RESEARCH WEEKLY: Mandated Community Treatment Benefits for Justice-Involved Individuals with Serious Mental Illness
Court oversight may be the key for criminal justice-involved people with serious mental illness to stay in community treatment and avoid criminal justice recidivism, according to new research.
People with severe mental illness who are arrested and subsequently found not guilty by reason of insanity (NGRI) may need continued support from the court well after their symptoms have abated, the authors suggest. The authors work to answer the question of whether court supervised community treatment must remain in place for re-arrest rates to stay low among this group. Mandated court oversight of treatment is often required for individuals released from hospitals after being declared NGRI. It is implemented with the goal of reducing recidivism for the individual and keeping the other members of their community safe. This study is one of the first to examine the effects of mandated treatment years after it is completed.
Study methods
This study used descriptive data from 93 patients committed to a large state psychiatric hospital in California under the NGRI statute and followed patient outcomes for an average of almost five years after they were discharged. NGRI criteria vary by state, but all statutes require the individual to have a “major mental disorder” and that this disorder directly relates to the offense committed.
Once an individual is adjudicated NGRI, they typically are transferred to a state hospital for inpatient treatment. Hospital and community treatment representatives provide ongoing assessments to determine if an individual still requires inpatient hospitalization and if and when they should be given conditional release. In California, conditional release lasts for at least one year, after which an individual can petition to have “restoration of sanity,” and if approved they are no longer subject to court-mandated treatment. Other individuals who have been hospitalized for a period longer than their sentence length can be released with no court-ordered conditions.
The authors compared rates of re-arrest among three groups:
- "patients released to the community with court-mandated treatment (conditional release),
- patients who were conditionally released but later “restored to sanity” with no further court supervision,
- and patients released from the hospital to the community by the court with no court-imposed conditions.”
The three groups looked very similar demographically and only varied in one major area: those “restored to sanity” saw much shorter times between their commitment offense and release from the hospital when compared to the other two groups.
Key findings
Ongoing community treatment might be essential to keeping re-arrest rates low. The study found that within the period of study, on average within five years of release from the hospital:
- patients released with no court requirement for community treatment reoffended at a rate of 44%,
- patients who were given conditional release reoffended at a much lower rate of 8.2%,
- patients who were restored to sanity and unconditionally released reoffended at a rate of 25%.
Due to the relatively small sample size of this study, particularly in the group restored to sanity, not all results were statistically significant. However, when comparing the group released with mandated treatment and the group released without mandated treatment, there is statistical significance. This means the authors can confidently say that mandated treatment is a predictor of re-arrest for patients released after a declaration of NGRI. In other words, those patients released without court supervised mandated treatment had higher odds of being rearrested after release from the hospital than those with court-ordered oversight of their treatment.
Though not statistically significant, likely due to small sample size, the study also found that “after an average of almost 4 years of stability in the community, individuals who were restored to sanity experienced an increase in arrest rates once mandated supervision was discontinued.” If this study can be replicated on a larger scale with a bigger sample size, then researchers could more conclusively state that ongoing, supervised mental health treatment might significantly reduce recidivism rates for all justice-involved individuals with severe mental illness.
Findings suggest more research should be done in the future
This study furthers the research surrounding community treatment for those with serious mental illness after a declaration of NGRI. The results mirror those found in Treatment Advocacy Center’s 2017 report, Treat or Repeat, which found that justice-involved individuals with serious mental illness are most successful in the community when they have complete and intensive treatment supported by state and local government.
While the study has limitations, the findings reveal that ongoing mandated community treatment may reduce re-arrest rates among individuals with severe mental illness who are criminal justice involved. More research is needed on a larger scale to confirm these results.
