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Research ArticleRegular Articles

Court-Ordered Evaluations From a Mental Health Court

Seth Judd and George F. Parker
Journal of the American Academy of Psychiatry and the Law Online March 2018, 46 (1) 52-62;
Seth Judd
Dr. Judd is a Fellow in Forensic Psychiatry, University of South Carolina School of Medicine. Dr. Parker is a Professor of Clinical Psychiatry and Director of Forensic Psychiatry, Indiana University School of Medicine, Indianapolis, IN.
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George F. Parker
Dr. Judd is a Fellow in Forensic Psychiatry, University of South Carolina School of Medicine. Dr. Parker is a Professor of Clinical Psychiatry and Director of Forensic Psychiatry, Indiana University School of Medicine, Indianapolis, IN.
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    Figure 1.

    Education level of persons who are CST versus those who are ICST.

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    Table 1

    Demographics of CST Evaluees from Mental Health Court vs. Other Criminal Courts

    CharacteristicMarion County (%)MHC Defendants (%)p
    Male48.274.2<.0002
    White62.734.0<.0001
    Black26.763.9<.0001
    Hispanic9.32.1<.0001
    High school graduate84.942.7<.0001
    Employed67.79.1<.0001
    On disability10.364.3<.0001
    • View popup
    Table 2

    Demographics of Mental Health Court Evaluees

    CharacteristicData Available (n)n%CSTICST
    n%n%
    MHC defendants96a4552
    Mean age (years)9640.839.242.3
    Male967174.0*3161.94178.9
    Race96
        Black6163.5*2862.23465.4
        White3334.4*1635.61732.7
        Hispanic22.1*12.211.9
    Marital status74
        Never married5473.03173.82371.9
        Divorced or separated1925.71126.2825.0
        Married11.400.013.1
    Mean education (years)8111.110.811.3
        <12 years4756.83061.2†1744.7
        12+ years3542.7*1431.8†2155.3
    Had housing at time of arrest735372.62773.02670.3
    Unemployed766990.8*3790.23391.7
    On disability694565.2*2565.82062.5
    Prior arrests968386.54088.94484.6
        Misdemeanor only2428.91435.01125.0
        Felony5971.12665.03375.0
    Current charges96
        Violent4546.92248.92344.2
        Nonviolent5153.12351.12853.9
    Prior psychiatric treatment90
        Any prior treatment7684.44193.2†3676.6
        No prior treatment1415.636.8†1123.4
    On psychiatric medication845463.13475.6†1936.5
        On an antipsychotic4990.73168.9†1836.4
    All diagnoses97
        Psychotic disorder6568.42555.6†4076.9
        Substance use disorder5052.62862.22242.3
        Cognitive disorder2526.31124.41426.9
        Mood disorder1313.71226.7†11.9
        Anxiety disorder22.124.400.0
        Other2214.41737.8†59.6
        Traumatic brain injury532445.31241.41248.0
    Cooperative with interview977779.44191.1†3684.6
    • ↵a One MHC defendant was evaluated twice.

    • ↵* p < .05 versus Marion County census data.

    • ↵† p < .05.

    • View popup
    Table 3

    Concordance of Evaluator Primary Diagnosis

    DiagnosisnConcordant (n)Concordant Diagnoses (%)κ
    Two diagnoses (n)675074.6.44*
    Primary diagnosis (n)
        Psychotic disorder503876.0.58
        Cognitive disorder12975.0.74
        Substance use7114.2.23
        Mood disorder6116.7.49
        Other disorders4125.0.38
    • ↵* Weighted κ.

    • View popup
    Table 4

    Concordance of Evaluator Primary Diagnosis and Court Outcome

    DiagnosisnCST (n = 45)ICST (n = 52)
    %κ%κ
    Concordant primary diagnosis5040.0*.3861.5.47
        Psychotic disorder3826.7*.5950.0.52
        Cognitive disorder911.1.797.7.68
        Substance use10.01.9.48
        Mood disorder12.1.210†
        Other disorders10−.051.91.0
    Discordant primary diagnosis1722.213.5
    • ↵* p < .05.

    • ↵† κ could not be calculated because no ICST defendants were assigned a mood disorder as a primary diagnosis.

    • View popup
    Table 5

    Frequency of Competence Opinions Among Evaluators

    EvaluatornCST OpinionICST OpinionCourt Agreement
    19543.256.888.4
    26429.770.376.6
    32646.253.973.1
    4862.537.562.5
    • Opinion and agreement data are expressed as percentages.

    • View popup
    Table 6

    Concordance of 96 Evaluator Opinions

    Opinionn%Court Decision (%)
    CSTICST
    Evaluators agreed7174.0*
        Both opinions ICST4546.9†11.1‡88.9
        Both opinions CST2627.1†100‡0
    Evaluators disagreed2526.052.048.0
    • ↵* κ = .46.

    • ↵† p < .01, ICST versus CST.

    • ↵‡ p = 0.0001.

    • View popup
    Table 7

    Primary Diagnoses in MHC Defendants Versus Defendants From Other Courts

    DiagnosisMental Health Courta (%; n = 97)All Other Courts (%; n = 242)
    Psychotic disorder68.4*40.7
    Cognitive disorder26.3*13.3
    Substance use disorder52.6*10.0
    Mood disorder13.711.2
    Other diagnosis14.415.4
    • ↵a Primary diagnosis from either evaluator.

    • ↵* p ≤ 0.01.

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Journal of the American Academy of Psychiatry and the Law Online: 46 (1)
Journal of the American Academy of Psychiatry and the Law Online
Vol. 46, Issue 1
1 Mar 2018
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Court-Ordered Evaluations From a Mental Health Court
Seth Judd, George F. Parker
Journal of the American Academy of Psychiatry and the Law Online Mar 2018, 46 (1) 52-62;

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Seth Judd, George F. Parker
Journal of the American Academy of Psychiatry and the Law Online Mar 2018, 46 (1) 52-62;
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