Program Profile: Bronx (NY) Mental Health Court

This is a problem-solving court program that seeks to divert mentally ill adults who committed misdemeanor and felony offenses out of the justice system and into treatment to address their mental health issues and reduce their risk of recidivism. The program is rated Ineffective. There was no statistically significant effect on rearrests or reconvictions for treatment group participants, compared with similar individuals with a mental disorder in jail, at the 30-month follow-up.

An Ineffective rating implies that implementing the program is unlikely to result in the intended outcome(s).

An Ineffective rating implies that implementing the program is unlikely to result in the intended outcome(s).

Program Goals

The Bronx Mental Health Court in New York is a program that seeks to divert mentally ill adults who have committed misdemeanor and felony offenses out of the justice system and into treatment. It is a specialized court housed within the Bronx Supreme Court. The goals of the diversion program are to ensure participants receive treatment for their mental disorders and avoid future contact with the justice system by reducing participants’ risk of recidivism. During the program, participants receive court monitoring, case management, and treatment services.

Target Population/Eligibility

To be eligible for the Bronx Mental Health Court, participants must be at least 16 years old, have serious mental illness, and have committed felony or misdemeanor offenses. Most often, participants have Axis–I disorders listed in the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, including bipolar disorder and major depression. The court also takes the risk for future violence into consideration when deciding whether to accept an individual into the program. Those who are unstable or require hospitalization are not eligible to participate.

The Bronx Mental Health Court does not accept individuals who have committed murder, sex offenses, or arson. The program does not require that the conviction offense be related to the individual’s mental illness. Referrals for the program can come from prosecutors, defense attorneys, judges, family members, community providers, jail mental health staff, probation officers, “730” competency hearings, other case management or diversion programs, or from the defendants themselves. Referrals are screened with a seven-question form developed by the Bronx Mental Health Court. All referrals are processed by the supervising case manager and assigned a preplacement case manager who then screens them for clinical eligibility using myriad measures, including a biopsychosocial assessment, a clinical interview, standardized risk assessment tools, and measures of mental health, substance use, health, social functioning, and criminal behavior. Ultimately, whether a defendant can participate in the program is based on recommendations from the Treatment Accountability for Safer Communities team, the prosecuting attorney, and the defense attorney. The final decision, however, rests with the defendants themselves, who must voluntarily agree to participate without knowing what the required treatment will be and make a guilty plea to a higher charge than they would otherwise receive.

Services Provided/Key Personnel

The Bronx Mental Health Court has a 6-month minimum treatment mandate for those convicted of misdemeanor offenses, and an 18- to 24-month mandate for those convicted of felony offenses.

The quarterly status hearings—one of the main components of the Mental Health Court—can increase in frequency, based on an individual’s specific case. A status hearing consists of a review of the progress and compliance of the program participant. Since there are no predetermined sanctions for instances of noncompliance, the judge decides how to sanction a defendant.

Prosecutors play a large role in the Bronx Mental Health Court, including in entry decisions, discretionary decisions on suggested sanctions for participant noncompliance, final sentencing offered after graduation, and how charges will be handled (e.g., charges dismissed or reduced). After individuals are accepted into the Bronx Mental Health Court, a preplacement clinical team helps them apply for public assistance and find appropriate treatment. Treatment placements may include therapeutic communities, outpatient drug or alcohol treatment programs, temporary housing, or substance abuse inpatient treatment. The most common treatment placements are community based.

Once participants are linked with treatment, their postplacement case managers communicate with treatment providers, monitor treatment progress, and help solve any issues they are having while in treatment. The participants are responsible for participating in community-based treatment and for staying in regular contact with the Treatment Accountability for Safer Communities team and the Bronx Mental Health Court staff. The Treatment Accountability for Safer Communities team schedules consistent weekly appointment times with clients who are in community-based treatment and monthly visits for those in residential treatment.

To graduate from the Bronx Mental Health Court, the Treatment Accountability for Safer Communities team, judge, defense attorney (typically from an indigent-defense firm), and prosecutor must determine that the participant’s treatment plan goals were achieved. After graduating from the Bronx Mental Health Court, those with felony charges are able to re-plead to a lesser felony charge or a misdemeanor charge, and those with misdemeanors may have their charges reduced to a violation or dismissed. Those participants who fail to graduate from the program are sentenced to the jail alternative that was specified in the plea agreement when they entered the program; however, they will still be able to participate in the program in the future.

Program Theory

The Bronx Mental Health Court is a type of problem-solving court with an approach based on several crime reduction theories, including therapeutic jurisprudence, procedural justice, deterrence, and social learning (Rossman et al., 2012). Therapeutic jurisprudence posits that legal rules and procedures can be used to improve psychosocial outcomes (e.g., Anglin, Brecht, and Maddahian, 1990; Belenko, 1999; Collins and Allison, 1983). Procedural justice theory predicts that individuals who perceive they have been treated fairly by the criminal justice system will demonstrate better procedural outcomes (for example, compliance with court mandates). Further, deterrence theory asserts that actual or threatened sanctions should deter crime (Roman, Rossman, and Rempel, 2011). Social learning theory posits that, because people learn both positive and negative behaviors from their environment, rewarding prosocial behaviors can reinforce those behaviors in group settings (Akers and Sellers, 2008). Taken together, these theories underlie the Bronx Mental Health Court’s approach to deter future offending by offering voluntary participation in a judicially supervised treatment plan with incentives that reward adherence to the plan or other court conditions, and imposing sanctions for nonadherence.

Study

Rossman and colleagues (2012) conducted a quasi-experimental evaluation with matched comparison analysis to examine the effect of the Bronx Mental Health Court on participants’ recidivism (rearrest and reconviction rates) during a 30-month follow-up period. The impact analysis compared arrestees who participated in the Bronx Mental Health Court, who were assessed for eligibility as described in the Program Description, with those in jail who were diagnosed with mental disorders and receiving services from the New York City Department of Health and Mental Hygiene.

The treatment group (n = 564) consisted of those who were enrolled to receive services from the Bronx Mental Health Court between Jan. 1, 2002, and Dec. 31, 2006. The comparison group (n = 564) received standard mental health services from the New York City Department of Health and Mental Hygiene.

Propensity score matching was used to control for the differences between the treatment and comparison groups. After matching, there were no statistically significant differences in baseline characteristics between the matched groups. Participants in the Mental Health Court were 57 percent Hispanic, 35 percent Black, and 7 percent white. Sixty-two percent of the treatment group was male, and the average age at arrest was 36.8 years. The comparison group was 61 percent Hispanic, 31 percent Black, and 7 percent white. Sixty-one percent of those in the comparison group were male, and the average age at arrest was 36.9 years. While there were no statistically significant differences between the matched groups, explanatory variables were used to control for any differences between the comparison group and treatment group, and they included baseline demographics (e.g., race, gender, and age at arrest), mental health conditions and drug use history, characteristics of the instant offense for which arrestees were referred to mental health courts, and criminal history.

For program participants, recidivism was measured as whether they had an arrest or conviction after being admitted to the Bronx Mental Health Court. For the comparison group, recidivism was measured as whether they had an arrest or conviction after the initial mental health diagnosis. Data came from the Bronx Mental Health Court and the New York City Department of Health and Mental Hygiene. Logistic regression was used to predict the chance of rearrest and reconviction, adjusting for relevant covariates including race, gender, age at arrest, instant offense, substance use history, and prior arrest history. No subgroup analysis was conducted.

These sources were used in the development of the program profile:

These sources were used in the development of the program profile:

Akers, Ronald L., and Christine S. Sellers. 2008. Criminological Theories: Introduction, Evaluation, and Application. New York, N.Y.: Oxford University Press.

Anglin, M. Douglas, Mary–Lynn Brecht, and Ebrahim Maddahian. 1990. “Pretreatment Characteristics and Treatment Performance of Legally Coerced Versus Voluntary Methadone Maintenance Admissions.” Criminology 27:537–57.

Belenko, Steven R. 1999. “Research on Drug Courts: A Critical Review 1999 Update.” National Drug Court Institute Review 2(2):1–58.

Collins, James J., and Margaret Allison. 1983. “Legal Coercion and Retention in Drug Abuse Treatment.” Hospital and Community Psychiatry 34(12):1145–49.

Roman, John K., Shelli Balter Rossman, and Michael Rempel. 2011. “Chapter 2. Review of the Literature.” In Shelli Balter Rossman, John K. Roman, Janine M. Zweig, Michael Rempel, and Christine H. Lindquist (eds.). Final Report of The Multisite Adult Drug Court Evaluation, Volume 1: Study Overview and Design. Washington, D.C.: Urban Institute.