University of Rochester,

Justice-Involved Women Conference -June 21, 2013-

CATHERINE KOTHARI, MA

Emergency Medicine Department,

Western Michigan University School of Medicine

catherine.kothari@med.wmich.edu (269) 501-4149

“Women’s Experiences in Mental Health Court”

Robert Butkiewicz, MA LPC

Criminal Justice Services Supervisor

Kalamazoo Community Mental Health and Substance Abuse Services

rbutkiewicz@kazoocmh.org

Women’s Justice Involvement is

Different than Men’s

• Women’s criminal justice involvement is growing

• Women have unique pathways into crime

– Mental illness, addiction & interpersonal trauma

• Women enter the criminal justice system with

– More family responsibilities & relationship investment

– Fewer socio-economic resources

Questions

1. Do women engage with Mental Health Court

(MHC) differently than men?

2. After participating in MHRC, do women have

different criminal justice and health outcomes

than men?

Data Collection

• Secondary Data Analysis

– Database: Program Evaluation of Kalamazoo County, Michigan

Mental Health Recovery Court (MHRC)

• 133 MHRC participants, 2008 through 2010

– 44 women & 89 men

• Database contained demographic, program participation

and outcome information (criminal justice, mental health,

medical health)

Database Information

Gender

Race

Education

Employment

Marital status

Mental health diagnosis

Demographics

Completion / Termination

WRAP participation

Sanctions

Medication compliance

Substance abuse tx compliance

MHRC Participation

Jail bookings, 2007-2011

-Charges

Psychiatric hospitalizations, 2007-2011

Emergency Department Visits, 2007-2011

Medical hospitalizations, 2007-2011

Outcomes

Before & After Annual Rates

Study Community: Specialty Courts

• District Court:

– Mental Health Recovery Court

– Sobriety Court

– Domestic Violence Court

• Multiple Drug Courts:

– Circuit: Women’s Drug Court & Men’s Drug Court

– Juvenile

– Family court

% of Women in county who are

KCMHSAS consumers: (99,327 Adult Female Population)

Study Community: Women Consumers in Jail

% of Women in JAIL* who are

KCMHSAS consumers: (1,688 Adult Females in Jail)

*Based upon 2009

WOMEN: 6 X more likely to be in jail than non-consumers

MEN: 2.5 X more likely to be in jail than non-consumers

Kalamazoo Mental Health Recovery Court

• Goal: Divert offenders out of the traditional criminal

justice track and into treatment

• Eligibility: – Kalamazoo County resident

– Be eligible for KCMHSAS case management services (severe & persistent

mental illness or co-occurring disorder)

– Not present a public safety risk

• Program Components: – Enter as Diversion (charges dismissed upon graduation) or Probation condition

– Bi-weekly or monthly team-based court hearings (service agency caseworker,

MHRC peer, KCMHSAS clinical staff present in addition to judge / court staff)

– Peer support (WRAP, one-on-one, home visits)

– Participation in treatment / recovery services

RESULTS: MHRC Enrollment & Participation

Characteristics

Women booked

into Jail, 2009

Women’s Presence in Mental Health &

Justice Systems (2009)

Women receiving

KCMHSAS services,

2009

2,544 1,688

Women’s Presence in Mental Health & Justice

Systems

Women who are both KCMHSAS

consumers and booked into jail

Women receiving

KCMHSAS services,

2009

2,544

Women booked

into Jail, 2009

1,688

237

Women’s Presence in Mental Health & Justice

Systems

Women participating

in MHRC in 2009

Women receiving

KCMHSAS services,

2009

2,544

Women booked

into Jail, 2009

1,688 19

Demographics: Women MHRC Participants

(N=19)*

• Minority race/ethnicity - 45% ( 9)

• High School graduate - 75% (12)

• In the labor force - 63% (10)

– Employed - 13% ( 2)

• Married - 6% ( 1)

Men have similar characteristics

* Missing data on 3.

Results for ALL MHRC Program Years

133 MHRC participants, 2008 through 2010

– 44 women & 89 men

Women

(44)

Men

(89)

p

Principle

MH Diagnosis

Mood disorder 22.7% (10) 24.7% (22)

.034

Bipolar 38.6% (17) 22.5% (20)

Psychotic disorder 4.5% (2) 5.6% (5)

Conduct disorder 2.3% (1) 3.4% (3)

Borderline 13.6% (6) 2.2% (2)

PTSD 2.3% (1) 1.2% (1)

Schizophrenia 13.6% (6) 36.0% (32)

Developmental Disorder 2.3% (1) 4.5% (4)

MHRC Enrollment: Women & Men

(N=133)

Women

(44)

Men

(89)

p

Entry into Program Diversion 54.3% (19) 63.6% (49)

.348 Probation 45.7% (16) 36.4% (28)

*Percentages based upon non-missing

Charge – Mental Health Recovery Court

*Retail fraud, trespass, child support, contempt of court

p.338

MHRC Participation: Women & Men

(N=133)

Women

(44)

Men

(89)

p

WRAP completion 59.5% (25) 62.9% (56) .709

Medication Compliance (as indicated)* 100% (38) 98.8% (83) .499

Substance Abuse Progress Noted 68.3% (30) 64.0% (57) .637

Substance Abuse Progress (as appropriate) 60.0% (18, of 30) 56.1% (32, of 57) .729

MHRC jail sanctions 27.3% (12) 31.5% (28) .625

*Percentages based upon non-missing

MHRC Program Completion Among those with final MHRC disposition (N=93)

p.390

Women and men have similar

MHRC enrollment & participation characteristics

RESULTS: Pre-Post MHRC Outcomes

JAIL Day Rate: Women & Men

Average Jail-Day Rate* Among Those with Final MHRC Disposition

Completed MHRC

* Annualized: [(# stays/days) / (# days in “after” period)] x 365

Terminated/Withdrew from MHRC

PSYCHIATRIC Hospitalization Day Rate:

Women & Men Average Day Rate* Among Those with Final MHRC Disposition

Completed MHRC

* Annualized: [(# stays/days) / (# days in “after” period)] x 365

0.5 0

5.74.5

0

5

10

Year before MHRC Year after MHRC*

Terminated/Withdrew from MHRC

EMERGENCY DEPARTMENT Visit Rate:

Women & Men Average Visit Rate* Among Those with Final MHRC Disposition

Completed MHRC

* Annualized: [(# visits/days) / (# days in “after” period)] x 365

3.8 3.0

9.2

6.5

0

5

10

Year before MHRC Year after MHRC*

Terminated/Withdrew from MHRC

MEDICAL Hospitalization Day Rate:

Women & Men Average Day Rate* Among Those with Final MHRC Disposition

Completed MHRC

2.9

0.31.1

2.2

0

5

10

Year before MHRC Year after MHRC*

Terminated/Withdrew from MHRC

* Annualized: [(# stays/days) / (# days in “after” period)] x 365

Study Limitations

• MHRC participants self-select and agency-select into

program.

• Small study group size

• Follow-up period is a only year (or less)

Conclusions

• Women and men have similar MHRC enrollment & participation

characteristics

• There are fewer gender differences among MHRC completers than

among those who are terminated or withdraw from the program

– Women who leave the program have fewer psychiatric

hospitalization days overall

– Women who leave appear to have a different pre-post jail

trajectory

THANK YOU