Major Finding: The use of mental health courts for some defendants results in fewer posttreatment arrests and days of incarceration.
Data Source: A prospective, longitudinal, quasiexperimental study of 447 people enrolled in mental health courts and 600 controls.
Disclosures: The study was supported by the Research Network on Mandated Community Treatment of the John D. and Catherine T. MacArthur Foundation. No financial disclosures were reported.
Inmates who participate in mental health courts that are designed to facilitate treatment and reduce incarceration experience lower posttreatment arrest rates and fewer days in jail, according to a study in the journal.
The study found that the mental health court participants with the best outcomes included those with fewer arrests and incarceration days in the 18 months prior to their participation in the mental health court.
In addition, higher rates of mental health treatment in the 6 months prior to participation in the court led to better outcomes, as did a diagnosis of bipolar disorder, the study said (Arch. Gen. Psychiatry 2010 [doi:10.1001/archgenpsychiatry.2010.134
Meanwhile, diagnoses of schizophrenia or depression and illegal substance use in the 30 days prior to court participation led to worse outcomes in inmates, Henry J. Steadman, Ph.D., who works public policy in a group practice in Delmar, N.Y., and his colleagues found.
About 250 mental health courts operate across the country with the goal of moving people with serious mental illness out of the criminal justice system and into community treatment without sacrificing public safety, Dr. Steadman and his colleagues reported. They called their investigation the first prospective, multisite study of mental health courts.
This is how mental health courts work: Potential clients are referred by jail staff, after which the court holds a hearing. Individuals then have the option of entering a guilty plea and agreeing to the terms established by the court, which usually includes treatment.
Individuals who agree to the terms usually are released into the community under mental health court supervision. The court holds subsequent hearings repeatedly, and can sanction individuals who violate the terms of their agreements through bench warrants, temporary reincarceration, and agreement revocation. The court also facilitates treatment options for these individuals.
The study looked at 447 individuals enrolled in four mental health courts in three states: California, Minnesota, and Indiana. A total of 600 individuals served as controls.
In the pre-court period, almost all the individuals in both groups had at least two arrests. However, in the 18-month postarrest period, 49% of the group that attended mental health court had an additional arrest, compared with 58% of the treatment-as-usual control group.
Both groups showed a decline in their annual arrest rates, but, overall, the mental health court group's annual arrest rates declined more than did the control group's rate.
When days of incarceration were measured, the study found that the mental health court group saw a 12% increase during the 18 months following their court participation, from 73 days to 82 days. However, those in the control group saw their incarceration days shoot up by 105%, from 74 days to 152 days, when those same two 18-month periods were compared.
“The average number of jail days increased for both samples,” the investigators wrote. “However, the small increase of 9 days for [mental health court] is not statistically significant and is unlikely to have practical implications.”
When the study compared the group attending the mental health court vs. the treatment-as-usual group, it was clear that the mental health court participants did much better in the follow-up period. “It appears that mental health courts are diversion programs for justice-involved persons with mental illness and, usually, co-occurring substance abuse disorders that warrant public policy support,” Dr. Steadman and his colleagues wrote.