May 01, 2015

When Research Challenges Policy and Practice: Toward a New Understanding of Mental Health Courts

By Carol Fisler

Mental health courts, like other innovations in justice, began as an experiment, testing the proposition that linking defendants with mental illnesses to court-supervised, community-based treatment as an alternative to incarceration would lead to improved mental health outcomes and reduced criminal justice involvement. A handful of mental health courts were launched in the late 1990s, a few dozen by 2003, and by 2010 approximately 300 were operating in more than 40 states, involving tens of thousands of defendants.

Jurisdictions were basing their decisions to open mental health courts, in part, on the success of drug courts. Research showed that participants in these courts had higher rates of treatment retention than addicts participating in treatment voluntarily and lower rates of recidivism than defendants in traditional courts.1 Another reason for the blossoming of mental health courts was a belief by judges and other stakeholders in the logic underlying their design and operations. They assumed that (1) untreated, or inadequately treated, mental illness contributes to criminal behavior; (2) criminal justice involvement can serve as an opportunity to connect people to appropriate treatment; (3) appropriate treatment can improve the symptoms of mental illnesses and reduce problematic behavior, especially when (4) judicial supervision, including the use of graduated incentives and sanctions, helps keep people in treatment; and, thus, (5) the combination of treatment and judicial supervision will reduce recidivism and improve public safety.

The growth in mental health courts preceded any significant research testing their underlying logic. By 2010, only a few studies of individual courts had provided evidence regarding the effectiveness of the program model. The pace of published mental health court research began to pick up in late 2010. Today, although a growing body of research shows consistent and promising results across a number of courts, it also squarely challenges the logic of the mental health court model. Participants in mental health courts do have lower rates of recidivism and spend fewer days incarcerated than similar people whose cases are handled in traditional courts. But these positive outcomes may have little to do with treatment or improvements in symptoms or functioning levels.

What does this mean? And what are the implications for the design and operations of mental health courts?

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