As policymakers try to stem the flow of mentally ill persons into the prison system, they're experimenting with the way the courts work. Here in Massachusetts, mental-health courts put the focus on treatment rather than punishment, and the model is catching on.
Mental health courts are an alternative to traditional criminal courts with the goal to reduce recidivism. Mental health courts aim to connect mentally ill offenders with services to address the underlying issues that lead to criminal behavior.
Each participant is paired with a social worker who provides case management. Defendants assigned to mental health courts are put on a treatment plan which includes regular meetings with a psychiatrist and/or clinical psychologist and usually includes medication.
Mental health courts are used in varying forms across the U.S.
Programs typically run for 12 months, although some programs run for up to 24 months. Eligibility standards vary, although in most jurisdictions defendants accused of violent crimes, repeat offenders, and defendants accused of sex crimes are not eligible.
We chose to base our model on an implementation of mental health courts in Los Angeles, CA. The Los Angeles County mental health courts utilize the following parameters:
18 months of intensive treatment which includes bi-weekly meetings with mental health professionals.
Only non-violent offenders who have not been charged with sex crimes are eligible.
Beyond our general intervention methods, we incorporated the following issues into our model:
Our model assumes that participants will have their charges dropped and be discharged from the program on successful completion. Some mental health courts have been criticized in recent years for not dropping charges against participants due to fear of political blowback.
To estimate the impact of a program or policy, we use systematic literature reviews to determine causal pathways and effect sizes. Well-researched interventions that have robust, high-quality evaluations allow us to model the impact of an intervention with greater certainty. However, sometimes interventions have limited evidence and not all of the outcomes that are likely to be associated with the intervention have been studied. In those cases, we can only model what is available in the evidence base. We urge future research to take the following gaps into consideration.
Long-Term Impact: Most studies of mental health courts have a limited follow-up period, with few extending longer than three years after the intervention. Studies examining the program's impact for ten years or more will allow for a more accurate projection of long-term cost savings.
Hospitalization Rates: There is insufficient research into long-term rates of hospitalization and institutionalization for mental health court participants compared with mentally-ill arrestees who do not go through the program. We have projected a reduction in hospitalization based on studies showing a reduction in psychiatric symptoms among program graduates.