication adherence.
  • Reduce rehospitalizations.[3]

In what little research exists on IMR for justice-involved individuals, researchers suggested adaptations for the population, such as specifically recognizing and altering criminogenic thinking.[4] Cost-benefit analyses demonstrate a ratio of $3.04 in benefits for every $1 spent on the program.[5]

Additional Resources

Illness Management and Recovery Fact Sheet

The Substance Abuse and Mental Health Services Administration (SAMHSA) Illness Management and Recovery Evidence-Based Practices (EBP) Kit

Family Psychoeducation (FPE)

FPE is an informative approach to help individuals with MHDs manage their symptoms by including family members in a supportive, team-based environment in partnership with practitioners. In FPE, “family” can be a relative or any other supportive person invited by the individual to take part in their recovery. Generally, FPE is comprised of three stages over nine months, including:

  • Sessions bringing together consumers, family, and mental health professionals.
  • An educational workshop about managing stress in the family.
  • Ongoing psychoeducational group sessions for individuals with MHDs and their families.[6]

Research indicates FPE may be able to:

  • Reduce hospitalizations.[7]
  • Improve global functioning and community integration in the long-term.[8]
  • Offer strategies to reduce the burden on relatives and caregivers.[9]
  • Improve family relationships.[10]
  • Offer cost savings on average per patient.[11]

Example in the Field

National Alliance on Mental Illness (NAMI) Family-to-Family

Additional Resources

SAMHSA’s Family Psychoeducation Evidence-Based Practices (EBP) Kit

Supportive Housing for Persons with MHDs

Homeless individuals with MHDs typically have high levels of involvement with the justice system.[12] Supportive housing reduces homelessness and associated contact with the justice system, while allowing individuals with MHDs to receive psychiatric services in the community.[13] No services are required as a condition of housing and participants are subject to the same rules as any other tenant.[14] Through the program, individuals should spend no more than 30 percent of their income on rent and the assistance should not be time-limited.[15]

Research indicates supportive housing may be able to reduce:

  • Emergency shelter stays.[16]
  • Hospital stays and shorten their length.[17]
  • Length of time incarcerated.[18]
  • Rearrests and reincarceration after prison release.[19]

Additional Resources

SAMHSA Fact Sheet: Housing Options for Adults with Mental and Substance Use Disorders Involved with the Criminal Justice System

SAMHSA’s Permanent Supportive Housing Evidence-Based Practices (EBP) Kit

The Urban Institute Report: Principles and Practice in Housing for Persons with Mental Illness Who Have Had Contact with the Justice System

Supported Employment (SE) for Persons with MHDs

The goal of supported employment (SE) is to match individuals with serious MHDs to jobs in the community while offering comprehensive mental health services. SE does not require individuals to undergo pre-employment training to meet a definition of “work readiness,” but instead focuses on rapid job placement and supportive services to meet employment goals.[20]

Supported employment has a strong evidence base of helping participants acquire and maintain employment in the competitive labor market.[21]

Research indicates SE may also be able to:

  • Help individuals find work sooner.[22]
  • Offer more working hours and more wage earnings.[23]
  • Increase self-esteem in clients who engage in competitive work.[24]

Cost-benefit analyses suggest SE can offer a savings of $3.04 for every dollar spent on program costs.[25]

When the program’s target population is limited to justice-involved individuals, improved employment outcomes persist over time; however, supported employment had no significant impact on rearrests or reincarceration rates.[26]

Example in the Field

SAMHSA’s Transforming Lives Through Supported Employment (SE) Program Grant

Additional Resources

SAMHSA Fact Sheet: Supported Employment for Justice-Involved People with Mental Illness

SAMHSA’s Supported Employment Evidence-Based Practices (EBP) Kit

Motivational Interviewing (MI)

MI promotes behavior change by helping individuals examine ambivalence, set goals, and consider actionable steps.[27] Therapists use open-ended questioning, reflective listening, and employ affirmations to motivate participants to change their behavior.[28] MI was originally developed for use with individuals with substance use disorders,[29] but has been expanded for use with individuals with MHDs to promote treatment adherence and with individuals who are justice-involved to reduce recidivism.

Crimesolutions.gov, the National Institute of Justice’s clearinghouse of EBPs, lists motivational interviewing as an EBP for treatment of substance abuse. MI also is often a component of practices that are evidence-based for improving mental health outcomes (e.g. Assertive Community Treatment).[30]

For those with MHDs, MI may be able to:

  • Increase treatment engagement and medication adherence.[31]
  • Improve mental health symptoms.[32]
  • Reduce alcohol and illegal drug use for those with co-occurring substance use disorders.[33]

Additional Resources

Case Western Reserve University – Center for Evidence-Based Practices: Motivational Interviewing

National Institute of Corrections: Motivating Offenders to Change, A Guide for Probation & Parole

National Institute of Corrections: Motivational Interviewing in Corrections

Integrated Co-Occurring Disorders Treatment

Integrated co-occurring disorders treatment aids individuals with a diagnosis of a mental health and substance use disorder, or co-occurring disorder (COD). About half of individuals in the United States who are diagnosed with severe MHDs are also affected by a substance use disorder.[34] Individuals with a COD are at increased risk for criminal justice involvement.[35] Individuals demonstrate improved outcomes related to recovery when receiving integrated treatment for both disorders from the same treatment team.[36] Integrated treatment often incorporates elements of cognitive-behavioral therapy, motivational interviewing, and family psychoeducation programs.

Individuals receiving treatment within non-integrated systems may be guided to sequentially address one disorder before the other or may receive separate treatment within each system (parallel treatment). These paths are less effective and more costly than integrated treatment.[37]

COD treatment of those who are incarcerated can be ineffective due to the lack of resources in correctional settings to cover the high cost of services.[38] Modifying in-prison residential substance abuse treatment programs (i.e. therapeutic communities) to target individuals with CODs in prisons has demonstrated more positive outcomes for this population than typical therapeutic community programs or standard correctional mental health treatment, including:

  • Decreased substance use.
  • Improved psychological functioning.
  • Reduced recidivism.[39]

Long-term follow-up with a mental health provider, known as aftercare, is essential for the success of individuals after completing prison-based COD treatment and returning to the community.[40]

Additional Resources

SAMHSA Fact Sheet: Integrating Mental Health and Substance Abuse Services for Justice-Involved Persons with Co-Occurring Disorders

SAMHSA’s Integrated Treatment for Co-Occurring Disorders Evidence-Based Practices (EBP) Kit

Psychopharmacology

Prescribed psychotropic medication can be used to reduce symptoms of MHDs by altering the chemistry of the brain.[41] All FDA-approved medications have been subject to rigorous clinical trials and are evidence-based. This type of treatment should be viewed as a medical decision tailored to an individual’s specific needs.[42] Individuals with MHDs should actively participate in decision-making when selecting medication.[43] For effective treatment leading to recovery, medication may need to be part of a long-term treatment plan.[44]

One evidence-based approach to medication management is MedTEAM (Medication Treatment, Evaluation and Management) which employs a team approach by promoting collaboration between prescribers, agency staff, other mental health practitioners, and consumers to systematically determine the impacts of medication.[45] This can be accomplished by consistently employing brief rating scales to measure impacts of medication on desired outcomes over time.[46]

Research indicates MedTEAM may be able to improve:

  • Clinical symptoms.
  • Treatment quality.
  • Adherence to treatment.
  • Consumer satisfaction.[47]

Jails and prisons may have a limited variety of prescription medications available in the facilities. In addition, staff psychiatrists may be instructed to give preference to medications that are less expensive, less likely to be diverted/misused, and extended-release formulations that do not require multiple doses throughout the day.[48] In addition, a federal court ruled that states are required to supply individuals with the necessary prescription medications to ensure continuity of care between release from prison and receipt of a prescription in the community.[49]

A study of individuals released from Florida psychiatric hospitals found that the receipt of medications for 90 days post-hospitalization significantly reduced the likelihood of arrest.[50] Further, individuals with schizophrenia or bipolar disorder who were referred for expedited enrollment in Medicaid upon release from prison were significantly more likely to fill a prescription in the community for mental health medication.[51]

Additional Resources

SAMHSA’s MedTEAM (Medication Treatment, Evaluation, and Management) Evidence-Based Practices (EBP) Kit

General Resources for Adapting EBPs

A Checklist for Implementing Evidence-Based Practices and Programs for Justice-Involved Adults with Behavioral Health Disorders: SAMHSA’s GAINS Center for Behavioral Health and Justice Transformation

Adapting Evidence-Based Practices for Persons with Mental Illness Involved with the Criminal Justice System[52]

References

  1. Mueser, K. T., Corrigan, P. W., Hilton, D. W., Tanzman, B., Schaub, A., Gingerich, S., Essock, S. M., Tarrier, N., Morey, B., Vogel-Scibilia, S., & Herz, M. I. (2002). Illness management and recovery: A review of the research. Psychiatric Services, 53(10), 1272-1284.

  2. Substance Abuse and Mental Health Services Administration. (2009). Illness management and recovery: Building your program. HHS Pub. No. SMA-09-4462, Rockville, MD: Author.

  3. Mueser, K. T., Corrigan, P. W., Hilton, D. W., Tanzman, B., Schaub, A., Gingerich, S., Essock, S. M., Tarrier, N., Morey, B., Vogel-Scibilia, S., & Herz, M. I. (2002). Illness management and recovery: A review of the research. Psychiatric Services, 53(10), 1272-1284.

  4. Mueser, K. T. (2013). Illness management and recovery. Rockville, MD: SAMHSA’S GAINS Center for Behavioral Health and Justice Transformation. Retrieved from https://www.prainc.com/wp-content/uploads/2015/10/fact-sheet-illness-management-recovery.pdf

  5. Washington State Institute for Public Policy. (2017). Illness management and recovery (IMR). Benefit-Cost Results. Retrieved from http://www.wsipp.wa.gov/BenefitCost/ProgramPdf/288/Illness-Management-and-Recovery-IMR

  6. Substance Abuse and Mental Health Services Administration. (2009). Family psychoeducation: Building your program. HHS Pub. No. SMA-09-4422, Rockville, MD: Author.

  7. Dixon, L., McFarlane, W. R., Lefley, H., Lucksted, A., Cohen, M., Falloon, I., … & Sondheimer, D. (2001). Evidence-based practices for services to families of people with psychiatric disabilities. Psychiatric Services, 52(7), 903-910.; Dyck, D. G., Hendryx, M. S., Short, R. A., Voss, W. D., & McFarlane, W. R. (2002). Service use among patients with schizophrenia in psychoeducational multiple-family group treatment. Psychiatric Services, 53(6), 749-754.

  8. Dixon, L., McFarlane, W. R., Lefley, H., Lucksted, A., Cohen, M., Falloon, I., … & Sondheimer, D. (2001). Evidence-based practices for services to families of people with psychiatric disabilities. Psychiatric Services, 52(7), 903-910.; Falloon, I. R., Held, T., Coverdale, J. H., Roncone, R., & Laidlaw, T. M. (1999). Family interventions for schizophrenia: A review of long-term benefits of international studies. Psychiatric Rehabilitation Skills, 3(2), 268-290.

  9. Cuijpers, P., & Stam, H. (2000). Burnout among relatives of psychiatric patients attending psychoeducational support groups. Psychiatric Services, 51(3), 375-379.

  10. Cuijpers, P., & Stam, H. (2000). Burnout among relatives of psychiatric patients attending psychoeducational support groups. Psychiatric Services, 51(3), 375-379.

  11. Tarrier, N., Lowson, K., & Barrowclough, C. (1991). Some aspects of family interventions in schizophrenia. II: Financial considerations. The British Journal of Psychiatry, 159(4), 481-484.

  12. Malone, D. K. (2009). Assessing criminal history as a predictor of future housing success for homeless adults with behavioral health disorders. Psychiatric Services, 60(2), 224-230.

  13. Fontaine, J. (2013). The role of supportive housing in successful reentry outcomes for disabled prisoners. Cityscape, 15(3), 53-76.

  14. Substance Abuse and Mental Health Services Administration. (2010). Permanent Supportive Housing: Building Your Program. HHS Pub. No. SMA-10-4509, Rockville, MD: Center for Mental Health Services, Substance Abuse and Mental Health Services Administration, U.S. Department of Health and Human Services.

  15. National Alliance on Mental Illness. (n.d.) Securing Stable Housing. Retrieved from https://www.nami.org/Find-Support/Living-with-a-Mental-Health-Condition/Securing-Stable-Housing.

  16. Culhane, D. P., Metraux, S., & Hadley, T. (2001). The impact of supportive housing for homeless people with severe mental illness on the utilization of the public health, corrections, and emergency shelter systems: The New York-New York Initiative. Housing Policy Debate, 13(1), 107-63.

  17. Culhane, D. P., Metraux, S., & Hadley, T. (2001). The impact of supportive housing for homeless people with severe mental illness on the utilization of the public health, corrections, and emergency shelter systems: The New York-New York Initiative. Housing Policy Debate, 13(1), 107-63.

  18. Culhane, D. P., Metraux, S., & Hadley, T. (2001). The impact of supportive housing for homeless people with severe mental illness on the utilization of the public health, corrections, and emergency shelter systems: The New York-New York Initiative. Housing Policy Debate, 13(1), 107-63.

  19. Fontaine, J. (2013). The role of supportive housing in successful reentry outcomes for disabled prisoners. Cityscape, 15(3), 53-76.

  20. Bond, G. R., Becker, D. R., Drake, R. E., Rapp, C. A., Meisler, N., Lehman, A. F., Bell, M. D., & Blyler, C. R. (2001). Implementing supported employment as an evidence-based practice. Psychiatric Services, 52(3), 313-322.

  21. Bond, G. R., Becker, D. R., Drake, R. E., Rapp, C. A., Meisler, N., Lehman, A. F., Bell, M. D., & Blyler, C. R. (2001). Implementing supported employment as an evidence-based practice. Psychiatric Services, 52(3), 313-322.

  22. Bond, G. R., Drake, R. E., & Becker, D. R. (2008). An update on randomized controlled trials of evidence-based supported employment. Psychiatric Rehabilitation Journal, 31(4), 280.

  23. Note: Hours worked may be due to personal preference or other factors; SE programs can provide individualized counseling to help participants understand how various types of employment could affect their eligibility for government assistance (e.g. Supplemental Security Income, Social Security Disability Insurance). See Bond et al. (2008) for more.;Drake, R. E., McHugo, G. J., Becker, D. R., Anthony, W. A., & Clark, R. E. (1996). The New Hampshire study of supported employment for people with severe mental illness. Journal of Consulting and Clinical Psychology, 64(2), 391.

  24. Bond, G. R., Resnick, S. G., Drake, R. E., Xie, H., McHugo, G. J., & Bebout, R. R. (2001). Does competitive employment improve nonvocational outcomes for people with severe mental illness?. Journal of Consulting and Clinical Psychology, 69(3), 489.

  25. Washington State Institute for Public Policy. (2017). Individual Placement and Support (IPS) for individuals with serious mental illness. Benefit-cost results. Retrieved from http://www.wsipp.wa.gov/BenefitCost/Program/293

  26. Bond, G. R., Kim, S. J., Becker, D. R., Swanson, S. J., Drake, R. E., Krzos, I. M., Fraser, V. V., O’Neill, S., & Frounfelker, R. L. (2015). A controlled trial of supported employment for people with severe mental illness and justice involvement. Psychiatric Services, 66(10), 1027-1034.

  27. Markland, D., Ryan, R. M., Tobin, V. J., & Rollnick, S. (2005). Motivational interviewing and self–determination theory. Journal of Social and Clinical Psychology, 24(6), 811-831.

  28. Martino, S., Carroll, K., Kostas, D., Perkins, J., & Rounsaville, B. (2002). Dual diagnosis motivational interviewing: a modification of motivational interviewing for substance-abusing patients with psychotic disorders. Journal of Substance Abuse Treatment, 23(4), 297-308.

  29. McMurran, M. (2009). Motivational interviewing with offenders: A systematic review. Legal and Criminological Psychology, 14(1), 83-100.

  30. Center for Evidence-Based Practices. (2016). Motivational interviewing. Cleveland, OH: Center for Evidence-Based Practices at Case Western Reserve University. Retrieved from https://www.centerforebp.case.edu/practices/mi

  31. Westra, H. A., Aviram, A., & Doell, F. K. (2011). Extending motivational interviewing to the treatment of major mental health problems: current directions and evidence. The Canadian Journal of Psychiatry, 56(11), 643-650.

  32. Cleary, M., Hunt, G. E., Matheson, S., & Walter, G. (2009). Psychosocial treatments for people with co‐occurring severe mental illness and substance misuse: Systematic review. Journal of Advanced Nursing, 65(2), 238-258.

  33. Cleary, M., Hunt, G. E., Matheson, S., & Walter, G. (2009). Psychosocial treatments for people with co‐occurring severe mental illness and substance misuse: Systematic review. Journal of Advanced Nursing, 65(2), 238-258.

  34. Drake, R. E., Essock, S. M., Shaner, A., Carey, K. B., Minkoff, K., Kola, L., Lynde, D., … & Rickards, L. (2001). Implementing dual diagnosis services for clients with severe mental illness. Psychiatric Services, 52(4), 469-476.

  35. Abram, K. M., & Teplin, L. A. (1991). Co-occurring disorders among mentally ill jail detainees: Implications for public policy. American Psychologist, 46(10), 1036.

  36. Substance Abuse and Mental Health Services Administration. (2009). Integrated Treatment for Co-Occurring Disorders: Building Your Program. DHHS Pub. No. SMA-08-4366, Rockville, MD: Center for Mental Health Services, Substance Abuse and Mental Health Services Administration, U.S. Department of Health and Human Services.

  37. Peters, R. H., Young, M. S., Rojas, E. C., & Gorey, C. M. (2017). Evidence-based treatment and supervision practices for co-occurring mental and substance use disorders in the criminal justice system. The American Journal of Drug and Alcohol Abuse, 43(4), 475-488.

  38. Peters, R. H., Wexler, H. K., & Lurigio, A. J. (2015). Co-occurring substance use and mental disorders in the criminal justice system: A new frontier of clinical practice and research. Psychiatric Rehabilitation Journal, 38(1), 1-6.

  39. Peters, R. H., Young, M. S., Rojas, E. C., & Gorey, C. M. (2017). Evidence-based treatment and supervision practices for co-occurring mental and substance use disorders in the criminal justice system. The American Journal of Drug and Alcohol Abuse, 43(4), 475-488.

  40. Johnson, J. E., Schonbrun, Y. C., Peabody, M. E., Shefner, R. T., Fernandes, K. M., Rosen, R. K., & Zlotnick, C. (2015). Provider experiences with prison care and aftercare for women with co-occurring mental health and substance use disorders: Treatment, resource, and systems integration challenges. The Journal of Behavioral Health Services & Research, 42(4), 417-436.

  41. Note: The National Institute of Mental Health defines the main categories of psychotropic medications as: stimulants, antidepressants, antipsychotics, mood stabilizers, and antianxiety agents.

  42. Blandford, A., & Osher, F. (2012). A Checklist for Implementing Evidence-Based Practices and Programs (EBPs) for Justice-Involved Adults with Behavioral Health Disorders. Delmar, NY: SAMHSA’s GAINS Center for Behavioral Health and Justice Transformation.

  43. Bond, G. R., Salyers, M. P., Rollins, A. L., Rapp, C. A., & Zipple, A. M. (2004). How evidence-based practices contribute to community integration. Community Mental Health Journal, 40(6), 569-588.

  44. Muller-Isberner, R., & Hodgins, S. (2000). Evidence-based treatment for mentally disordered offenders. Violence, Crime and Mentally Disordered Offenders: Concepts and Methods for Effective Treatment and Prevention. Toronto: John Wiley & Sons, Ltd.

  45. Substance Abuse and Mental Health Services Administration. (2010). MedTEAM: Building your program. HHS Pub. No. SMA-10-4548. Rockville, MD: Author.

  46. Substance Abuse and Mental Health Services Administration. (2010). MedTEAM: Building your program. HHS Pub. No. SMA-10-4548. Rockville, MD: Author.

  47. Substance Abuse and Mental Health Services Administration. (2010). MedTEAM: Evaluating your program. HHS Pub. No. SMA-10-4548. Rockville, MD: Author.

  48. Agency for Healthcare Research and Quality. (2012). Interventions for adults with serious mental illness who are involved with the criminal justice system. Research Protocol. U.S. Department of Health & Human Services. Retrieved from https://effectivehealthcare.ahrq.gov/topics/mental-illness-adults-prisons/research-protocol.; Daniel, A. E. (2006). Preventing suicide in prison: A collaborative responsibility of administrative, custodial, and clinical staff. Journal of the American Academy of Psychiatry and the Law Online, 34(2), 165-175.; Daniel, A. E. (2007). Care of the mentally ill in prisons: Challenges and solutions. Journal of the American Academy of Psychiatry and the Law Online, 35(4), 406-410.

  49. Lurigio, A. J., Rollins, A., & Fallon, J. (2004). The effects of serious mental illness on offender reentry. Federal Probation, 68, 45.

  50. Van Dorn, R. A., Desmarais, S. L., Petrila, J., Haynes, D., & Singh, J. P. (2013). Effects of outpatient treatment on risk of arrest of adults with serious mental illness and associated costs. Psychiatric Services, 64(9), 856-862.

  51. Morrissey, J. P., Domino, M. E., & Cuddeback, G. S. (2016). Expedited Medicaid enrollment, mental health service use, and criminal recidivism among released prisoners with severe mental illness. Psychiatric Services, 67(8), 842-849.

  52. Osher, F. C., & Steadman, H. J. (2007). Adapting evidence-based practices for persons with mental illness involved with the criminal justice system. Psychiatric Services, 58(11), 1472-1478.

Intercepts 1-5: Behavioral Interventions

Description:

Behavioral interventions work to change the behavior of individual clients, teaching self-monitoring to reinforce new coping skills to handle stressful situations. Cognitive behavioral therapy and dialectical behavior therapy are examples of effective behavioral intervention techniques. These therapies can be used across intercepts.

Cognitive Behavioral Therapy (CBT):

CBT is a form of structured talk therapy administered by a therapist or psychotherapist.[1] Unlike other forms of talk therapy, which can last for months or years, clients attend 10 to 20 structured sessions.[2] CBT is based on the cognitive model, which holds that a person’s perception of a situation is determined more by their own reaction to an event than the actual event itself.[3] CBT has been found to be effective in treating a number of mental health disorders (MHDs) by encouraging recognition of problematic thinking patterns and teaching problem-solving skills to cope with difficult situations.[4]

Dialectical Behavior Therapy (DBT):

DBT is a cognitive behavioral approach to therapy that was developed in the late 1980s.[5] The term dialectic refers to embracing both acceptance and change, allowing individuals to feel supported and validated when being asked to make changes.[6] DBT employs the dialectical philosophy to focus on emotional regulation, as well as mindfulness and acceptance.[7] Therapists must be trained and certified to administer DBT, and many therapists employ DBT “consultation teams” to ensure fidelity to the approach.[8]

Goals:

CBT and DBT teach individuals to observe, evaluate, and regulate their own behavior to:

  • Change unhealthy behaviors and thought patterns.[9]
  • Develop coping mechanisms to increase distress tolerance.[10]
  • Reduce recidivism by learning to manage negative reactions and behaviors.[11]

Eligibility:

While eligibility criteria may vary based on the program, CBT and DBT can be used to treat many problematic behaviors. However, due to limited resources in most jail and court settings, participation in these programs is usually limited to individuals with a severe mental health and/or substance use disorder.[12] Both CBT and DBT are effective therapeutic models for the justice-involved population, especially for those classified as medium to high risk for recidivism.[13]

Research Evidence and Examples in the Field:

Cognitive Behavioral Therapy

Overall, CBT has a significant evidence base; however, the outcomes differ somewhat depending on the disorder that the practice is intended to treat.[14] CBT has been shown to be effective in treating depression, anxiety, substance use disorders, and severe mental illness, among others.[15]

Research indicates CBT may be able to:

  • Improve symptoms of MHDs.[16]
  • Reduce recidivism.[17]
  • Reduce substance use.[18]

There is some evidence that CBT may be more effective with juveniles, because their thinking patterns are not as deeply ingrained as adults’ and are more easily altered.[19]

Examples in the Field

Seeking Safety is a curriculum-based program for individuals with co-occurring mental health and substance use disorders.[20] It has been used with success in treating women in correctional settings.[21] The program integrates CBT and trauma-informed care.[22] Research indicates Seeking Safety may be able to:

  • Reduce trauma symptoms.[23]
  • Increase treatment retention.[24]
  • Improve interpersonal relationships.[25]
  • Decrease illegal drug use.[26]

Clients report high levels of satisfaction with the Seeking Safety program.[27] The National Institute of Justice’s clearinghouse of research on programs and practices, Crimesolutions.gov, rates Seeking Safety as a “Promising” program.

A similar program for women with co-occurring disorders is the Trauma Recovery and Empowerment Model (TREM).[28]

Reasoning & Rehabilitation (R&R) is a CBT-based program that teaches prosocial behaviors to adults and juveniles in the justice system. These skills are taught in small group settings of six to 12 participants over 36 sessions.[29]

Research indicates R&R can:

  • Reduce rearrests.[30]
  • Improve employment outcomes.[31]
  • Increase problem-solving skills and coping strategies.[32]

R&R has been adapted for justice-involved youth and adults with MHDs in a program called R&R2 MHP. This program is delivered over 16 sessions and incorporates a structured mentoring component by assigning each participant a “PAL” (Participant’s Aid for Learning) who provides individual coaching between group sessions.[33] An evaluation of R&R2 MHP found that those who completed the program self-reported less violent attitudes and facility staff reported less disruptive behavior from participants, compared to before program implementation.[34]

Similar CBT programs for individuals involved in the criminal justice system include:

Dialectical Behavior Therapy

Research indicates DBT may be able to:

  • Reduce incidents of self-harm and suicidal behavior.[37]
  • Reduce hospitalizations.[38]
  • Improve treatment retention.[39]
  • Decrease treatment costs.[40]

Example in the Field

Dialectical Behavior Therapy – Corrections Modified (DBT-CM) adapts standard DBT for use in correctional facilities. Modifications from traditional DBT include:

  • Fewer individual therapy sessions (due to limited resources).
  • Training to develop new coping skills that are relevant to the correctional setting and/or combat criminal behaviors.
  • Modifying group therapy sessions to enhance safety/security.[41]

The program includes16 weeks of skills training and eight weeks of follow-up coaching.[42] DBT-CM can:

  • Reduce negative behaviors that require in-prison disciplinary action.
  • Reduce aggression.
  • Improve coping.[43]

Additional Resources:

Dialectical Behavior Therapy: Evidence for Implementation in Juvenile Correctional Settings: California Department of Corrections and Rehabilitation, Office of Research

Reducing Criminal Recidivism for Justice-Involved Persons with Mental Illness: Risk/Needs/Responsivity and Cognitive-Behavioral Interventions: The Substance Abuse and Mental Health Services Administration’s GAINS Center for Behavioral Health and Justice Transformation

Thinking for a Change and Cognitive-Behavioral Programs (Annotated Bibliography): National Institute of Corrections

References

  1. Mayo Clinic Staff. (2017). Cognitive behavioral therapy. Mayo Clinic Patient Care & Health Information, Tests & Procedures. Retrieved from https://www.mayoclinic.org/tests-procedures/cognitive-behavioral-therapy/about/pac-20384610

  2. Mayo Clinic Staff. (2017). Cognitive behavioral therapy. Mayo Clinic Patient Care & Health Information, Tests & Procedures. Retrieved from https://www.mayoclinic.org/tests-procedures/cognitive-behavioral-therapy/about/pac-20384610

  3. Beck, J.S. (2010). Questions and answers about cognitive behavior therapy. Beck Institute for Cognitive Behavior Therapy. Retrieved from https://www.beckinstitute.org/wp-content/uploads/2017/08/Question-Answer-Packet-2010.pdf

  4. Najavits, L. M., & Hien, D. (2013). Helping vulnerable populations: A comprehensive review of the treatment outcome literature on substance use disorder and PTSD. Journal of Clinical Psychology, 69(5), 433-479.

  5. Berzins, L. G., & Trestman, R. L. (2004). The development and implementation of dialectical behavior therapy in forensic settings. International Journal of Forensic Mental Health, 3(1), 93-103.

  6. Behavioral Tech. (n.d.). What is Dialectical Behavior Therapy (DBT)? Behavioral Tech: A Linehan Institute Training Company. Retrieved from https://behavioraltech.org/resources/faqs/dialectical-behavior-therapy-dbt/#Team

  7. Chapman, A. L. (2006). Dialectical behavior therapy: Current indications and unique elements. Psychiatry (Edgmont), 3(9), 62-68.

  8. Behavioral Tech. (n.d.). What is Dialectical Behavior Therapy (DBT)? Behavioral Tech: A Linehan Institute Training Company. Retrieved from https://behavioraltech.org/resources/faqs/dialectical-behavior-therapy-dbt/#Team

  9. Rotter, M., & Carr, W. A. (2013). Reducing criminal recidivism for justice-involved persons with mental illness: Risk/needs/responsivity and cognitive-behavioral interventions. Rockville, MD: SAMHSA’s GAINS Center for Behavioral Health and Justice Transformation. Retrieved from http://forensiccounselor.org/images/file/ReduceCrimRecidMIRiskNeedsResponCogBehavInter.pdf

  10. Rotter, M., & Carr, W. A. (2013). Reducing criminal recidivism for justice-involved persons with mental illness: Risk/needs/responsivity and cognitive-behavioral interventions. Rockville, MD: SAMHSA’s GAINS Center for Behavioral Health and Justice Transformation. Retrieved from http://forensiccounselor.org/images/file/ReduceCrimRecidMIRiskNeedsResponCogBehavInter.pdf

  11. Rotter, M., & Carr, W. A. (2013). Reducing criminal recidivism for justice-involved persons with mental illness: Risk/needs/responsivity and cognitive-behavioral interventions. Rockville, MD: SAMHSA’s GAINS Center for Behavioral Health and Justice Transformation. Retrieved from http://forensiccounselor.org/images/file/ReduceCrimRecidMIRiskNeedsResponCogBehavInter.pdf

  12. Berzins, L. G., & Trestman, R. L. (2004). The development and implementation of dialectical behavior therapy in forensic settings. International Journal of Forensic Mental Health, 3(1), 93-103.

  13. Aos, S., & Drake, E. (2013). Prison, police and programs: Evidence-based options that reduce crime and save money. Olympia: Washington State Institute for Public Policy.

  14. Hofmann, S. G., Asnaani, A., Vonk, I. J., Sawyer, A. T., & Fang, A. (2012). The efficacy of cognitive behavioral therapy: A review of meta-analyses. Cognitive Therapy and Research, 36(5), 427-440.

  15. American Psychological Association (n.d.). What is cognitive behavioral therapy? PTSD Clinical Practice Guideline. Retrieved from http://www.apa.org/ptsd-guideline/patients-and-families/cognitive-behavioral.pdf

  16. Butler, A. C., Chapman, J. E., Forman, E. M., & Beck, A. T. (2006). The empirical status of cognitive-behavioral therapy: A review of meta-analyses. Clinical Psychology Review, 26(1), 17-31.

  17. Hofmann, S. G., Asnaani, A., Vonk, I. J., Sawyer, A. T., & Fang, A. (2012). The efficacy of cognitive behavioral therapy: A review of meta-analyses. Cognitive Therapy and Research, 36(5), 427-440.;Landenberger, N. A., & Lipsey, M. W. (2005). The positive effects of cognitive–behavioral programs for offenders: A meta-analysis of factors associated with effective treatment. Journal of Experimental Criminology, 1(4), 451-476.

  18. Hien, D. A., Cohen, L. R., Miele, G. M., Litt, L. C., & Capstick, C. (2004). Promising treatments for women with comorbid PTSD and substance use disorders. American Journal of Psychiatry, 161(8), 1426-1432.

  19. Feucht, T. & Holt, T. (2016). Does cognitive behavioral therapy work in criminal justice? A new analysis from Crimesolutions.gov. NIJ Journal (277)10-17. Retrieved from https://www.ncjrs.gov/pdffiles1/nij/249825.pdf

  20. Hien, D. A., Cohen, L. R., Miele, G. M., Litt, L. C., & Capstick, C. (2004). Promising treatments for women with comorbid PTSD and substance use disorders. American Journal of Psychiatry, 161(8), 1426-1432.

  21. Substance Abuse and Mental Health Services Administration National GAINS Center. (2011). Trauma-specific interventions for justice-involved individuals. Rockville, MD: Substance Abuse and Mental Health Services Administration. Retrieved from http://23.29.59.141/assets/document-library/archive/library/forensics/ofo - ebp traumaspecificinterventions.pdf; Zlotnick, C., Najavits, L. M., Rohsenow, D. J., & Johnson, D. M. (2003). A cognitive-behavioral treatment for incarcerated women with substance abuse disorder and posttraumatic stress disorder: Findings from a pilot study. Journal of Substance Abuse Treatment, 25(2), 99-105.

  22. Najavits, L. (2002). Seeking safety: A treatment manual for PTSD and substance abuse. New York: The Guilford Press.

  23. Najavits, L. M., Gallop, R. J., & Weiss, R. D. (2006). Seeking safety therapy for adolescent girls with PTSD and substance use disorder: A randomized controlled trial. The Journal of Behavioral Health Services & Research, 33(4), 453-463.; Zlotnick, C., Johnson, J., & Najavits, L. M. (2009). Randomized controlled pilot study of cognitive-behavioral therapy in a sample of incarcerated women with substance use disorder and PTSD. Behavior Therapy, 40(4), 325-336.

  24. Gatz, M., Brown, V., Hennigan, K., Rechberger, E., O'Keefe, M., Rose, T., & Bjelajac, P. (2007). Effectiveness of an integrated, trauma‐informed approach to treating women with co‐occurring disorders and histories of trauma: The Los Angeles site experience. Journal of Community Psychology, 35(7), 863-878.

  25. Najavits, L. M. (2002). Seeking Safety: Therapy for trauma and substance abuse. Corrections Today, 64(6), 136-141.

  26. Hien, D. A., Cohen, L. R., Miele, G. M., Litt, L. C., & Capstick, C. (2004). Promising treatments for women with comorbid PTSD and substance use disorders. American Journal of Psychiatry, 161(8), 1426-1432.

  27. Reichert, J., Gatens, A., Adams, S., Gleicher, L., Weisner, L., & Head, C. (2018). Co-occurring mental health and substance use disorders of women in prison: An evaluation of the WestCare Foundation’s Dual Diagnosis Program in Illinois. Chicago, IL: Illinois Criminal Justice Information Authority.; Zlotnick, C., Najavits, L. M., Rohsenow, D. J., & Johnson, D. M. (2003). A cognitive-behavioral treatment for incarcerated women with substance abuse disorder and posttraumatic stress disorder: Findings from a pilot study. Journal of Substance Abuse Treatment, 25(2), 99-105.

  28. Fallot, R. D., & Harris, M. (2002). The Trauma Recovery and Empowerment Model (TREM): Conceptual and practical issues in a group intervention for women. Community Mental Health Journal, 38(6), 475-485.

  29. Robinson, D., & Porporino, F. J. (2001). Programming in cognitive skills: The reasoning and rehabilitation programme. In C. R. Hollin (Ed.), Handbook of offender assessment and treatment (pp. 179-193). Chichester: Wiley

  30. Joy Tong, L. S., & Farrington, D. P. (2006). How effective is the “Reasoning and Rehabilitation” programme in reducing reoffending? A meta-analysis of evaluations in four countries. Psychology, Crime & Law, 12(1), 3-24.; Van Voorhis, P., Spruance, L. M., Ritchey, P. N., Listwan, S. J., & Seabrook, R. (2004). The Georgia cognitive skills experiment: A replication of reasoning and rehabilitation. Criminal Justice and Behavior, 31(3), 282-305.

  31. Van Voorhis, P., Spruance, L. M., Ritchey, P. N., Listwan, S. J., & Seabrook, R. (2004). The Georgia cognitive skills experiment: A replication of reasoning and rehabilitation. Criminal Justice and Behavior, 31(3), 282-305.

  32. Clarke, A. Y., Cullen, A. E., Walwyn, R., & Fahy, T. (2010). A quasi-experimental pilot study of the Reasoning and Rehabilitation programme with mentally disordered offenders. The Journal of Forensic Psychiatry & Psychology, 21(4), 490-500.

  33. Young, S. J., & Ross, R. R. (2007). R&R2 for youths and adults with mental health problems: A prosocial competence training program. Ottawa, ON: Cognitive Centre of Canada. Retrieved from https://www.academia.edu/9330716/R_and_R2_for_Youths_and_Adults_with_Mental_Health_Problems

  34. Young, S., Chick, K., & Gudjonsson, G. (2010). A preliminary evaluation of Reasoning and Rehabilitation 2 in mentally disordered offenders (R&R2M) across two secure forensic settings in the United Kingdom. The Journal of Forensic Psychiatry & Psychology, 21(3), 336-349.

  35. Ferguson, L. M., & Wormith, J. S. (2013). A meta-analysis of Moral Reconation Therapy. International Journal of Offender Therapy and Comparative Criminology, 57(9), 1076-1106.

  36. Lowenkamp, C. T., Hubbard, D., Makarios, M. D., & Latessa, E. J. (2009). A quasi-experimental evaluation of Thinking for a Change: A “real-world” application. Criminal Justice and Behavior, 36(2), 137-146.

  37. Barnicot, K., Savill, M., Bhatti, N., & Priebe, S. (2014). A pragmatic randomised controlled trial of dialectical behaviour therapy: Effects on hospitalisation and post-treatment follow-up. Psychotherapy and Psychosomatics, 83(3), 192-193.; Landes, S. J., Chalker, S. A., & Comtois, K. A. (2016). Predicting dropout in outpatient dialectical behavior therapy with patients with borderline personality disorder receiving psychiatric disability. Borderline Personality Disorder and Emotion Dysregulation, 3(1), 9.

  38. Barnicot, K., Savill, M., Bhatti, N., & Priebe, S. (2014). A pragmatic randomised controlled trial of dialectical behaviour therapy: Effects on hospitalisation and post-treatment follow-up. Psychotherapy and Psychosomatics, 83(3), 192-193.

  39. Robins, C. J., & Chapman, A. L. (2004). Dialectical behavior therapy: Current status, recent developments, and future directions. Journal of Personality Disorders, 18(1), 73-89.

  40. The Mental Health Center of Greater Manchester, New Hampshire. (1998). Integrating dialectical behavioral therapy into a community mental health program. Psychiatric Services, 49(10), 1338-40.

  41. Sampl, S., Wakai, S., & Trestman, R. L. (2010). Translating evidence-based practices from community to corrections: An example of implementing DBT-CM. The Journal of Behavior Analysis of Offender and Victim Treatment and Prevention, 2(2), 114.

  42. Sampl, S., Wakai, S., & Trestman, R. L. (2010). Translating evidence-based practices from community to corrections: An example of implementing DBT-CM. The Journal of Behavior Analysis of Offender and Victim Treatment and Prevention, 2(2), 114.

  43. Shelton, D., Sampl, S., Kesten, K. L., Zhang, W., & Trestman, R. L. (2009). Treatment of impulsive aggression in correctional settings. Behavioral Sciences & the Law, 27(5), 787-800.

Intercepts 1-5: Trauma-Informed Therapies

Description:

The majority of individuals in the justice system have experienced trauma, and a portion go on to suffer from a trauma-related disorder, such as posttraumatic stress disorder (PTSD).[1] PTSD has been found to be up to 10 times more common in the correctional population than in individuals in the community.[2] Trauma-informed therapies have been shown to be effective modalities for treating those who have experienced trauma, including those who have developed PTSD. They also are relatively simple for prison staff to integrate into their supervision practices.[3]

Trauma-informed therapies aim to identify trauma and create structures within care settings that acknowledge the impact of trauma on people’s lives.[4] In institutional settings, a trauma-informed approach acknowledges that prison and jail environments can amplify symptoms of trauma.[5] The Substance Abuse and Mental Health Services Administration (SAMSHA) outlines six key principles for the development of a trauma-informed approach:

  1. Safety
  2. Trustworthiness and Transparency
  3. Peer support
  4. Collaboration and mutuality
  5. Empowerment, voice and choice
  6. Cultural, Historical, and Gender Issues[6]

Goals:

The goal of trauma-informed therapy is to address the trauma in a justice-involved individual’s history, specifically in relation to behaviors that contribute to recidivism. In the case of correctional facilities, trauma-informed principles can affect practices related to many areas, including treatment, intake, and professional development for staff. SAMHSA proposes four key principles of trauma-informed approaches:

  • Realization of the effects of trauma.
  • Recognition of the signs and manifestations of trauma.
  • Response with application of trauma-informed practices throughout the organization.
  • Resistance to re-traumatization of both clients and staff.[7]

Eligibility:

These types of therapies can be used in many settings and with patients of all ages. Due to the high rate of trauma exposure among individuals in correctional settings and limited resources with which to address it, some programs limit eligibility to those with the most severe symptoms or those who are diagnosed with PTSD.[8] Validated trauma screening and assessment tools can be used to accurately identify the appropriate population for these services.[9]

Research Evidence:

Trauma-informed therapies can:

  • Improve symptoms of trauma and stressor-related disorders.[10]
  • Reduce negative mental health symptoms, including depression and anxiety.[11]
  • Improve skills and abilities to cope with trauma.[12]
  • Increase sense of personal safety.[13]

Because trauma-informed care is a framework implemented at the program or organizational level, it can be difficult for research to isolate the specific impact of trauma-informed practices.

Examples in the Field:

Trauma Affect Regulation: Guide for Education and Therapy (TARGET) is a trauma-informed intervention to treat PTSD and co-occurring disorders helping individuals develop new coping behaviors.[14] The curriculum is centered on development of self-monitoring skills by participants.

Research indicates TARGET can:

  • Alleviate symptoms of PTSD.[15]
  • Reduce negative behavioral incidents leading to disciplinary sanctions in correctional settings.[16]

TARGET is included in SAMHSA’s National Registry of Evidence-based Program and Practices (NREPP)[17] and listed as an effective practice by crimesolutions.gov.[18]

Other evidence-based programs and practices for the treatment of trauma include:

Additional Resources:

SAMHSA’s Concept of Trauma and Guidance for a Trauma-Informed Approach

The Damaging Consequences of Violence and Trauma: Facts, Discussion Points, and Recommendations for the Behavioral Health System: National Association of State Mental Health Program Directors

Trauma Treatment for Adults: California Evidence-Based Clearinghouse for Child Welfare

References

  1. Adams, S., Gleicher, L., Reichert, J., Konefal, K., & Cantrell, D. (2017). An examination of traumatic experiences and posttraumatic stress disorder among a sample of Illinois prisoners. Chicago, IL: Illinois Criminal Justice Information Authority.; Kubiak, S. P., Covington, S. S., & Hillier, C. (2017). Trauma-informed corrections. In D. W. Springer & A. R. Roberts (Eds.). Social work in juvenile and criminal justice systems. (pp. 92-104). Springfield, IL, USA: Charles C. Thomas Publisher Ltd.

  2. Ford, J. D., Chang, R., Levine, J., & Zhang, W. (2013). Randomized clinical trial comparing affect regulation and supportive group therapies for victimization-related PTSD with incarcerated women. Behavior Therapy, 44(2), 262-276.

  3. Miller, N. A., & Najavits, L. M. (2012). Creating trauma-informed correctional care: A balance of goals and environment. European Journal of Psychotraumatology, 3(1), 17246.

  4. Harris, M., & Fallot, R. D. (Eds.). (2001). New directions for mental health services. Using trauma theory to design service systems. San Francisco, CA, US: Jossey-Bass.; Miller, N. A., & Najavits, L. M. (2012). Creating trauma-informed correctional care: A balance of goals and environment. European Journal of Psychotraumatology, 3(1), 17246.

  5. Kubiak, S. P., & Rose, I. M. (2007). Trauma and posttraumatic stress disorder in inmates with histories of substance use. Handbook of Forensic Mental Health with Victims and Offenders, 445-466.

  6. Substance Abuse and Mental Health Services Administration. (2014). Guiding principles of trauma-informed care. SAMHSA News, 22(2). Retrieved from https://www.samhsa.gov/samhsaNewsLetter/Volume_22_Number_2/trauma_tip/guiding_principles.html

  7. Substance Abuse and Mental Health Services Administration. (2014). SAMHSA’s concept of trauma and guidance for a trauma-informed approach. HHS Publication No. (SMA) 14-4884. Rockville, MD: Substance Abuse and Mental Health Services Administration.

  8. Ford, J. D., Steinberg, K. L., Hawke, J., Levine, J., & Zhang, W. (2012). Randomized trial comparison of emotion regulation and relational psychotherapies for PTSD with girls involved in delinquency. Journal of Clinical Child & Adolescent Psychology, 41(1), 27-37.

  9. Substance Abuse and Mental Health Services Administration. (2014). SAMHSA’s concept of trauma and guidance for a trauma-informed approach. HHS publication No. (SMA) 14-4884. Rockville, MD: Substance Abuse and Mental Health Services Administration.

  10. Jennings, A. (2011). Models for developing trauma-informed behavioral health systems and trauma-specific services: An update of the 2004 report. Washington, DC: United States Department of Health and Human Services.; Mueser, K. T., Rosenberg, S. D., Xie, H., Jankowski, M. K., Bolton, E. E., Lu, W., ... & Wolfe, R. (2008). A randomized controlled trial of cognitive-behavioral treatment for posttraumatic stress disorder in severe mental illness. Journal of Consulting and Clinical Psychology, 76(2), 259.

  11. Ford, J. D., Steinberg, K. L., Moffitt, K. H., & Zhang, W. (2008). Breaking the cycle of trauma and criminal justice involvement: The Mothers Overcoming and Managing Stress (MOMS) study. Final report to the U.S. Department of Justice. Farmington, Conn.: University of Connecticut Health Center.http://www.ncjrs.gov/pdffiles1/nij/grants/222910.pdf

  12. Toussaint, D. W., VanDeMark, N. R., Bornemann, A., & Graeber, C. J. (2007). Modifications to the Trauma Recovery and Empowerment Model (TREM) for substance‐abusing women with histories of violence: Outcomes and lessons learned at a Colorado substance abuse treatment center. Journal of Community Psychology, 35(7), 879-894.

  13. Fallot, R. D., McHugo, G. J., Harris, M., & Xie, H. (2011). The trauma recovery and empowerment model: A quasi-experimental effectiveness study. Journal of Dual Diagnosis, 7(1-2), 74-89.

  14. SAMHSA. (2017, April 24). Trauma Affect Regulation: Guide for Education and Treatment (TARGET). Retrieved from https://nrepp.samhsa.gov/ProgramProfile.aspx?id=1222#hide3

  15. Ford, J. D., Steinberg, K. L., Moffitt, K. H., & Zhang, W. (2008). Breaking the cycle of trauma and criminal justice involvement: The Mothers Overcoming and Managing Stress (MOMS) study. Final report to the U.S. Department of Justice. Farmington, Conn.: University of Connecticut Health Center.http://www.ncjrs.gov/pdffiles1/nij/grants/222910.pdf; Ford, J. D., Steinberg, K. L., Hawke, J., Levine, J., & Zhang, W. (2012). Randomized trial comparison of emotion regulation and relational psychotherapies for PTSD with girls involved in delinquency. Journal of Clinical Child & Adolescent Psychology, 41(1), 27-37.

  16. Ford, J. D., & Hawke, J. (2012). Trauma affect regulation psychoeducation group and milieu intervention outcomes in juvenile detention facilities. Journal of Aggression, Maltreatment & Trauma, 21(4), 365-384.

  17. SAMHSA. (2017). Trauma Affect Regulation: Guide for Education and Treatment (TARGET). Retrieved from https://nrepp.samhsa.gov/ProgramProfile.aspx?id=1222#hide3

  18. Office of Justice Programs. (2011). Program profile: Trauma affect regulation: Guide for education and therapy (TARGET). Retrieved from https://crimesolutions.gov/ProgramDetails.aspx?ID=145

  19. Cohen, J. A., Deblinger, E., Mannarino, A. P., & Steer, R. A. (2004). A multisite, randomized controlled trial for children with sexual abuse–related PTSD symptoms. Journal of the American Academy of Child & Adolescent Psychiatry, 43(4), 393-402.

  20. Fallot, R. D., & Harris, M. (2002). The Trauma Recovery and Empowerment Model (TREM): Conceptual and practical issues in a group intervention for women. Community Mental Health Journal, 38(6), 475-485.