Program Profile: Mental Health Courts (Multisite)

This program consists of post-booking jail diversion mental health courts, which seek to keep justice-involved individuals with serious mental illnesses out of the court system and place them into community-based treatment without jeopardizing public safety. This program is rated Promising. Mental health courts in the four studied cities were shown to have statistically significant reductions in participants’ rates of arrests and incarceration days at the 18-month follow-up.

A Promising rating implies that implementing the program may result in the intended outcome(s).

This program's rating is based on evidence that includes either 1) one study conducted in multiple sites; or 2) two or three studies, each conducted at a different site. Learn about how we make the multisite determination.

Program Goals

Mental health courts (MHCs) are postbooking jail diversion programs that aim to divert justice-involved individuals with serious mental illnesses out of the court system and into community-based treatment without jeopardizing public safety. The goal is to reduce program participants’ recidivism by enhancing access and use of treatment.

There are over 250 MHCs operating around the country (Steadman et al. 2011). Four major metropolitan areas that operate MHCs include San Francisco County (San Francisco), Calif.; Santa Clara County (San Jose), Calif.; Hennepin County (Minneapolis), Minn.; and Marion County (Indianapolis), Ind. These four MHCs were the focus of the MacArthur Mental Health Court Study (described below in the Evaluation Methodology).

Target Sites/Population

Although eligibility criteria vary by site, courts usually accept both felony and misdemeanor charges (with the general exclusion of violent crimes) and require an Axis I diagnosis (such as schizophrenia, bipolar disorder, and depression) to enroll. Participation in MHCs is voluntary. Eligible persons have the choice to participate in the MHC or keep their cases in regular criminal court processing.

Services Provided

MHCs use a similar model of other problem-solving courts, such as drug courts. One important feature of MHCs is the periodic status review hearings before the MHC judge. If eligible individuals agree to participate, they have an initial hearing before the MHC judge where they may enter a guilty plea and agree to the conditions established by the program as well as the disposition of the criminal charges. MHC participants are required to keep in frequent contact with the judge, their caseworkers, and community treatment staff by attending subsequent status hearings. The purpose of the hearings is to monitor compliance and keep the participants on track.

Another important feature of MHCs is the use of sanctions and incentives to ensure adherence to the conditions of the program, including treatment compliance and attendance at status hearings. Sanctions are generally used to enforce program conditions, and may range from a scolding from the judge to increased supervision to a jail sentence. Incentives allow participants to be rewarded for compliance, and may range from praise from the judge to gift cards to reduced supervision.

Most MHCs require treatment as a condition of enrollment. Participants in the MHCs may receive intensive services (such as inpatient stays at short-term psychiatric facilities, 24-hour residential care, and detox services) or therapeutic services (including community-based treatment and support services such as day treatment, individual and group therapy, medication management, and case management).

One important difference between MHCs and drug courts is the philosophy underlying both programs. MHCs use a recovery model, in which relapse is considered part of the treatment process, whereas drug courts use an abstinence (from drug and alcohol use) model (Callahan et al. 2013).

Study 1

Steadman and colleagues (2011) conducted the MacArthur Mental Health Court Study, which was a longitudinal, quasi-experimental study to determine if participation in a mental health court (MHC) was associated with favorable criminal justice outcomes compared with processing through the regular criminal court system. The study examined four MHCs in San Francisco County (San Francisco), Calif.; Santa Clara County (San Jose), Calif.; Hennepin County (Minneapolis), Minn.; and Marion County (Indianapolis), Ind. The courts were selected based on a national survey conducted in an earlier phase of the study. To be included in the study, the courts had to have a large enough caseload from which to draw a treatment sample, be located in a jurisdiction with large county jails from which to draw a comparison sample, have operated long enough to have stability in the program, and represent a range of types of courts from level of sanctioning to types of defendants such as both misdemeanor and felony cases.

The treatment group included newly enrolled MHC participants (n = 447). The treatment as usual (TAU) comparison group included newly booked jail detainees who were eligible for MHC but were never referred or were never rejected from the MHC (n = 600). A propensity score model was used to match the MHC and TAU groups on a number of variables, such as age, race, sex, marital status, arrest history, and hospitalizations. The MHC treatment group was 41.8 percent female with an average age of 37.5 years. The group was 10.5 percent Hispanic and 55.6 percent white (the other races/ethnicities for the remainder of the sample were not provided). The mental health diagnoses included schizophrenia (40.3 percent), bipolar disorder (28.2 percent), depression (19.0 percent), or other (12.5 percent). The TAU comparison group was 36.8 percent female with an average age of 36.6 years. The group was 17.0 percent Hispanic and 58.8 percent white (again, the other races/ethnicities for the remainder of the sample were not provided). The diagnoses included schizophrenia (19.8 percent), bipolar disorder (22.2 percent), depression (46.3 percent), and other (11.7 percent).

The study participants were interviewed at baseline (study enrollment) and 18 months later at each site. The primary outcomes of interest were rearrests and average number of days spent incarcerated in county jails and state prisons. Arrest data was obtained from study participants’ Federal Bureau of Investigation reports and included only new arrests (it excluded warrants and violations). The incarceration days were obtained from the local jail records and the state departments of correction. Because some of the outcome variables have outliers and large variance, the data was examined using a quantile regression model. The authors did not conduct subgroup analyses.

These sources were used in the development of the program profile:

These sources were used in the development of the program profile:

Following are CrimeSolutions-rated programs that are related to this practice:

Adult Mental Health Courts

Specialized, treatment-oriented, problem-solving courts that divert mentally ill persons 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.

Evidence Ratings for Outcomes

	Crime & Delinquency - Multiple crime/offense types
	Mental Health & Behavioral Health - Multiple mental health/behavioral health outcomes

Why might a practice's outcome ratings differ from the ratings of specific programs encompassed by that practice?