Abstract

This research will be looking at whether or not mentally ill offenders who are released from jails/prison are receiving the treatment that he or she needs in order to succeed in reentering society. The research will compare how mentally ill offenders are released from incarceration between New York City, who operates with mental health courts and Essex County Correction Facility, which does not have, or operate, any mental health courts, and how the mentally ill offenders are receiving treatment post-release. One hundred mentally ill offenders, 50 from NYC and 50 from Essex County, in all will be interviewed and observed to determine whether or not mental health courts have any statistically significant impact on reducing the rates of recidivism among mentally ill offenders who are released from incarceration. Over the course of twelve months, it will be determined if mental health courts are performing the way they were designed and helping mentally ill offenders rehabilitate and function in society or if mentally ill offenders are not receiving the help they need, as well as lowering the recidivism rates of mentally ill offenders. . Potential policy changes for mental health courts or jurisdictions without mental health courts will be made based on the analysis and outcome of the data.

Table of Contents:

Page 1: Title Page

Page 2: Abstract

Page 3: Table of Contents

Page 4: Specific Aims

Pages 5-8: Literary Review

(Pages 8-15: Research Design)

Pages 8-10: Sample Selection

Pages 10-13: Data Collection

Pages 13-15: Data Analysis

Pages 16-17: Proposed Budget

Pages 17-18: Budget Narrative

Page 19: Proposed Timeline/Schedule

Pages 20-22: Human Subject Issues

Page 23: Biblography

Specific Aims

I hypothesis that mentally ill offenders do not receive the treatment he or she needs from the mental health court system to be able to go back into society as a fully, able bodied citizen; the specific aims over the next 12 months are:

1. Interview the proprietors of the mental health courts to accurately determine how they handle mentally ill offenders who are being released from prison; interview warden of prison in a jurisdiction that does not have a mental health court in order to determine how that jurisdiction handles the release of the incarcerated mentally ill.
2. Interview fifty recently released mentally ill offenders from a jurisdiction with mental health courts for a period of nine months, and interview fifty recently released mentally ill offenders from a jurisdiction without mental health courts. The data gathered from the interviews with be compared with one another to determine whether or not mental health courts are helping mentally ill offenders receive the treatment he or she needs to go back to society and not recidivate.
3. All the data collected from interviews will be gathered and analyzed to determine whether or not the hypothesis is true. This analysis will show that mentally ill offenders are either receiving or not receiving the treatment he or she needs in order to go back into society.
4. The final aim is, after analyzing the data, to develop recommendations and possible policy changes based on the outcome of the research.

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Literature Review

The implementation of mental health courts is a relatively recent occurrence. Operating much like drug courts, mental health courts were implemented in only as recently as 1995. Since then, not many studies have been performed on determining on how effective mental health courts are at reducing recidivism and treating mentally ill offenders. Nearly no study has looked at whether or not mental health courts have been effective in their treatment in offenders, rather whether or not the courts were more effective at reducing recidivism rates among the mentally ill who are released from incarceration.

One of the first studies performed on mental health courts, titled “The Use of Criminal Charges and Sanctions in Mental Health Courts,” was performed by P. Griffin, Ph.D, and published in 2002. They interviewed the staff of four mental health courts to determine the strategies that mental health courts are using to treat mentally ill offenders. According to Griffin, it was found that “Mental health courts use one or more of three approaches…” when dealing with mentally ill offenders and treatment in the community. By the end of the research, Griffin found that the mental health courts rarely use jail as a way to treat the offender, but rather use community-focused rehabilitation techniques. This finding shows that areas with mental health courts, though in its nascent stages, were trying to not use jail as a treatment for mentally ill offenders. Rather, moreover probationary techniques were being used to treat mentally ill offenders.

The next group of research came after the passing of a law by congress giving aid to mentally ill offenders. Congress passed the “Mentally Ill Offender Treatment and Crime Reduction Act of 2004.” This granted more federal money to jurisdictions to research and develop mental health courts. This is important to note because there was a growth in the amount of research being done with mentally ill offenders.

In 2007, Doctor Dale McNiel and Doctor Renee Binder published their research under the title, “Effectiveness of a mental health court in reducing criminal recidivism and violence.” This study observed 170 mentally ill offenders moving through the new mental health court system. They were comparing the mental health court recidivism with the recidivism rates of mentally ill offenders moving through the traditional correction system. They used a “Propensity-weighted Cox regression analysis….finding that participation in mental health court programs was associated with longer time without new criminal charges or new charges for violent crimes.” This is important because it was showing that mental health courts were affecting the recidivism rates of mentally ill offenders. This is imperative to my study because it shows that although the courts are reducing the amount of time between mentally ill offenders recidivating, they are still committing crimes and going back to jail. There is something wrong with the treatment that, long term, offenders are still going back to jail.

Also in 2007, Doctor Anasseril Daniel published in the American Academy of Psychiatry and law, and article titled “Care of the Mentally Ill in Prisons: Challenges and Solutions.” Here, Daniel is observing that there is a major increase of the amount of mentally ill in prisons, and the numbers seem to keep rising. He observed the care and treatment that went on in prisons; concluding that prisons need “Innovative and comprehensive treatment programs in prisons, coupled with state-of-the-art diversionary measures…” This is important because here Daniel is highlighting the current problem with the amount of mentally ill in prisons and jails, and that they need innovative ways to deal with them because they are such a unique and vulnerable population. This highlights a need for my study because my study will look at the treatment that should be recommended for corrections or mental health courts and the best policy to adopt. Innovative and state-of-the-art technologies are costly for the already expensive prison systems. By determining what exactly is needed for the treatment of mentally ill offenders will help the state and prisons.

In 2011, Henry Steadman, Ph.D, and Allison Redlich, Ph.D published the “Effect of Mental Health Courts on Arrests and Jail Days,” in the JAMA Psychiatry journal. This study examined the effectiveness and operations of multiple mental health courts from multiple locales. They claim that mental health courts have “notorious idiosyncrasies,” and that more than one court needs to be studied using the same methodology. The researchers observed four different sites using a quaisexperimental design. The main question was looking at whether or not the courts are bringing more favorable outcomes for mentally ill offenders than the current use of jails. They found that on average, participants in mental health courts have more favorable outcomes in terms of treatment and recidivism than those who go to jail, but each mental health court uses his or her own methodology in achieving that goal. This is important to note because my study will be looking at what treatment mentally ill offenders feel they need most, quantifying that, and producing recommendations of treatment based on the results. Also important to note, is that this study was looking at short term effectiveness rather than long term effectiveness, short term being roughly six months. My study will be looking at treatment nearly twice as long, and can make longer term recommendations based on the findings.

In an article published in 2015, Marlon Pfleuger, Irina Franke, and Henning Hachtel wrote “Predicting general criminal recidivism in mentally disordered offenders using a random forest approach.” Here, the researchers were looking at the criminal recidivism of mentally ill offenders, and observing the elapsed time of recidivism. More than half were reconvicted, and the researchers were looking for a better way to predict who would be reconvicted again. This is majorly important because if we can look at the predictions of mentally ill offenders who are more likely to reconvict we can observe what he or she needs as treatment. While it is not for certain that this is a guarantee, being able to predict who is more likely to recidivate, than we can look at what treatments seem to be working and which ones are not.

Over the past few years there have been more studies being performed on mental health courts and the effect on mentally ill offenders. While more research continues, the number of mentally ill offenders in jails and prisons only continues to grow. There are currently on three hundred mental health courts in the country. While this is an improvement, my study will be using this past data and looking at what treatment can be improved for the mentally ill offender.

Sample:

This study is designed to use a deductive approach to determine whether or not the hypothesis, that mentally ill offenders are not receiving the treatment he or she needs after the release from incarceration, is true or false. There are currently about “705,000 mentally ill offenders currently incarcerated in state facilities, and roughly 480,000 in local jails” (National Institute of Corrections). After receiving approval from the IRB, I will begin by partnering with New York City’s Mental Health Court, and Essex County Correctional Facility. This study will observe a total of one hundred mentally ill offenders who are released from incarceration, observe the treatment they receive post-release, and if the offender recidivates back to incarceration. Non-probability sampling will be used to gather the sample group for this study. The first fifty mentally ill offenders who go through New York City’s Mental Health Court will be selected to be a part of this study. If, at some point, one of the fifty denies voluntary permission to be involved in this study, then we will simply move the fifty-first person to be released from the mental health court, and so on. The same sample process will be used for the sample gathered from Essex County Correctional Facility, where no mental health courts are used. The first fifty inmates, who have been identified to have a mental illness, will be chosen, upon release, to be a part of this study. If, at some point, of of the fifty deny permission to be used as part of this study, then we will simply move onto the next offender to be released. I will use this method because the study is designed to track how mentally ill offenders are receiving treatment from the start of their release over a one year period. This method will garner the best results for being able to follow and observe the treatment of mentally ill offenders. This method will ensure that we, the researchers, are looking at someone from the moment that he or she is released, and how they reenter society. This also keeps the sampling somewhat randomized, as there is no picking and choosing who will be a part of the study. It will simply be the first group of people the jail is releasing or the mental health court is treating.

Data Collection:

The initial data collected will be the recidivism rates/percent’s of mentally ill offenders; this will be requested from both jurisdictions. Next, will be cross-sectional interviews that will be with the judges and prosecutors of the New York City Mental Health Court to determine how they treat or handle mentally ill offenders going through the court. They will be asked the following questions:

What is the process used to treat mentally ill offenders coming through the court; what treatment is available after the offender has gone through the court system; are there any follow-ups the court uses?

Next, interviews will be held with the warden or administration of the Essex County Correctional Facility in order to determine how they handle and treat the incarceration and release of mentally ill offenders. They will be asked essentially the same questions as the New York City court, in-order to keep consistency between the two jurisdictions in the study. The questions asked with be as follows:

What is the process the jail uses to treat mentally ill offenders who are incarcerated; what treatment is available to the offender upon release of incarceration; are there any follow-ups the jail has with the offender after the release from incarceration?

After these interviews are done with the officials, interviews and surveys will start to be taken with the offenders who have been released; all will be done on a face-to-face basis.  These offenders who are interviewed will have follow-up interviews done roughly once a month, over a period of twelve months. The initial interviews will have a mix of qualitative and quantitative questions. The following is an example of the questions that will be asked for initial interviews:

1. How many times have you been arrest?
2. How many times have you gone to jail/prison?
3. Did you receive treatment for your illness in jail/prison?

1. Did you feel that the treatment was adequate?

4. Did you feel as though you received the right treatment after release?
5. Are you confident that the treatment provided will help keep you out of jail/prison?
6. (If applicable) Was mental health court more helpful/beneficial for you, or was jail better to go through?
7. Upon release, were you given any resources to help you treat any problems?
8. Were you given medication upon release?

1. If so, how much medication were you given?

9. Are you addicted to any drugs?

1. If so, do you use these in-lieu of your medication?

10. Do you feel like you are getting the right treatment now that you have been released?

These initial questions will help me and the researchers get an adequate idea of what it is like for the mentally ill offender to be released from incarceration or how they feel going through the mental health court. Along with this initial interview, it will be important to note the race, ethnicity, age, and other biographical data of the offender.

Following the initial interview, the mentally ill offender will be given a survey once a month for them to fill out. This survey will allow us to see how the offender is coping with reentering society and the treatment they are receiving. The following figure is an example of the survey they will fill out:

Either the main researcher, I, or one of the part-time researchers giving this survey will notify the subject that the researcher can read it to them and help fill it out. Tape recorders will also be used during any conversation to provide capture any extra data that may be said and not written down. This data will be collected for a period of twelve months.

Data Analysis

The data collected from the one hundred mentally ill offenders at the end of the twelve month period will be analyzed between the two jurisdictions looked at. The information collected about how mentally ill offenders feel about their treatment will have been obtained from the thirteen surveys/interviews done over the time period. This data will reveal how mentally ill offenders are treated between mental health courts and correctional facilities. Review of the data will be used to classify how offenders are being treated, how long they have received treatment, if any have recidivate, and how they are going back into society. All of this data will be broken down over four-three month periods, and used comparatively between one another. The main research question will also be answered — whether or not mentally ill offenders feel as if they are receiving the treatment he or she needs upon release from the courts and corrections. This information will be used and charted (see figure 1 below).

The qualitative data will be used to find if a significant amount of offenders feel as if they are receiving the treatment they need, or if they are not receiving the treatment he or she needs. This data will also be used to answer the question of “why” they do or do not feel they are getting the treatment he or she feels like they need. Questions that can be answered yes/no will be coded and applied to SPSS software; then we will run a chi-squared test to determine whether our hypothesis is correct. To measure this, we are looking for data that shows that at least seventy-five percent of the subjects questioned do not feel like he or she is receiving the treatment necessary for them.

Quantitative data will be used to determine what portions of populations are affected by treatment, and the stress that is brought on from release. We will look at age, race, ethnicity, gender, and economic status of each participant. This information will be applied to their answers of whether or not they are receiving the correct and necessary treatment. Cross-tabulations will be run in SPSS to determine common threads between age, race, ethnicity, and if they feel like they are getting the necessary treatment. Data will be broken down between race, age, ethnicity, and economic status. This will show whether or not there are certain groups that are receiving better treatment or worse treatment.

Finally, we will compare the treatment between offenders who have gone through mental health courts and those who have gone through the correction system. This will show if one is providing better treatment to mentally ill offenders or if they are roughly the same kind of treatment. A comparative pie graph, (see figure two) will be made to answer this. The graph will show the percentage of mentally ill offenders from mental health courts and their perspective on treatment versus the percentage of mentally ill offenders from the correctional facility and their perspective on treatment. This will all be used in order to give recommended policy changes that will improve treatment for the mentally ill offender.

Figure 1:

Figure 2:

Budget

We are requesting a total budget of 110,410 dollars. The budget for the research will be as follows:

Budget Narrative

The first items on the budget are personnel costs. The first cost is for sixty thousand dollars, and that is to pay the main researcher — myself. The second personnel cost is for two employees to assist with the research. Because the research will require that interviews be done for a one year period with mentally ill offenders, employees will be of great help gathering that data and compiling the information into usable data. Included in personnel cost are the insurance cost needed to cover each employee during the research term. This payment is for a total one year of research, and includes a full year of pay for each employee.

Following personnel costs are line costs that will help with the research. The first line item are for three computers. One computer for each person involved with the research; the computers will allow each person to type and save all their collected data. The electronic recorders will allow each of the researchers to record all conversations they have with interviewee’s. Recording conversations will allow the researchers in the study to playback information collected and help with data analysis. The Google Drive for Work is an online software that will allow for all research to be saved and shared with the other researchers instantly. All recorded information from the electronic recorders will also be stored on Google Drive for Work. This item will also allow everything to be shared with ease between each researcher. This will assist in eliminating possible confusion and extra work between employees. The transportation cost will cover any and all transportation between the two jurisdictions (New York City and Essex County Correctional Facility) for the researchers to conduct interviews with mentally ill offenders and those who are in-charge of their release and rehabilitation back into society (the proprietors of the mental health courts and the warden of the Essex County Correctional Facility). The next two items requested budget are tied together, but separated for ease of seeing what the budget is being applied too. Requested are three cell phones, and a business cell phone network plan, for each employee will allow for the ease of communication and collaboration between the researchers. This will allow the researchers to talk and plan together even when they cannot meet in person. The cell phones will also give access to Google Drive for Work for when the researchers cannot access the program via computer. The money for the office supplies will be used for printer, paper, ink and toner, writing utensils, and necessary notebooks. Additionally, the miscellaneous supplies section will be used for anything that breaks or needs repair. This will allow the research team to be able to replace items as necessary.

It is important to note that none of those who are participating in the subject are receiving compensation for their time during the study. The study is solely voluntary, and will be treated as such. Each participant will be sure to be thanked for his or her time involved in the study.

Schedule/Time Line

The schedule for the study is to be conducted over a one year period. This one year period will incorporate the data collection, the analysis of the data, and the recommendations or policy changes that should be made based on the outcome of the data. The study will be slated to begin in the month of June, 2015. Here, the first interviews will be made with proprietors of the mental health courts in New York City, and the Warden or administration of the Essex County Correctional System. After the interviews with the courts and warden are done, the sampling pool with be selected based on a non-probability sampling method. Interviews will begin with mentally ill offenders who were just released from incarceration. The interviews with the mentally ill offenders will happen over a twelve month period. This period will include the interviews with one hundred mentally ill offenders — fifty in NYC and fifty Essex County. This time period will track how the recently released offenders are coping with release from incarceration, and if they are able to go back to society. It will also track whether or not the offenders are recidivating and not receiving the help they need.  After these twelve months of tracking mentally offenders and interviewing them, the next part of the timeline will consist of compiling the data, analyzing it, and determining if the mentally ill offenders who were treated by the mental health courts were giving the tools and the treatment needed to go back to society after incarceration. The completion of the time line will yield the final results of the data, and any recommended policy changes that should occur due to the results found.

Human Subject Issues:

Because this study will be observing recently incarcerated mentally ill offenders, there is a high sensitivity to possible human subject issues. Mentally ill are people who are more vulnerable to possible abuse or misuse by researchers; many people who are mentally ill have a harder time understanding and knowing what the researchers are saying to them. It is easy, therefore, for mentally ill people to be taken advantage of, even unknowingly. That is why extra care will be taken when dealing with those who are mentally ill offenders. First, and foremost, I will obtain informed consent from the research subjects. A form (see fig. 1 at end of section) will be not only given to them, but also explained to ensure that he/she understands what they are agreeing to. This will be a voluntary approach that can be denied at any time. Before going any further with research, each research subject will fully understand and have had agreed to the stipulations of the study. If, at any time, the subject rejects or no longer wants to be involved with the study, then I, the researcher, will have an obligation to move on and no longer question that particular person. Next, the researchers, either myself or the employees, will need to do everything possible to minimize possible harm that we can cause. This includes, but is not limited to, the emotional pain or economic hardships that may be brought up when talking about having a mental illness and being released from incarceration. If, at any point, the subject is, or appears to be, hurting themselves in a seriously negligent way, the correct authorities will need to be contacted.

Thirdly, because of the sensitivity of the nature of the research, all postings in the study about individuals will be completely anonymous. This will be done to ensure the protection of the individual from any potential harm that may come from the study. Nothing said by any offender involved with the study will be able to be traced back to a particular person. This protects the person and their personal lives. Much like anonymity, confidentiality will be particularly important. Any particular information that may contain anything that may identify anyone who is a subject in the study will be kept completely confidential. This will eliminate, or inhibit, any possible damage to the person(s) reputation, life, or lifestyle. It will also eliminate anyone who reads the published study to be able to identify a particular subject of the study. Finally, there is the question of whether or not the potential risks outweigh the benefit that comes from this study. The potential impact this study has on improving the overall treatment and health care of mentally ill offenders who are released from incarceration far outweighs the risk of mentally ill offenders being a part of the study. The study is designed to recommend policy changes that would change the nature of one's release for the better.

Because of the sensitive nature and vulnerability of mentally ill offenders, it will be of utmost importance in this study to address any, and all, human subject issues. All measures in this study will be done to ensure that as many risks as possible are eliminated, and that the safety of any subject is upheld.

The following is the form that will be given to, and read to, all participants of the study. They will need to initial next to each of the statements, after it has been explained to them, indicating that they understand what is being given to them.

Figure 1

Bibliography

1. Adult Mental Health Treatment Courts Database. (n.d.). Retrieved May 21, 2015, from http://gainscenter.samhsa.gov/grant_programs/adultmhc.asp

2. Almquist, L. (2009). Mental Health Courts: A guide to research informed policy and practice. MacArthur Foundation, 1-54.

3. Daniel, A. (2007). Care of the Mentally Ill in Prisons: Challenges and Solutions. PsycEXTRA Dataset, 35(4), 406-410.

4. Griffin, P. (2002). The Use of Criminal Charges and Sanctions in Mental Health Courts. Psychiatric Services, 53(10), 1285-1289. http://dx.doi.org/10.1176/appi.ps.53.10.1285

5. McNiel, D., & Binder, R. (2007). Effectiveness Of A Mental Health Court In Reducing Criminal Recidivism And Violence. American Journal of Psychiatry, 164(9), 1395-1403. http://dx.doi.org/10.1176/appi.ajp.2007.06101664

6. NICIC.gov: Mentally Ill Persons in Corrections. (n.d.). Retrieved May 21, 2015, from http://nicic.gov/mentalillness

7. Pflueger, M., Franke, I., Graf, M., & Hachtel, H. (2015). Predicting general criminal recidivism in mentally disordered offenders using a random forest approach. BMC Psychiatry.

8. Steadman, H., Redlich, A., Callahan, L., Robbins, P., & Vesselinov, R. (2011). Effect of Mental Health Courts on Arrests and Jail Days. Arch Gen Psychiatry Archives of General Psychiatry, 68(2), 167-167.