Do MHC’s reduce psychiatric symptoms and improve mental health?

Mental Health Court

Do MHC’s reduce psychiatric symptoms and improve mental health?

  • The research in this area is in its infancy, although a few studies suggest that MHC participants have fewer psychiatric hospitalization days as compared to matched control groups.
  • Some studies suggest that implementation of MHC’s may increase awareness and understanding of mental health issues across the court system, leading to improved psychiatric and psychosocial outcomes for all offenders.
  • The ability of MHC’s to improve important psychiatric outcomes may largely be a function of the range and quality of services available.

One of the first studies to assess the effectiveness of MHC’s in improving mental health was a 2005 study investigating a MHC in California (Cosden, Ellens, Schnell, and Yamini-Diouf, 2005). The authors hypothesized that participants in MHC would show improvement in their independent functioning and quality of life, and decreases in their psychological distress and drug and alcohol problems relative to participants receiving TAU (treatment as usual). However, no significant differences were found between the two groups in most areas of functioning. These authors commented that such findings do not suggest MHC’s are ineffective, but rather an unintended side effect of implementing a MHC was a change in global practices towards mentally ill offenders such that participants in both groups received necessary services and had high levels of treatment engagement. For example, the authors noted that the MHC judges also presided over the TAU offenders, and used their training and awareness of mental health issues to recommend needed interventions.

In another empirical study, Boothroyd et al. (2005) compared changes in symptoms in a sample of defendants in Broward County mental health court to changes in a comparison sample of defendants in a regular court. Participants included 116 defendants from the mental health court, and 106 defendants from a magistrate court who were assessed using the Brief Psychiatric Rating Scale at 1, 4, and 8 months after an initial court appearance. Both administrative and self-report data were used to identify defendants who received treatment after their initial court appearance, and participants were only included in the analyses if they had attended at least one follow-up treatment. The results suggest that, while the mental health court significantly increased defendants’ access to mental health services, they had little control over the type and quality of services that the defendants received. Furthermore, reductions in mental health symptoms were not observed among defendants who received treatment in either court setting. The authors concluded that the results obtained were more likely to be a reflection of the quality of the public mental health system and the chronicity of some of the mental illnesses (e.g., psychotic disorders), rather than a failure of the mental health court to meet its articulated goals.

More recently, a 2010 study looking at Washoe County, Nevada MHC found that MHC participants and graduates (compared to a matched control group) had significantly fewer psychiatric hospitalization days in the year after graduation than they did in the year before enrollment, indicating that they were less in need of this intensive mental health service after participating in the MHC. This is one of the only empirical findings to specifically study and report on changes in clinical outcomes as a function of participation in MHC.


Cosden, M., J. Ellens, J.L., Schnell, and Y. Yamini-Diouf, 2005. Efficacy of a mental health treatment court with assertive community treatment. Behavioral Sciences and the Law 23 (2): 199-214.

Frailing, Kelly. (2010). How mental health courts function: Outcomes and observations. International Journal of Law and Psychiatry, 33, 207-213.

Boothroyd, R.A., Calkins Mercado, Cynthia, Poythress, Norman G., Christy, A., & Petrila, J. (2005). Clinical Outcomes of Defendants in Mental Health Court. Psychiatric Services, 57, 829-834.