Program Profile: Brooklyn (NY) Mental Health Court

This program seeks to divert adults with mental illness diagnoses who have committed misdemeanor and felony offenses away from the justice system and into treatment. The goals of the program are to ensure participants receive treatment for their mental disorders and do not have future contact with the justice system. The program is rated Promising. Participants had a statistically significant lower likelihood of being rearrested and reconvicted, compared with the comparison group.

A Promising rating implies that implementing the program may result in the intended outcome(s).

Program Goals

The Brooklyn Mental Health Court (MHC) in New York is a program that seeks to divert mentally ill adults who have committed misdemeanor and felony offenses away from the justice system and into treatment. The goals of the diversion program are to ensure participants receive treatment for their mental disorders and avoid future contact with the justice system. During the program, participants receive court monitoring, case management, and treatment services.

Target Population/ Eligibility

The Brooklyn MHC targets adults (who are 16 years or older) with serious mental illness who have committed nonviolent offenses. Participants have Diagnostic and Statistical Manual of Mental Disorders, 4th Edition (DSM-IV) Axis–I disorders, which include schizophrenia, major depression, and bipolar and schizoaffective disorders. The Brooklyn MHC accepts adults who have committed felony and misdemeanor offenses, unless they have committed murder or rape. Violent felonies are presumably ineligible, but are reviewed on a case-by-case basis.

Legal eligibility is determined by the Brooklyn MHC judge in conjunction with the program’s designated assistant district attorney. The Brooklyn MHC makes eligibility considerations based on referrals. Referrals originate from a variety of sources, including the Office of the District attorney, defense attorneys, “730” competency hearings, other judges, and other sources within the Brooklyn court system.

Brooklyn MHC clinical staff begin the assessment process once all parties (defendant, defense attorney, judge) signal their agreement to begin the process. After the client’s first appearance, a clinical assessment occurs, which consists of a psychosocial assessment and a psychiatric evaluation, the results of which contribute to the final eligibility determination by the court’s clinical director.

The Brooklyn MHC is a voluntary program, which means that eligible individuals may decline participation and have their cases processed through conventional means (i.e., through the traditional criminal court system). Also, if found eligible, individuals can participate more than once.

Services Provided

Once accepted into the program, Brooklyn MHC participants must submit a guilty plea and agree to participate. An individualized treatment plan is then created by the court program’s clinical staff for the specified period. This mandated community-based treatment ranges from a 12-month period for misdemeanors to a 12- to 18-month period for first-time felony charges to an 18- to 24- month period for predicated offenses.

The individualized treatment plan includes mental health treatment, substance use treatment, community-based case management, supported housing, and vocational/educational services. Treatment plans are tailored to the individual to best serve participants’ clinical and legal needs. Frequent appearances before the judge are required to monitor client progress. Pre-participation program candidates appear once a month, and fully enrolled participants appear every 1 or 2 weeks for the first 3 months and then monthly unless otherwise specified. Defendants meet with their case management staff whenever there is a scheduled court appearance. The most common court appearance is a status hearing, which is held weekly, biweekly, or monthly and involves progress monitoring of the client.

The Brooklyn MHC uses a clinical court team design wherein the clinical team is part of the court and not a separate agency. Clinical staff develop a shared knowledge of each program participant through regular team case reviews. Also, the case management team engages in back-and-forth problem solving with community treatment providers, which is designed to monitor participant progress and troubleshoot possible obstacles on the part of the participant or treatment provider.

After successful completion of the program, those who have a misdemeanor offense or a first-time nonviolent felony offense have their pleas vacated and their cases dismissed, while those who have a first-time violent offense or have subsequent felony offenses may have their felony reduced to a misdemeanor. Those who do not successfully complete the program are sentenced to the jail or prison term agreed to at the time of the plea.

Key Personnel

The Brooklyn MHC team consists of a project director, clinical director, social worker, two full-time and one part-time forensic coordinators, judge, resource coordinator, assistant district attorney, and designated defense attorneys.

Program Theory

The underlying assumption of the Brooklyn MHC is that defendants’ criminal behaviors are the result, at least in part, of untreated or inadequately treated mental illness. The idea is that treating a defendants’ mental illness will lead to stability, which in turn, will lead to a reduction in criminal behavior.

Study

Rossman and colleagues (2012) used a quasi-experimental design and included process and impact analyses to examine the impact of the Brooklyn Mental Health Court (MHC) on participants’ recidivism during a 30-month, follow-up period. The program took place in Brooklyn, New York. Multiple data sources were used, including semi-structured interviews with program staff and key partners, repeated courtroom observations, document review, and administrative data from the New York City Department of Health and Mental Hygiene (DOHMH) and the New York State Division of Criminal Justice Services (DSJC). Impact analysis compared recidivism outcomes of Brooklyn MHC participants with matched comparison groups of individuals with mental illness who were processed in traditional criminal courts.

The treatment group (n = 327) consisted of those who participated in the Brooklyn MHC between March 1, 2002, and December 31, 2006. Participants were 76 percent male, and the average age at arrest was 33 years. Fifty-eight percent of the treatment group were Black, 38 percent were white, and 4 percent were marked as other race/ethnicity. Twenty-one percent were of Hispanic ethnicity. Additionally, 84 percent of the Brooklyn MHC sample were arrested for a felony offense. Mood disorders (e.g., bipolar disorder, major depression) were the most prevalent diagnoses among the sample (55 percent), followed by psychotic disorders such as schizophrenia (37 percent). Co-occurring substance use problems were very common among the sample (62 percent).

Of the 327 MHC participants, 303 were matched using a one-to-one propensity score matching procedure. The comparison group (n = 303) received standard mental health services from the DOHMH. Participants in the DOHMH control group were 55 percent Black, 41 percent white, and 4 percent were marked as other race/ethnicity. Twenty-two percent were of Hispanic ethnicity. Seventy-eight percent of the control group was male, and the average age at arrest was 35 years.

There were still significant differences between the treatment and control groups after matching. Specifically, treatment group members were, on average, 1.5 years younger than comparison group members at the time of first arrest. Also, slightly more subjects in the treatment group (24 percent) were arrested for drug crimes than those in the comparison group (21 percent). Lastly, there were significant differences between the Brooklyn MHC group and the DOHMH samples in terms of mental health conditions, but these differences were balanced following the matching process.

Recidivism, the outcome of interest, was measured as a subsequent arrest or conviction after being admitting to MHC. For the DOHMH comparison group, recidivism was measured as a subsequent arrest or conviction after the initial mental health diagnosis. Results were examined using logistic regression models. No subgroup analysis was conducted.

There were several challenges to implementation, including a lengthy and confusing referral process, a lower volume of participants than anticipated, and severe limitations in local treatment and housing capacity. More information on implementation of the Brooklyn Mental Health Court is available at http://www.courtinnovation.org/sites/default/files/BMHCevaluation.pdf.

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

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

Following are CrimeSolutions-rated programs that are related to this practice:

Adult Mental Health Courts

Specialized, treatment-oriented, problem-solving courts that divert mentally ill persons away from the criminal justice system and into court-mandated, community-based treatment programs in order to reduce recidivism and decrease the amount of contact that mentally ill individuals have with the criminal justice system. The practice is rated Promising for reducing recidivism, but rated No Effects on measures of clinical outcomes.

Evidence Ratings for Outcomes

	Crime & Delinquency - Multiple crime/offense types
	Mental Health & Behavioral Health - Multiple mental health/behavioral health outcomes

Why might a practice's outcome ratings differ from the ratings of specific programs encompassed by that practice?