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• W2108739968 abstract "Back to table of contents Previous article Next article CommentaryFull AccessNew Models of Collaboration Between Criminal Justice and Mental Health SystemsJoseph P. Morrissey Ph.D.Jeffrey A. Fagan Ph.D.Joseph J. Cocozza Ph.D.Joseph P. Morrissey Ph.D.Search for more papers by this authorJeffrey A. Fagan Ph.D.Search for more papers by this authorJoseph J. Cocozza Ph.D.Search for more papers by this authorPublished Online:1 Nov 2009https://doi.org/10.1176/appi.ajp.2009.09050670AboutSectionsPDF/EPUB ToolsAdd to favoritesDownload CitationsTrack Citations ShareShare onFacebookTwitterLinked InEmail In 2007, 2.3 million persons were in prisons and jails in the United States compared with fewer than 400,000 only 35 years ago. This “trend” has been attributed to urbanization, political and social concerns about growing crime severity, and epidemics of drug abuse. In response, state legislatures abandoned the principles of individualized justice and therapeutic punishment that were hallmarks of American jurisprudence in the first half of the 20th century (1) . In its place, a new punitive criminal justice policy emerged. Most states passed sentencing laws that fixed lengthy minimum incarceration terms for specific offenses and offenders. This policy shift has had greater consequences for some subgroups of offenders. In particular, the large numbers of adults and juveniles with mental disorders entering the justice system have placed considerable strain on the ability of judges and corrections officials to apply these categorical decisions without forgoing individualized responses to these compromised individuals. As a result, there are now hundreds of thousands of individuals with mental illness under criminal and juvenile justice supervision throughout the United States (2) . Out of necessity, criminal and juvenile justice agencies have turned to would-be partners and collaborators in mental health and drug treatment to find new solutions. Consequently, new models have sprung up as local solutions, striking responsive chords with communities who face similar problems, and they have diffused rapidly throughout the country, although without solid evidence about their effectiveness. New Models of CollaborationCo-occurring substance use and mental disorders associated with deviant behavior and harsh sanctions for drug-related offenses are principal factors driving criminal involvement among persons with mental illness. However, the inattention of the mental health community to risk assessments and the over-reliance of the criminal justice system on such measures have created disconnects in care. In the last two decades, these two systems have formed new relationships where accommodation and antagonism have given way to joint efforts to find shared solutions. These newer arrangements integrate roles, rules, and relationships between the two systems in ways that appear to allow the needs of mentally ill persons to be addressed without undermining public safety goals. Three collaborative models (crisis intervention teams, mental health courts, and mental health probation and parole personnel) have received the most attention from practitioners and policy makers in both adult and juvenile systems.Crisis Intervention Teams Crisis intervention teams are police-based interventions situated at the front end of the justice system (3) . The original model was developed in Memphis in 1988 (4) . Sworn officers receive 40 hours of training about mental illness, de-escalation management, and how to divert persons suspected of having a serious mental illness by bringing them to a special mental health assessment facility rather than taking them to jail. One-fifth of the officers in each adopting law enforcement agency are trained. More than 300 municipal or county departments across the country have followed this approach. The current evidence in support of crisis intervention teams is mainly descriptive (5) . The following questions pertaining to outcomes-oriented research would help to develop an evidence base for the effectiveness of crisis intervention teams: Training and community contextAre there selection biases associated with the voluntary nature of enrollment such that officers’ pre-existing attitudes and beliefs rather than crisis intervention team training account for their behavior as crisis intervention team officers? Are crisis intervention team effects confounded with the availability and adequacy of local mental health services, differences in emergency commitment statutes, and other community characteristics?Disposition outcomesHow many individuals who are diverted into mental health services are stabilized and engaged in treatment? How do their experiences compare with individuals with mental illness who are arrested and jailed?Costs and benefitsWho benefits and who pays for crisis intervention teams? Are there efficiencies for law enforcement? What is the impact on the mental health system? What is the impact on public safety?Mental Health Courts The blending of legal coercion and intensive treatment is the core of the mental health court model (6) . The court typically adopts a therapeutic jurisprudence orientation in which both mental health workers and probation officers participate in the proceedings and offenders are placed on probation on condition of participation in treatment and making regular court appearances to report on their progress. Since the first mental health court appeared in Broward County, Fla., in 1997, there are now well over 250 courts. Consensus guidelines on essential elements for a mental health court have been issued by the Council of State Governments Justice Center (7) , but practices are quite variable across jurisdictions. Factors such as the growing need to respond to people with mental illness entering the justice system, the legal leverage these courts offer, and enhanced access to treatments have been identified as justification for their proliferation. At the same time, some advocates view mental health courts as a misguided attempt to address the problems of people with mental illnesses who become involved with the justice system (8) . These concerns have raised a number of significant questions about the role and effectiveness of mental health courts:Case referral and selectionDo these courts result in more individuals being referred for court-mandated treatment than would be expected in comparable jurisdictions without a mental health court? Are only those individuals who are most likely to succeed selected?Access to treatmentDoes participation in a mental health court actually result in greater access to appropriate treatment? Can adherence to treatment be effectively “forced” on participants? To what extent do criminal offenders jump the line to get community-based treatment before others?EffectivenessAre criminal justice (public safety) and behavioral health outcomes (treatment engagement, symptom reduction, enhanced functioning) improved as a result of participation in mental health courts compared with usual criminal justice processing?Mental Health Probation and Parole Mental health probation and mental health parole are two other blended collaboration approaches combining community supervision via the courts (probation) or a state releasing authority (parole) with mental health treatment (9) . Often, mental health probation is included as a component of other interventions, such as mental health courts and forensic assertive community treatment teams (10) . The California Department of Corrections (11) employs mental health clinicians within its parole division to operate community-based outpatient clinics for offenders with mental illness. A recent review commissioned by the Council of State Governments Justice Center (12) found only a handful of studies on probation. Recidivism rates for offenders with mental illness are nearly twice as great as those for the general prison population (13) . Some studies indicate that criminal justice involvements via revocations and technical violations are actually greater when probation or parole officers participate in mental health treatment teams (14) , but arrests for new offenses may be lower. However, there are a number of questions that still need to be addressed: Compliance and treatment engagementAre offenders with mental illness more compliant with their probation/parole when supervised by officers with mentally ill only caseloads? Are they more engaged in treatment services? Do these compliance and engagement rates vary by probation or parole status, seriousness of offense, or seriousness of mental illness?Community adjustment and recidivismDoes joint community supervision and mental health treatment promote public safety through reduced offending, enhanced functioning, and lowered recidivism rates? Are the rates of technical violations, revocations, and rearrests for new crimes greater for joint programs compared with usual arrangements?Advancing Research on CollaborationsCurrent efforts at both the federal and state levels provide ample occasions for policy research to address research questions about criminal justice mental health collaborations.For the most part, however, these initiatives do not have a formal research component. Growing a firm evidence base will require well-designed multisite and multistate longitudinal studies. Without knowing whether the actual performance of these collaborative arrangements is consistent with the enthusiasm of their proponents, it is difficult to say whether they should continue to be expanded across the country or curtailed and abandoned.Address correspondence and reprint requests to Dr. Morrissey, University of North Carolina at Chapel Hill, Cecil G. Sheps Center for Health Services Research, 725 Martin Luther King, Jr. Blvd., Campus Box 7590, Chapel Hill, NC 27599-7590; [email protected] (e-mail). Commentary accepted for publication July 2009 (doi: 10.1176/appi.ajp.2009.09050670).The authors report no financial relationships with commercial interests.Prepared under the auspices of the John D. and Catherine T. MacArthur Foundation Network on Mental Health Policy Research.References1. Garland D: Culture of Control: Crime and Social Order in Contemporary Society. New York, Oxford University Press, 2000Google Scholar2. Lurigio A, Swartz J: Changing the contours of the criminal justice system to meet the needs of persons with serious mental illness, in Criminal Justice 2000, vol 3: Policies, Processes, and Decisions of the Criminal Justice System. Edited by Horney. Washington, DC, DOJ, 2000, pp 45–108. http://www.ncjrs.gov/criminal_justice2000/vol3_2000.htmlGoogle Scholar3. Deane M, Steadman H, Borum R, Veysey B, Morrissey J: Emerging partnerships between mental health and law enforcement. Psychiatr Serv 1999; 50:99–101Google Scholar4. Dupont R, Cochran S: Police response to mental health emergencies: barriers to change. J Am Acad Psychiatry Law 2000; 28:338–344Google Scholar5. Compton MT, Bahora M, Watson AC, Oliva JR: A comprehensive review of extant research on crisis intervention team (CIT) programs. J Am Acad Psychiatry Law 2008; 36:47–55Google Scholar6. Monahan J, Redlich AD, Swanson J, Robbins PC, Appelbaum PS, Petrila J, Steadman HJ, Swartz M, Angell B, McNiel DE: Use of leverage to improve adherence to psychiatric treatment in the community. Psychiatr Serv 2005; 56:37–44Google Scholar7. Thompson M, Osher F, Tomasini-Joshi D: The Essential Features of a Mental Health Court. New York, Council of State Governments Justice Center, 2008Google Scholar8. Seltzer T: Mental health courts: a misguided attempt to address the criminal justice system’s unfair treatment of people with mental illnesses. Psychol Pub Pol Law 2005; 11:570–586Google Scholar9. Skeem JL, Louden JE: Toward evidence-based practice for probationers and parolees mandated to mental health treatment. Psychiatr Serv 2006; 57:333–342Google Scholar10. Lamberti JS, Weisman R, Faden DI: Forensic assertive community treatment: preventing incarceration of adults with severe mental illness. Psychiatr Serv 2004; 55:1285–1293Google Scholar11. Farabee D, Yip R, Garcia D, Lu A, Sanchez S: Second annual report of the mental health services continuum program of the California Department of Corrections Parole Division. Sacramento, Calif, California Department of Corrections, 2004Google Scholar12. Prins SJ, Draper L: Improving outcomes for people with mental illnesses under community corrections supervision: a guide to research-informed policy and practice. New York, Council of State Governments Justice Center, 2008Google Scholar13. Baillargeon J, Binswanger IA, Penn JV, Williams BA, Murray OJ: Psychiatric disorders and repeat incarcerations: the revolving prison door. Am J Psychiatry 2009; 166:103–109Google Scholar14. Solomon P, Draine J: Explaining lifetime criminal arrests among clients of a psychiatric probation and parole service. J Am Acad Psychiatry Law 1999; 27:239–251Google Scholar FiguresReferencesCited byDetailsCited byDisrupting the Trauma- To - Prison Pipeline For Justice-Involved Young Women Victimized By Violence10 September 2022 | Journal of Child & Adolescent Trauma, Vol. 116Intersectoral violence prevention: the potential of public health–criminal justice partnerships5 July 2022 | Health Promotion International, Vol. 37, No. 3Promoting Mental Health and Criminal Justice Collaboration Through System-Level Partnerships1 February 2022 | Frontiers in Psychiatry, Vol. 13Evolution of Forensic Social Work in the United States: Implications for 21st Century Practice2 February 2011 | Journal of Forensic Social Work, Vol. 1, No. 1Costs and Savings Associated With the Police Use of the interRAI Brief Mental Health Screener18 October 2021 | Frontiers in Psychiatry, Vol. 12Psychosis, Mania and Criminal Recidivism: Associations and Implications for Prevention3 April 2020 | Harvard Review of Psychiatry, Vol. 28, No. 3A qualitative study of forensic patients' perceptions of quasi‐coercive offers of biological treatmentBehavioral Sciences & the Law, Vol. 38, No. 2Mental health treatment among older adults with mental illness on parole or probation28 March 2019 | Health & Justice, Vol. 7, No. 1Sexual Abuse, Vol. 31, No. 5Policing: A Journal of Policy and Practice, Vol. 12, No. 2Violence and Victims, Vol. 33, No. 1Perceptions of Procedural Justice and Coercion during Community-Based Mental Health Crisis: A Comparison Study among Stand-Alone Police Response and Co-Responding Police and Mental Health Clinician Response19 December 2016 | Policing, Vol. 37Preventing Criminal Recidivism Through Mental Health and Criminal Justice CollaborationJ. Steven Lamberti, M.D.15 July 2016 | Psychiatric Services, Vol. 67, No. 11Police Decision-Making in the Gray Zone5 October 2015 | Criminal Justice and Behavior, Vol. 43, No. 4Health & Justice, Vol. 4, No. 1Clinical Characteristics and Service Use of Incarcerated Males with Severe Mental Disorders: A Comparative Case-Control Study with Patients Found Not Criminally Responsible29 July 2014 | Issues in Mental Health Nursing, Vol. 35, No. 8References4 December 2013Balancing Accessibility and Selectivity in 21st Century Public Mental Health Services: Implications for Hard to Engage Clients15 December 2012 | The Journal of Behavioral Health Services & Research, Vol. 40, No. 2Behavioral Sciences & the Law, Vol. 31, No. 4Journal of Family Violence, Vol. 28, No. 7Complex Trauma and Aggression in Secure Juvenile Justice Settings10 May 2012 | Criminal Justice and Behavior, Vol. 39, No. 6Journal of Law and Religion, Vol. 27, No. 2Law and Human Behavior, Vol. 36, No. 3Journal of Crime and Justice, Vol. 35, No. 2BMC Psychiatry, Vol. 12, No. 1Public Policy and Limits of Diversion Programs for Reducing Jail Exposure of Persons With Serious Mental IllnessWilliam H. Fisher, Ph.D., Albert J. GrudzinskasJr., J.D., Kristen M. Roy-Bujnowski, M.S., and Nancy Wolff, Ph.D.1 December 2011 | Psychiatric Services, Vol. 62, No. 12Psychiatric Disorders and Unmet Needs in Australian Police Cells1 November 2010 | Australian & New Zealand Journal of Psychiatry, Vol. 44, No. 11Child and Adolescent Social Work Journal, Vol. 27, No. 6Journal of Police Crisis Negotiations, Vol. 10, No. 1-2 Volume 166Issue 11 November, 2009Pages 1211-1214THE AMERICAN JOURNAL OF PSYCHIATRY November 2009 Volume 166 Number 11 Metrics PDF download History Published online 1 November 2009 Published in print 1 November 2009" @default.
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