Do Mental Health Courts Work?

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Adult Mental Health Courts Receive Mixed Ratings

Adult Mental Health Courts are specialized, treatment-oriented, problem-solving courts that divert mentally ill offenders away from the criminal justice system and into court-mandated, community-based treatment programs in order to reduce recidivism and decrease the amount of contact that mentally ill individuals have with the criminal justice system. The practice is rated “Promising” for reducing recidivism, but rated “No Effects” on measures of clinical outcomes.

Details:

Practice Goals
Mental health courts (MHCs) are specialized, treatment-oriented, problem-solving courts that divert mentally ill offenders away from the criminal justice system and into court-mandated, community-based treatment programs. MHCs were developed as a way to address the large number of individuals with mental illnesses who come into contact with the criminal justice system. The goal of MHCs is to reduce recidivism and decrease the amount of contact that mentally ill individuals have with the criminal justice system by linking them to treatment and services to improve their social functioning.

Target Population/Eligibility
Mentally ill defendants are usually referred to MHCs by defense attorneys, judges, service providers, jail staff, or family members. Participation in the court process and treatment is voluntary, but usually contingent upon a plea of guilty. The eligibility criteria for participation in an MHC will vary by program. Individuals diagnosed with a severe mental illness, such as bipolar disorder or schizophrenia, are eligible to participate. However, some courts may limit eligibility only to persons with a mental illness for which there is a known treatment. MHCs can accept individuals with a variety of offenses, including misdemeanor and felony charges.

Practice Components
MHCs often share a number of similar features, but implementation of the programs may greatly vary and depend on a number of factors, such as availability of treatment in the community. MHCs operate in the same way as other types of problem-solving courts (e.g., drug courts). MHCs have a separate docket for mentally ill defendants, and there is usually a dedicated judge, prosecutor, and defense counsel for all court hearings and monitoring sessions.

MHCs use mental health assessments and individualized treatment plans. The process involves intensive supervision of offenders with ongoing court monitoring and emphasizing accountability. Monthly drug screenings may be required and medication may be checked in the court every week to ensure that participants are adhering to the treatment plan. Immediate sanctions may be used to address negative behavior and noncompliance, while incentives may be used to encourage positive behavior and compliance. As participants progress through the program, they are not required to attend court as often. In addition, some MHCs allow for dismissal of charges or avoidance of incarceration once participants have successfully completed the program requirements.

Key Personnel
The court process is collaborative among criminal justice personnel, mental health professionals, and other support systems that may be involved. MHC teams usually include a prosecutor, defense attorney, probation or parole officer, case manager, and a representative from the mental health treatment provider. They meet to discuss each case and report on a participant’s progress to the judge. The MHC teams will also consider sanctions for noncompliance, or rewards for compliance to treatment.

Meta-Analysis Outcomes

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Promising - More than one Meta-Analysis Crime & Delinquency – Multiple crime/offense types
Overall, three meta-analyses found that adult mental health courts (MHCs) were associated with significant reduction in recidivism for participants with serious mental illness in the criminal justice system. However, one meta-analysis found no significant impact of MHCs on recidivism. Cross (2011) examined the recidivism outcomes from 18 studies of MHCs and found a statistically significant, positive effect size (d=0.32). This result suggests that MHCs have a small to moderate effect in reducing recidivism. When looking at the outcomes from 12 studies, Sarteschi, Vaughn, and Kim (2011) also found a statistically significant effect size (Hedges’ g=-0.55). This result suggests that MHCs may have a moderate effect for reducing recidivism. Similarly, across six studies, Lee and colleagues (2012) found a significant effect size of -0.22, which suggests MHCs have a small effect on crime. Conversely, the review of six studies conducted by the Utah Criminal Justice Center (2012) found a positive, but nonsignificant effect of MHCs on recidivism (OR=0.60). This suggests that MHCs do not have an impact on crime outcomes.
No Effects - One Meta-Analysis Mental Health & Behavioral Health – Multiple mental health/behavioral health outcomes
Only one meta-analysis looked at the effect of adult mental health courts on clinical outcomes. Cross (2011) examined the clinical outcomes from five studies and found a nonsignificant effect size (d=-0.09). This suggests that MHCs were not a

Learn more about this program and the evaluations on CrimeSolutions.gov.

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