Comparing Public Safety Outcomes for Traditional Probation vs Specialty Mental Health Probation [2017]

Key Points
Question Does specialty probation yield better public safety outcomes than traditional probation for people with mental illness?

Findings In this longitudinal study that included 359 probationers with mental illness, specialty probation did not significantly reduce violence but substantially reduced rearrest rates. At 2 years, an estimated 28.6% of specialty probationers and 51.8% of traditional probationers had been rearrested.

Meaning In the current era of criminal justice reform, specialty probation holds substantial promise as a method for reducing mass incarceration for people with mental illness.

Importance Probation is a cornerstone of efforts to reduce mass incarceration. Although it is understudied, specialty probation could improve outcomes for the overrepresented group of people with mental illness.

Objective To test whether specialty probation yields better public safety outcomes than traditional probation.

Design, Setting, and Participants A longitudinal observational study with group matching on age, sex, race/ethnicity, probation time, and offense at 2 urban agencies that exemplify specialty and traditional probation. Enrollment began October 19, 2005; follow-up data were complete January 26, 2013. Participants were 359 diverse probationers with serious mental health problems and functional impairment. Probationers and officers were assessed 3 times (for probationers, 6-month retention, 315 of 359 [88%]; 12-month retention 304 of 359 [85%]) and follow-up records were obtained. Machine learning algorithms were combined with a targeted maximum likelihood estimation, a double robust estimator that accounts for associations between confounders and both treatment assignment and outcomes. Statistical analysis was conducted from January 1, 2016 to May 5, 2017.

Interventions Specialty probationers were assigned to small, homogeneous caseloads supervised by experts. Prior data indicate that specialty officers had better relationships with probationers, participated more in probationers’ treatment, and relied more on positive compliance strategies than traditional officers.

Main Outcomes and Measures Violence during 1 year, determined by probationer report, officer report, and records, and rearrest during a period of 2 to 5 years, according to Federal Bureau of Investigation records.

Results Participants were 183 specialty (73.8% of 248 eligible) and 176 traditional (56.6% of 311 eligible) probationers (205 men and 154 women; mean [SD] age, 36.9 [10.6]). Although specialty probation had no significant effect on violence (odds ratio, 0.97; 95% CI, 0.69-1.36), the odds of rearrest were 2.68 times higher for traditional probationers than for specialty probationers (95% CI, 1.86-3.84; P < .001). At 2 years, estimated probabilities of rearrest were 28.6% for specialty probationers and 51.8% for traditional probationers. Survival analyses indicate that arrest effects endured up to 5 years.

Conclusions and Relevance Although it did not specifically reduce violence, well-implemented specialty probation appears to be effective in reducing general recidivism. Reform efforts for people with mental illness could leverage probation—a ubiquitous and revitalized node of the justice system.

Jennifer L. Skeem, PhD; Sarah Manchak, PhD; Lina Montoya, MA

JAMA Psychiatry, 2017;74(9)