Deciding to participate in mental health court: Exploring participant perspectives

Psychiatric disorders and reoffending risk in individuals with community sentences in Sweden: a national cohort study

BACKGROUND

Community sentences are widely used in many countries, often comprising the majority of criminal justice sanctions. Psychiatric disorders are highly prevalent in community-sentenced populations and are thus potential targets for treatment interventions designed to reduce reoffending. We examined the association between psychiatric disorders and reoffending in a national cohort of individuals given community sentences in Sweden, with use of a sibling control design to account for unmeasured familial confounding.

METHODS

We did a longitudinal cohort study of 82 415 individuals given community sentences between Nov 1, 1991, and Dec 31, 2013, in Sweden using data from population-based registers. We calculated hazard ratios (HRs) for any reoffending and violent reoffending with Cox regression models. We compared community-sentenced siblings with and without psychiatric disorders to control for potential familial confounding. Additionally, we calculated population attributable fractions to assess the contribution of psychiatric disorders to reoffending behaviours. The primary outcomes of the study were any (general) reoffending and violent reoffending.

FINDINGS

Between Nov 1, 1991, and Dec 31, 2013, those given community sentences who were diagnosed with any psychiatric disorder had an increased reoffending risk in men (adjusted HR 1·59, 95% CI 1·56-1·63 for any reoffending; 1·60, 1·54-1·66 for violent reoffending) and women (1·71, 1·61-1·82 for any reoffending; 2·19, 1·88-2·54 for violent reoffending). Risk estimates remained elevated after adjustment for familial confounding. Schizophrenia spectrum disorders, personality disorders, and substance use disorders had stronger associations with violent reoffending than did other psychiatric disorders. Assuming causality, the adjusted population attributable risk of psychiatric disorders on violent reoffending was 8·3% (95% CI 6·6-10·0) in the first 2 years of community follow-up in men and 30·9% (22·7-39·0) in women.

INTERPRETATION

Psychiatric disorders were associated with an increased risk of any reoffending and violent reoffending in the community-sentenced population. The magnitude of the association between psychiatric disorders and reoffending varied by individual diagnosis. Substance use disorders had the highest absolute and relative risks. Most of the increased risk for any reoffending in individuals with psychiatric disorders could be attributed to comorbid substance misuse. Given their high prevalence, substance use disorders should be the focus of treatment programmes in community-sentenced populations.

FUNDING

Wellcome Trust.

"You feed and water a rose bush and eventually it blossoms": Constructions of self-transformation among mental health court defendants

This study qualitatively examined adaptive responses to mental health court mandates through individual interviews with defendants in a mental health court (n = 31). Thematic analysis of interview data revealed that defendants engaged in meaning-making to comprehend and adapt to the perceived programmatic demands of mental health court. Programmatic burdens, court-enforced accountability, and intrinsic rewards were themes that converged to form a distinct adaptive response: construction of self-transformation narratives. Defendants in this study tended to interpret the intense burdens of participation as intrinsically rewarding and meaningful, leading them to see the expectations of mental health court as an opportunity to better themselves. The findings help to differentiate between compliance versus full treatment engagement among defendants with serious mental illness (SMI). This study's findings have important implications for how individuals with serious mental illness engage with court diversion programs and mandated treatment, and how these defendants may be best served in specialized mental health court programs.

New justice system responses to mentally impaired defendants in New Zealand

On 16 March 2020 the District Court in Auckland, New Zealand, had its first sitting as a court dedicated exclusively to cases where issues of fitness to stand trial or insanity had been raised. The impetus for these court sittings, called 'the CPMIP Court' [after the Criminal Procedure (Mentally Impaired Persons) Act 2003], was to reduce delays for mentally impaired defendants, and improve the coverage and efficiency of mental health advice to the Court from both Court Liaison Nurses and Health Assessors (Psychiatrists and Psychologists). This article looks at the model in operation and reflects on some early outcome data, as the possibility of further expansion of this model is contemplated in other regions. We also consider broader challenges currently facing mentally impaired defendants in New Zealand's criminal justice system, and argue that other innovative judicial approaches such as the establishment of problem-solving mental health courts should be considered.