Mental Health Courts

Mental Health Courts

There has been an increase in specialty courts in the US as jurisdictions attempt to address the needs of certain groups of offenders away from traditional business-as-usual style courts. One such court is the mental health court (MHC). This court primarily focuses on offenders who have mental illnesses. Offenders considered for this court are identified by mental health assessments and screening and also voluntary participation in a treatment plan that is developed by mental health experts together with a team of court staff. This plan is judicially supervised to ensure that the rights of the offenders are not abused.  Adherence to court resolutions in terms of plan compliance has certain incentives attached to it whereas non-compliance may in certain cases be sanctioned. Graduation from this process is determined through a predetermined completion of goals.

There has been a systematic shift in the way that matters of people with mental illnesses have been handled. Earlier on, mental illness populations were treated in residential areas then gravitated to sate-run psychiatric institutions and eventually to community based settings which allowed for the deinstitutionalization of individuals with mental illnesses. The necessity for law enforcers to process mentally challenged offenders under their purviews has led to development of these courts. MHCs have grown from problem-solving courts, where grassroots responses were developed for drug offenders including arrests and prosecutions which eventually overwhelmed conventional courts. The result was the development of a successful and well documented strategy whose main purpose was to mitigate substance abuse, ensuring that relapses do not occur while supporting efforts that are geared towards desistance in crime eventually reducing the number of crimes committed altogether.

There is consistent and stable participation of all the actors in the MHC processes. This factor facilitates the smooth operations of the court while aligning it to the problem-solving team approach that was the precursor of the MHCs. The presence of the same judge, district attorney, lead agency and clinical director is one of the most important factors in determining the success of the court’s processes. This means that there is a shared understanding in terms of policies, philosophy and procedures that make for a better assessment of this approach. The team approach has been advocated as the best approach for people with mental illnesses as it gives them enough requisite support. There is a significant difference in the operations of the mental health court compared to drug courts. Substantive interactions and shared decision-making seem to be confined to the formative stages of the treatment process (Rossman et al., 2011). Community partners and the criminal justice staff are largely involved during eligibility determination. After the decision to accept or decline a case is made, most of the team work is left to the clinical team and the judge. Most of the updates and recommendations about cases come from either the judge or the clinical team. In contrast, drug court cases elicit the participation of a wide array of stakeholders including attorneys, law enforcement representatives, treatment staff and prosecutors, who gather to assess the progress of offenders. Additionally, these stakeholders are active in weighing the merits and demerits of case advancement as well as determining sanctions or incentives. Some researchers have however pointed to the fact that the team approach between the judge and the clinical team could be a strategy to share responsibility and commitment among themselves while checking the participation of other judicial actors considered as adversarial.

Assessments from statistics gathered from mental health courts and business-as-usual courts where people with mental illnesses have been processed show that those in the former courts are less likely to recidivate compared to those in the latter. In a study done in the Bronx, re-arrest rates for people who went through the MHC stood at 69% whereas that of the comparison group was at 75%. A similar study in Brooklyn showed that the numbers reduced from 68% to 60%. This difference shows that the MHCs have a statistically significant and positive impact on re-arrests of people with mental illnesses. Further, the same studies showed that there was a significant improvement in terms of re-conviction of offenders. In the Bronx, nearly 62% of both the MHC and those in the comparison group were reconvicted. This was in sharp contrast to Brooklyn where there was a reduction of more that 17% between the two groups of offenders (Rossman et al., 2012).

It is prudent to note that the determinants of recidivism are many and the mode of criminal prosecution is just one. Others include: age of the offenders, number of previous offences, gravity of those offenses and prevalence to drugs. On the overall however, there seems to be a reduction in recidivism for participants of MHCs.

The major observation is that although there is evidence of significant reductions in participation in MHCs and recidivism, the rate is still very high. Many observers and researchers assert that these rates are high since offenders are trapped in a revolving door in the criminal justice system because of their conditions and also because of inadequate or inappropriate treatment. Others claim that there is no direct link between mental illness and criminal behavior since those affected do not participate in crime. People who have been incarcerated with mental disorders usually have extensive criminal records and a higher crime activity after being released (Baillargeon et al., 2009). This leads to the conclusion that people with mental illnesses come into contact with the legal system in the same way that those without the illnesses do: criminogenic needs (Skeem et al., 2009). However, regardless of these assertions, statistics suggest that MHCs serve the mentally ill better than conventional courts.



Baillargeon, J. et al., (2009). Psychiatric Disorders and Repeat Incarcerations: The Revolving Prison Door. American Journal of Psychiatry 166: 103-109.

Rossman, S. et al., (2012). Criminal Justice Interventions for Offenders with Mental Illness: Evaluation of Mental Health Courts in Bronx and Brooklyn, New York. U.S. Department of Justice

Rossman, S. et al., (2011). Final Report of The Multi-Site Adult Drug Court Evaluation. Executive Summary and Volumes 1-4. Washington, DC: The Urban Institute.

Skeem, J. et al., (2009). Social Networks and Social Control of Probationers with Co-Occurring Mental and Substance Abuse Problems. Law and Human Behavior 33, 122–135.

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