Cooperating for better care.

News & Views

The complex reality of mental-health courts

Share this:


For Kaiser Health News

Mental-health courts are popular in many communities, and it’s easy to understand why. Rather than sending someone who’s mentally ill to an overcrowded jail that is poorly equipped to manage his condition, mental-health courts offer treatment and help with housing and other social services. The community saves on the cost of locking someone up and offenders get support to stay healthy and may have their charges expunged. Everybody wins, right?

The reality is more complex. Mental-health courts have been in existence since the 1990s, modeled after drug courts that offer an alternative for people with substance-abuse problems who are charged with drug-related crimes. After initially accepting only those charged with misdemeanor crimes such as vandalism or trespassing, many of the roughly 350 mental-health courts nationwide now accept people charged with some felonies such as robbery, and even violent crimes in some cases.

Local judges, frustrated at seeing the same faces repeatedly, are often the driving force behind establishing a mental-health court. Once established, the judges may dedicate a day or more a week to these cases. Programs vary widely, but they often oversee a team of mental-health experts and social-services case managers who refer participants to services available in the community. Offenders generally return to the court regularly for the judge to review their progress and offer encouragement or, if necessary, sanctions.

But research is still scanty on the courts’ effectiveness at addressing offenders’ mental-health problems or discouraging offenders from relapsing into criminal behavior. And some experts are concerned that offenders who are charged with minor crimes would be better off staying out of the criminal-justice system and instead just getting treatment.

The popularity of mental-health courts also aligns with growing concerns about prison crowding and the ever increasing costs to taxpayers. Estimates vary, but according to one study up to two-thirds of people in jails and prisons had a mental-health problem in the previous year, compared with 11 percent of the general population. Although inmates have a constitutional right to health care in prison, correctional institutions are generally not set up to provide treatment for mentally ill prisoners.

In Florida’s Miami-Dade County, Judge Steve Leifman presides in the 11th Judicial Circuit and oversees the mental-health court. The approach there to dealing with mentally ill offenders is multilayered, Leifman says. Many arrests are averted by a crisis-intervention team of police who refer people to treatment before they’re booked. Offenders who are arrested and complete the mental-health court program have a much lower recividism rate than their peers: 20 percent versus 72 percent.

“The key is to identify people and get them treatment earlier,” Leifman says. To that end the program is now training teachers on how to identify signs and symptoms of mental illness in children.

A report by the Urban Institute that summarized research on mental health courts concluded that they seemed to be modestly effective at reducing recidivism, but it was unclear whether they had a positive effect on participants’ mental health.

These courts handle only a tiny fraction of cases dealing with mentally ill offenders, by some estimates 5 percent or less. Given their limited resources, it’s critical that mental-health courts target the right people, generally those who are at highest risk for committing a new crime and who have serious mental illness, say experts.

From that perspective, the shift toward including people who are charged with more serious crimes and may be facing a sentence of several years makes sense.

“That’s when you start to see real cost benefits [to the system] in that you’re averting real jail time,” says Dr. Fred Osher, director of health systems and services policy at the Council of State Governments Justice Center, a nonprofit that consults on public safety issues.

As for the individuals themselves, if they’re facing just a few weeks or months behind bars for conviction of a minor crime, they may balk at enrolling in a program that requires them to return to court repeatedly for up to two years. On the other hand, if they’re facing five years in jail versus a one- to two-year supervised program with the mental-health court, “their lawyer may say it’s a viable option,” Osher says.

Some research suggests that offenders who have committed violent crimes may benefit more from mental health court than non-violent offenders, says KiDeuk Kim, a senior research associate at the Urban Institute’s Justice Policy Center.

“Their recividism rate was lower than non-violent participants,” Kim says, referring to astudy of the mental-health courts in Brooklyn and the Bronx that he coauthored.

Not everyone is a fan of mental-health courts.

“It’s an inefficient solution, and one that has costs that haven’t really been examined,” says Ira Burnim, legal director at the Bazelon Center for Mental Health Law. “It’s inefficient in the sense that these courts are doing the work of managing the process of engaging and working with the individual that the mental health system should be doing.”


Contact Info

(617) 230-4965

Wellesley, Mass