Diversion completion is related to criminological, clinical, psychosocial, and procedural factors. This is the bottom line of a recently published article in International Journal of Forensic Mental Health. Below is a summary of the research and findings as well as a translation of this research into practice.
Featured Article | International Journal of Forensic Mental Health | 2018, Vol. 17, No. 1, 1-12
Seto, C. Michael, Royal Ottawa Health Care Group
Basarke, Sonya, Ryerson university
Healey, V. Lindsay, Royal Ottawa Health Care Group
Sirotich, Frank, Canadian Mental Health Association & University of Toronto
Mental health diversion is an important option for offenders with mental illness who do not pose a serious risk to public safety and who would otherwise be better served outside the criminal justice system. Predictors of complete vs. incomplete diversion were examined in a sample of 708 defendants seen in Toronto’s mental health diversion programs. Univariate analyses revealed that
unsuccessfully diverted defendants were significantly more likely to be younger, homeless, and have more clinical and legal needs compared to those who were successfully diverted. In multivariate analyses, criminological factors (e.g., criminal history) had the strongest association with diversion completion, compared to clinical (e.g., primary diagnosis) and psychosocial (e.g., employment status) factors outside of marital status, which was strongly associated with completion. The results from this research add to previous research on mental health courts and diversion by giving guidance on how to select and prepare diversion candidates. These findings suggest that diversion programs may benefit from adaptations in order to better suit high need clients.
Diversion, mental health court, mentally disordered offenders
Summary of the Research
“Evidence indicates that successful diversion provides better legal outcomes compared to the traditional criminal justice system or unsuccessful diversion” (p. 2).
Therefore “a more thorough understanding of what factors are associated with successfully completing a diversion program is crucial to designing and adapting programs to effectively assist clients with a serious mental illness” (p. 3).
“The mandate of the Consortium is to reduce or prevent criminal justice involvement for individuals over 16 with serious mental illness who have been charged with a criminal offense. One way this is accomplished is by assisting individuals with the mental health diversion process by developing individualized community treatment plans and linking individuals to treatment and support services” (p. 3).
The aim is to prevent the client’s further involvement with the criminal justice system by connecting him or her with clinical and social services and supports that address mental illness and psychosocial issues” (p. 3).
“As an alternative to prosecution, a defendant with a mental illness charged with a relatively minor offense may participate in a treatment or supervision plan” (p. 3).
“If diversion was successfully completed, the charges could be stayed, withdrawn, or the Crown could order a peace bond (a court order requiring an individual to keep the peace and be of good behavior) instead of pursuing a conviction” (p. 3).
“Data were obtained for a total of 708 diversion clients drawn from a common database maintained by the Mental Health Court Support Consortium, a network of community-based organizations that provide mental health court support to five courts in Toronto, Canada.” (p. 3).
“Variables included in the study represented five broad domains: (1) demographic (e.g., age, gender); (2) psychosocial (e.g., marital status, primary income source, employment status, residence type, living arrangement, psychosocial presenting issues, psychosocial service referrals needed); (3) clinical (e.g., primary diagnosis, substance use problem, clinical presenting issues, clinical service referrals needed); (4) criminological (e.g., total prior sentencing events and offenses, index offense, total current offenses and legal needs); and (5) procedural (e.g., time in program)” (p. 4).
“For the present study, diversion completion was defined as an individual having his or her charges stayed or withdrawn, or being given a peace bond, none of which results in a criminal record. Unsuccessful diversion referred to an individual dropping out, being noncompliant with the program, or being deemed not suitable for diversion by the Crown after participating in a treatment program” (p. 4).
“It was found that individuals who successfully completed diversion were significantly older than individuals who were unsuccessful or not approved for diversion. Housing type at admission was significantly related to diversion outcome; homeless individuals were more likely to be in the unsuccessful diversion group” (p. 8).
“In regard to the clinical variables, it was found that the successful diversion group had a lower mean number of clinical needs compared to the unsuccessful diversion group. In addition, the only significant difference on primary diagnosis was that the unsuccessful group had higher than expected proportion of those with no diagnosis at all.
“[T]he successful diversion group had significantly longer lengths of stay in the program compared to the unsuccessful group.” (p.8).
“A surprising finding was that substance use issues were not related to diversion outcome which is in contrast to research that has found a link between substance abuse and legal involvement, including recidivism” (p.8).
Translating Research into Practice
“[D]iversion completion was related to criminological, clinical, psychosocial, and procedural factors. The results are consistent with previous findings, but also identify important psychosocial factors associated with diversion success. Criminological factors were the strongest predictors of success in the sample. Individuals who were successfully diverted were less likely to have a criminal history or legal needs” (p. 9).
“Among the clinical predictors, none of the diagnostic variables, including substance use, were related to the outcome. Greater need for clinical services such as a psychiatrist or treatment program was modestly and inversely associated with diversion completion” (p. 9).
“Sociodemographic factors reflecting higher client needs, such as lower income, less education, substance use problems, and presence of mental disorder or psychological distress (e.g., suicide thoughts) have all been shown to increase the odds of dropout from general outpatient mental health treatment in Canada and the U.S … In addition, a meta-analytic review on offender treatments concluded that the participants who were the most likely to be unsuccessful in programs were those with the highest risk and the highest needs (p.9).
“[G]iven that the severity of the violent index offense (measured by the Cormier-Lang scale) was just as likely to predict an unsuccessful diversion as nonviolent offenses, consideration may be given to expanding the scope of offenses deemed eligible for diversion to include more serious offenses” (p. 10).
“A practical problem with not having criminal history is that it is an important predictor of recidivism, as are other well-established criminological risk factors such as young age, being male, and substance use problems” (p. 10).
“[E]nsuring diversion clients are appropriately linked to general practitioners, psychiatrists and other clinical services could potentially increase their likelihood of diversion success, and is also consistent with the mandate and intention behind mental health diversion” (p. 10).
“[C]lients who may be less complex or difficult to serve—in terms of having less criminal history, and fewer clinical and legal service needs—were more likely to complete diversion” (p. 10).
Other Interesting Tidbits for Researchers and Clinicians
“[The study] did not find a significant association for age, gender, primary diagnosis, or substance use. Potential explanations for these differences include the selection of diversion candidates, diversion programming, and decision-making about diversion termination” (p. 9).
“Of note, the only psychosocial variable which was significant was being married. This result is an important contributor to the current body of literature considering marital status has been shown to have no impact on diversion success and has actually shown to be associated with withdrawal from community mental health services in a national sample” (p. 9).
“[A] number of areas for further research, including more rigorous evaluations of mental health court diversion effectiveness, evaluations of cost-effectiveness, and identification of the components of diversion that might be most helpful” (p. 10).
“It would be valuable to replicate and extend our findings by following defendants with mental health concerns prospectively, collecting information about their criminal histories, clinical needs, as well as more nuanced indicators of diversion involvement such as the program components they participated
in, level of participation, and compliance (or noncompliance) with diversion recommendations” (p. 10)
Join the Discussion
As always, please join the discussion below if you have thoughts or comments to add!