title: Does gender matter? Exploring mental health recovery court legal and health outcomes.
abstract: BACKGROUND
  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.
  
  
  METHODS
  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.
  
  
  RESULTS
  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.
  
  
  CONCLUSIONS
  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.
authors.affiliation: Biomedical Sciences Department, Western Michigan University School of Medicine, Kalamazoo, MI 49008, USA.
authors.forename: Catherine L
authors.initials: CL
authors.lastname: Kothari
authors.affiliation: Criminal Justice Services, Kalamazoo Community Mental Health and Substance Abuse Services, Kalamazoo, MI 49074, USA.
authors.forename: Robert
authors.initials: R
authors.lastname: Butkiewicz
authors.affiliation: Biomedical Sciences Department, Western Michigan University School of Medicine, Kalamazoo, MI 49008, USA.
authors.forename: Emily R
authors.initials: ER
authors.lastname: Williams
authors.affiliation: Criminal Justice, Department Governors State University, University Park, IL 60484, USA.
authors.forename: Caron
authors.initials: C
authors.lastname: Jacobson
authors.affiliation: Department of Psychiatry, University of Rochester School of Medicine, Rochester, NY 14642, USA.
authors.forename: Diane S
authors.initials: DS
authors.lastname: Morse
authors.affiliation: Department of Psychiatry, University of Rochester School of Medicine, Rochester, NY 14642, USA.
authors.forename: Catherine
authors.initials: C
authors.lastname: Cerulli
keywords: Criminogenic factors; Gender and justice; Healthcare utilization; Mental health court