Do MHC’s affect criminal justice outcomes?

Mental Health Court

Do MHC’s affect criminal justice outcomes?

  • Research studies suggest that success in MHC can be defined and measured in a multitude of ways, and varies considerably across study.
  • Meta-analytic studies generally suggest that participants that successfully graduate from MHC are at a moderately decreased risk for future recidivism and re-arrest, although research remains limited.
  • Evaluating the effectiveness of MHCs from a scientific perspective is very challenging due to significant idiosyncrasies between courts, relatively weak methodological designs, as well as macro influences that are difficult to quantify and standardize. Very few studies use random matched comparison groups, and expected base rate of recidivism against which program effectiveness can be judged often remains unknown.
  • Future research is moving towards the investigation of mediators and moderators, and asking the important question, “For whom, and under what circumstances, are MHCs effective?”

All mental health courts share common public safety and public health goals – to link offenders with mental illness to treatment; increase each client’s level of functioning and quality of life; and decrease recidivism and improve public safety. These courts have dramatically increased in number in recent years, to over 300 today with programs in almost every state. As these courts continue to expand, researchers have been investigating whether or not this alternative to incarceration is achieving its stated goals.

One of the first longitudinal, multisite investigations of the effects of MHCs on subsequent arrests and jail days was conducted by Steadman and colleagues in 2011. These authors investigated four mental health courts (two in California, one in Minnesota, and one in Indiana) using treatment (MHC enrollees) and control groups. This latter group consisted of offenders who were eligible for MHC but were never referred, or were never rejected, from MHC and identified by jail mental health staff as having psychiatric problems and demographic characteristics similar to the MHC enrollees. The investigators found that across five different public safety outcome measures,  re-arrest rates and subsequent incarceration days of MHC participants  were significantly lower than participants in the treatment as usual group. For example, 18 months after the index offense, the MHC participants were significantly less likely than the control group to be arrested (49% vs. 58%).

More recently, Sarteschi, Vaughn, & Kim (2011) utilized meta-analytic techniques to conduct the first quantitative, systematic review of the mental health court literature to determine whether mental health courts are an empirically efficacious intervention. The authors focused on 18 empirical studies (through 2009) of mental health courts that reported at least one quantifiable mental health/clinical or recidivism outcome permitting computation of effect size comparisons. Across the 18 studies meeting inclusion criteria, MHCs were found to  significantly reduced recidivism by an overall effect size of -0.54 (effect sizes of +/- 0.3 to 0.5 are in the moderate range;  -0.54  is a significant effect), suggesting these courts may be moderately effective interventions for reducing recidivism. The authors also uncovered a “dose-response effect” in that participants who did not graduate from the program consistently did worse than participants who completed or graduated from the program. Another important factor that seemed to make a difference in the success of participants in an MHC court program was the relationship of participants with court personnel and staff, which the authors noted seemed to play a part overall success rates.

References: 

Steadman, H.J., Redlich, A., Callahan, L., Robbins, P.C., & Vesselinov, R. (2011). Effect of Mental Health Courts on Arrests and Jail Days. Archives of General Psychiatry, 68, 167-172.

Sarteschi, C.M., Vaughn, M.G., Kim, K. (2011). Assessing the effectiveness of mental health courts: A quantitative review. Journal of Criminal Justice, 39, 12-20.