Special courts help mentally ill stay crime-free

By Anne Harding

NEW YORK (Reuters Health) - Mentally ill people who commit crimes and go through a special mental health court rather than the standard criminal justice system are less likely to be re-arrested, and are also at lower risk of future arrest for violent crimes, a study of a San Francisco program shows.

"This mental health court model has promise as one approach to reducing the unnecessary criminalization of people with mental disorders," Dr. Dale E. McNiel of the University of California at San Francisco, a study author, told Reuters Health. "Clearly other interventions have promise, including enhancing the mental health services in the community."

As many as 15 percent of prisoners in US jails are severely mentally ill, McNiel and his colleague Dr. Renee L. Binder note in the American Journal of Psychiatry. These individuals often "cycle through" jails, psychiatric hospitals and substance abuse treatment without getting better.

Communities have adopted a number of strategies to address the problem, including mental health courts, the researchers add. People who enter these courts must agree to treatment in the community mental health system, and are allowed to "graduate" once they have been stable for a given amount of time.

While there were two such courts in the US in 1997, there were roughly 90 in 2005. But there has been little research to date on whether these courts actually help prevent people from committing future crimes, and whether they are appropriate for individuals who commit violent crimes.

McNiel and Binder compared 170 mentally ill people who were seen by a San Francisco mental health court with 8,067 mentally ill people who were processed through the regular criminal justice system. The researchers used statistical techniques to adjust for differences between the two groups, because assignment to mental health court was not random.

Eighteen months after entering the system, 6 percent of mental health graduates had been charged with committing a new violent crime, compared to 13 percent of individuals who went through the criminal justice system. At this time, 42 percent of the mental health court graduates had been charged with any type of new crime, compared to 57 percent of those who went through the standard courts. Differences between the two groups became greater as follow-up lengthened.

Mental health courts aren't for everyone with a mental disorder who commits a crime, McNiel noted; instead, they are targeted to people with more severe illness who frequently cycle through the system. They also wouldn't be appropriate for people who have committed murder or other extremely violent crimes, he added. But the findings do show, he said, that for violent yet less serious offenses, the courts work.

Some people may be concerned about exposing the community to "undue risk," McNiel said. "We found the opposite, that it actually enhanced public safety to provide this type of program."

SOURCE: American Journal of Psychiatry, September 2007.