By Susan White
For years, states across the country have been using specialty courts, such as mental health courts, to connect offenders with mental health and substance abuse disorders with community-based treatment and services. Still, many have struggled to keep people with mental illnesses from cycling in and out of the criminal justice system. At UNC’s School of Social Work, Assistant Professor Gary Cuddeback is working to improve the impact of these courts.
The National Institute of Mental Health (NIMH) recently awarded Cuddeback a nearly $665,000 grant for a three-year feasibility study to test the use of “motivational interviewing” in a mental health court that serves Orange and Chatham counties. Motivational interviewing is an evidence-based practice that psychologists, social work practitioners and counselors often use as a way of helping individuals with substance abuse disorders and mental illness to engage in treatment and to pursue permanent change in their lives.
There are nearly 300 mental health courts already operating across the country. These specialty courts generally give persons with mental illness, particularly those charged with non-violent misdemeanors, a chance to get connected with community-based services in exchange for deferred or dismissed criminal charges. However, randomized studies rarely have been conducted in these courts, Cuddeback said. Furthermore, very little research has been done to test the effectiveness of interventions such as motivational interviewing in these same settings, he added. The assistant professor hopes to add to that body of knowledge.
In the UNC study, Cuddeback will use a randomized controlled trial to compare the mental health and criminal justice outcomes of mental health court participants who receive motivational interviewing versus those who do not. The study will target individuals who have co-occurring substance abuse and mental illness disorders.
“What this study is supposed to address are some of the primary challenges encountered by mental health courts, which are substance abuse, lack of motivation and lack of engagement on the part of consumers,” he said.
Courts serve as the entry and transition points for offenders, and offer a “platform for delivering interventions that might help offenders stay out of the criminal justice system, get out earlier, or not return after they’re released,” Cuddeback said.
“So mental health courts have great potential to begin to address key clinical issues—substance abuse and dependence—that often bring persons with mental illness into contact with the justice system,” he said. “We just need to find interventions to make these courts more effective.”
At a time when so many jails and prisons are serving as de facto hospitals for people with mental illnesses, Cuddeback’s research is “path-finding,” said Mark Fraser, the School of Social Work’s associate dean for research. According to a 2010 report from the Treatment Advocacy Center and the National Sheriffs’ Association, Americans with mental illnesses are three times more likely to wind up behind bars that in a hospital for treatment.
“Gary is working at the intersection of mental health and criminal justice where practice is uncharted and where the long-term costs of failed policies escalate,” Fraser said. That Cuddeback was also able to secure a federal grant when such funding is declining nationwide also “testifies to the creativity of Gary’s ideas and the rigor of his methods, both in terms of practice innovation and research design,” Fraser added.
A total of about 120 participants are expected to be enrolled in the study, Cuddeback said. The first phase of the project should begin within the next month or so and will focus on training a court case manager to administer high-fidelity motivational interviewing.
Long-term, Cuddeback hopes that the feasibility study’s findings will enable him to pursue a larger federal grant to support a multi-state study.
“If you think about the volume of individuals who go through these courts, this has the potential to have a significant public health and public safety impact,” he said. “If this feasibility study produces presumptive evidence that motivational interviewing can be used in mental health courts to improve mental health and criminal justice outcomes, it has the potential to help large numbers of people with severe mental illness and substance abuse disorders within the justice system.”