The Risk-Need-Responsivity model may be an effective case management approach for MHCs to assist with decision-making regarding admission, supervision intensity, and intervention targets. Interventions in mental health court contexts should attend to both criminogenic and mental health needs. This is the bottom line of a recently published article in Law and Human Behavior. Below is a summary of the research and findings as well as a translation of this research into practice.
Featured Article | Law and Human Behavior | 2015, Vol. 39, No. 5, 489-502
Multidimensional Evaluation of a Mental Health Court: Adherence to the Risk-Need-Responsivity Model
Mary Ann Campbell and Donaldo D. Canales University of New Brunswick-Saint John and Centre for Criminal Justice Studies, Saint John, New Brunswick, Canada
Angela E. Totten Saint John Police Force and Centre for Criminal Justice Studies, Saint John, New Brunswick, Canada
Ran Wei University of British Columbia–Okanagan
Alex C. Macaulay and Julie L. Wershler University of New Brunswick-Saint John and Centre for Criminal Justice Studies, Saint John, New Brunswick, Canada
The current study examined the impact of a mental health court (MHC) on mental health recovery, criminogenic needs, and recidivism in a sample of 196 community-based offenders with mental illness. Using a pre–post design, mental health recovery and criminogenic needs were assessed at the time of MHC referral and discharge. File records were reviewed to score the Level of Service/Risk-Need- Responsivity instrument to capture criminogenic needs, and a coding guide was used to extract mental health recovery information at each time point. Only mental health recovery data were available at 12 months post-MHC involvement. Recidivism (i.e., charges) was recorded from police records over an average follow-up period of 40.67 months post-MHC discharge. Case management adherence to the Risk-Need-Responsivity (RNR) model of offender case management was also examined. Small but significant improvements were found for criminogenic needs and some indicators of mental health recovery for MHC completers relative to participants who were prematurely discharged or referred but not admitted to the program. MHC completers had a similar rate of general recidivism (28.6%) to cases not admitted to MHC and managed by the traditional criminal justice system (32.6%). However, MHC case plans only moderately adhered to the RNR model. Implications of these results suggest that the RNR model may be an effective case management approach for MHCs to assist with decision-making regarding admission, supervision intensity, and intervention targets, and that interventions in MHC contexts should attend to both criminogenic and mental health needs.
case management, mental health court, mental health recovery, offenders with mental illness, Risk-Need-Responsivity (RNR) model
Summary of the Research
“Mental health courts (MHCs) are diversionary programs that redirect offenders with mental illness away from the criminal justice system and into the mental health system. Although studies have demonstrated the positive impact of MHCs on mental health and recidivism outcomes, a limitation of MHCs is that none have made use of a theoretically and empirically based risk assessment instrument to aid in case management and treatment planning, nor do they draw from models of effective correctional rehabilitation. The goal of the current study was to evaluate a Canadian MHC, the Saint John MHC, within the context of a well- validated correctional case management strategy known as the Risk-Need-Responsivity (RNR) model” (p. 489).
Mental Health Courts (MHC)
“MHCs are problem solving– oriented courts designed to reduce recidivism and meet the mental health needs of persons with mental illness who come into contact with the criminal justice system. These courts attempt to balance the legal responsibility of protecting the public with meeting the mental health needs of the accused by integrating mental health and social service interventions into the court’s operations. Although there is no prototypical model of MHCs, they have common features. MHCs use a team approach, often composed of at least legal, mental health, and public safety professionals. Cases appear on a separate docket from traditional court, and legal and treatment-oriented sanctions are imposed for noncompliance. Participation is usually voluntary, and the participant must accept responsibility for their behavior, though not necessarily in the form of a guilty plea. Completion of a MHC program usually results in a reduction or dismissal of the index criminal charges that led to the MHC referral. MHC participants have described their MHC experience in positive terms and perceive meaningful differences from traditional court environments, which tend to be more adversarial in nature” (p. 490).
“With regard to mental health recovery outcomes, MHC evaluations have generally produced positive findings. Studies have linked participation in MHCs with increased access to mental health services, enhanced capacity for independent functioning, reduced substance use, and improved mental health outcomes in its participants” (p. 490).
The Risk-Need-Responsivity (RNR) Model
“The RNR model is comprised of the three principles of risk, need, and responsivity. The risk principle states that intensive case management and intervention services should be reserved for high-risk offenders, whereas low risk offenders only require minimal services. The need principle states that to reduce recidivism risk, treatment should target criminogenic needs (i.e., risk and need factors that have an empirically demonstrated association with criminal behavior). The “Central 8” risk/need factors include a history of antisocial behavior, procriminal attitudes, antisocial peers/limited prosocial peers, antisocial personality, lack of prosocial leisure activities, lack of education/employment, family/marital problems, and substance abuse. The responsivity principle states that treatments based on cognitive- social learning methods are the most effective at reducing criminal behavior, and intervention strategies should be tailored to match the offender’s individual learning styles, motivations, and abilities (e.g., physical disabilities, mental health, low intelligence). Research has demonstrated the value of adherence to the RNR model for the purposes of risk reduction in offender populations” (p. 490-491).
“Applied to a MHC context, the RNR model would advocate for case management plans that match supervision and intervention intensity to an individual’s recidivism risk, emphasize the importance of treating criminogenic needs directly tied to criminal behavior in conjunction with mental health specific intervention, and would do so using evidence-based methods of intervention that are tailored to each client’s strengths and weaknesses. The RNR model has relevance to offenders with mental illness given that the major risk factors for general and violent recidivism are generally the same for offenders with or without mental illness. Furthermore, mental illness is only directly tied to criminal behavior in a minority of cases. Thus, a primary focus on mental health intervention while neglecting criminogenic factors and recidivism risk status will likely limit the ability of any program to reduce the risk of future criminal behavior in offenders with mental illness” (p. 491).
This study conducted a retrospective file-based review of cases that had been referred to the St. John MHC, in New Brunswick, Canada, to “(a) to evaluate the capacity of a MHC to lead to changes in mental health recovery, criminogenic needs, and recidivism risk, and (b) to examine the degree to which RNR principles were naturally embedded within the evaluated MHC program model even though this particular program had not been developed with this model in mind” (p. 491).
Results of the study revealed that “across assessment periods, completers had significant score decreases for most criminogenic needs. In contrast, partial-completers had a significant increase in Criminal History scores and there were no changes for nonstarters” (p. 495). Further, “there was a tendency for completers to have the lowest rate of recidivism relative to partial-completers and nonstarters, but these differences were not statistically significant” (p. 495). Additionally, findings suggest that at the time of discharge, issues related to mental health recovery had stabilized or improved.
“One of our core objectives was to examine whether MHC involvement facilitated recidivism risk reduction. At discharge, completers had moderate reductions in general recidivism risk and criminogenic needs, whereas partial-completers and nonstarters had little to no changes in these areas. In line with previous research, these results suggest that involvement in MHC has the potential to affect recidivism risk, with the greatest gains achieved by receiving the full dosage of the MHC program” (p. 499).
Translating Research into Practice
“The similar general recidivism patterns, particularly between completers and nonstarters, suggest that being processed through the MHC has an equivalent impact on recidivism as found by those cases processed through the traditional court system. However, our regression analyses indicated that matching needs to intervention is essential to facilitate recidivism reduction. This result highlights the need to pay closer attention to criminogenic factors and better integration of RNR principles in any program attempting to reduce criminal behavior, including MHCs” (p. 499).
Formal integration of the RNR model should be considered to bolster positive outcomes that MHCs have to offer mentally ill offenders. “The need principle of the RNR model advocates for correctional interventions that target specific dynamic criminogenic needs of the individual. The lack of attention to criminogenic risk factors in MHCs has been a noted criticism in the literature. Although addressing clinical concerns is an essential component of mental health recovery and can positively impact lifestyle factors that make one vulnerable to the influence of criminogenic risk factors, there should exist a balance between addressing mental health needs and criminogenic needs” (p. 500). “In addition, an integrated RNR and mental health recovery focused assessment and case management process may improve the capacity of MHCs to effectively achieve their dual goal of reducing the criminalization of offenders with mental illness and enhancing their functioning” (p. 501).
Other Interesting Tidbits for Researchers and Clinicians
“The benefit of the MHC intervention was primarily limited to offenders who completed the full dose of the program. Further research is needed to understand the reason why some offenders succeed in the program, but others do not” (p. 501).
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