Are MHC’s cost effective?

Mental Health Court

Are MHC’s cost effective?

  • The cost-effectiveness and economic utility of MHC’s have received relatively little empirical attention.
  • Estimating the cost-effectiveness of MHC’s faces several challenges, and there is no perfect formula to determine which outcomes should be included in a full economic analysis, making comparisons across studies difficult.  

Only a handful of empirical studies have investigated the cost effectiveness of mental health courts, and results to date are inconclusive. The first empirical study to look at this issue was the RAND mental health court study, which examined 365 individuals who participated in the Allegheny County Mental Court between 2001 and 2004. The researchers collected fiscal impact data (combining mental health treatment costs, criminal justice costs, and welfare system costs) from six state and county public agencies for MHC participants. They compared these data to costs that would have been incurred by participants had they gone through the usual court system process. The authors found that participation in MHC led to an increase in mental health services and decrease in jail days, and that the decrease in jail expenditures mostly offset the cost of the treatment services one year post-arrest. In the second year of MHC participation, there was an even greater decrease in number of jail days, leading to increased cost savings. The authors noted that the “more-seriously distressed subgroups” (felony offenders, participants with significant psychiatric problems and low overall functioning) had larger estimated long-term cost savings. The full 48-page report, Justice, Treatment, and Cost: An Evaluation of the Fiscal Impact of Allegheny County Mental Health Court, can be found at and at www.justicecen

In contrast to the promising findings noted above, Steadman and colleagues (2014) found that total annual costs for MHC participants across six sites (Indianapolis, San Francisco, and Minneapolis) were $4,000 higher compared with a matched comparison group three years after an index arrest. Participants with the highest costs were those with co-occurring substance use disorders and those who had spent a longer period in jail prior to the index arrest.


Steadman, H.J., Callahan, L., Robbins, P.C., Vesselinov, R., McGuire, T.G., Morrissey, J.P. (2014). Criminal justice and behavioral health care costs of Mental Health Court participants: a six year study. Psychiatric Services 65(9):1100-1104. doi.10.1176/