Kothari Catherine L, Butkiewicz Robert, Williams Emily R, Jacobson Caron, Morse Diane S, Cerulli Catherine
Biomedical Sciences Department, Western Michigan University School of Medicine, Kalamazoo, MI 49008, USA.
Criminal Justice Services, Kalamazoo Community Mental Health and Substance Abuse Services, Kalamazoo, MI 49074, USA.
Health Justice. 2014 Dec 5;2(1):12. doi: 10.1186/s40352-014-0012-0.
Based upon therapeutic justice principles, mental health courts use legal leverage to improve access and compliance to treatment for defendants who are mentally ill. Justice-involved women have a higher prevalence of mental illness than men, and it plays a greater role in their criminal behavior. Despite this, studies examining whether women respond differently than men to mental health courts are lacking. Study goals were to examine gender-related differences in mental health court participation, and in criminal justice, psychiatric and health-related outcomes.
This study utilized a quasi-experimental pre-posttest design without a control group. The data were abstracted from administrative records of Kalamazoo Community Mental Health and Substance Abuse agency, the county jail and both county hospitals, 2008 through 2011. Generalized estimating equation regression was used to assess gender-differences in pre-post program outcomes (jail days, psychiatric and medical hospitalization days, emergency department visits) for the 30 women and 63 men with a final mental health court disposition.
Program-eligible females were more likely than males to become enrolled in mental health court. Otherwise they were similar on all measured program-participation characteristics: treatment compliance, WRAP participation and graduation rate. All participants showed significant reductions in emergency department visits, but women-completers had significantly steeper drops than males: from 6.7 emergency department visits to 1.3 for women, and from 4.1 to 2.4 for men. A similar gender pattern emerged with medical-hospitalization-days: from 2.2 medical hospital days down to 0.1 for women, and from 0.9 days up to 1.8 for men. While women had fewer psychiatric hospitalization days than men regardless of program involvement (2.5 and 4.6, respectively), both genders experienced fewer days after MHRC compared to before. Women and men showed equal gains from successful program completion in reduced jail days.
Despite similar participation characteristics, findings point to greater health gains by female compared to male participants, and to lower overall psychiatric acuity. Mental-health-court participation was associated with decreased psychiatric hospitalization days and emergency department visits. Successful program completion correlated to fewer jail days for both women and men.
基于治疗正义原则，心理健康法庭利用法律手段，帮助患有精神疾病的被告获得治疗并提高其治疗依从性。涉及司法程序的女性比男性患精神疾病的比例更高，且精神疾病在她们的犯罪行为中起更大作用。尽管如此，目前仍缺乏研究来探讨女性对心理健康法庭的反应是否与男性不同。本研究的目的是考察心理健康法庭参与情况以及刑事司法、精神科和健康相关结果方面的性别差异。
本研究采用了无对照组的准实验前后测设计。数据取自卡拉马祖社区心理健康与药物滥用机构、县监狱以及两家县医院2008年至2011年的行政记录。采用广义估计方程回归来评估30名女性和63名男性最终通过心理健康法庭处置后的项目前后结果（入狱天数、精神科和医疗住院天数、急诊就诊次数）的性别差异。
符合项目条件的女性比男性更有可能加入心理健康法庭。在所有衡量项目参与特征方面，她们则是相似的：治疗依从性、个性化康复计划（WRAP）参与度和毕业率。所有参与者的急诊就诊次数均显著减少，但完成项目的女性下降幅度明显大于男性：女性从6.7次急诊就诊降至1.3次，男性从4.1次降至2.4次。医疗住院天数也出现了类似的性别模式：女性从2.2个医疗住院日降至0.1个，男性从0.9个增至1.8个。无论是否参与项目，女性的精神科住院天数都比男性少（分别为2.5天和4.6天），但与心理健康法庭处置前相比，两性在处置后的住院天数都减少了。成功完成项目的女性和男性在减少入狱天数方面取得了相同的成效。
尽管参与特征相似，但研究结果表明，与男性参与者相比，女性参与者在健康改善方面更大，且总体精神疾病严重程度更低。参与心理健康法庭与精神科住院天数和急诊就诊次数减少有关。成功完成项目与女性和男性入狱天数减少相关。
