Assessing the effectiveness of mental health courts: A quantitative review

doi:10.1016/j.jcrimjus.2010.11.003

Journal of Criminal Justice

Volume 39, Issue 1, January–February 2011, Pages 12-20

https://doi.org/10.1016/j.jcrimjus.2010.11.003 Get rights and content

Abstract

Purpose

The purpose of this review is to quantitatively review the accumulating MHC studies that have been conducted of both peer-reviewed and non-peer-reviewed studies. The primary objective of the current study is to provide a clearer picture as to whether MHCs are an empirically efficacious intervention for a significant health and criminological problem.

Methods

This study used meta-analytic techniques to assess the effectiveness of MHCs. A systematic search of the literature and electronic databases through July 2009, as well as an e-mail survey of mental health court program directors, generated 18 studies.

Results

Aggregate effects for recidivism outcomes revealed a mean effect size of -0.54 and -0.55 among quasi-experimental studies analyzed separately. There was a positive improvement among a limited number of clinical outcomes.

Conclusions

Our findings suggest that MHCs are an effective intervention but this assertion is not definitive. Methodologically, many of the studies are not as strong as would be ideal thus limiting our conclusions.

Research Highlights

► We used quantitative analysis to examine mental health court interventions. ► Eighteen published and unpublished studies were analyzed. ► Our findings suggest they are effective but this assertion is not definitive.

Introduction

Mental health courts (MHCs) are being implemented as a means of diverting the increasingly large numbers of persons with severe mental illness who have committed crimes, into court mandated treatment programs instead of the prison system. Using the latest data available, as of June 2004, nearly 321,884 of the 2.1 million prisoners suffered from a serious mental illness (Lamb, Weinberger, Marsh, & Gross, 2007). These total numbers have likely increased, given that there are currently an estimated 2.3 million persons in state and federal prisons (West & Sabol, 2009). A recent study of mental illness in jails found that 14.5% of men and 31% of women had a serious mental illness (Steadman, Osher, Clark Robbins, Case, & Samuels, 2009). That number rose to 17.1% and 34.3%, respectively when Post Traumatic Stress Disorder (PTSD) was included as a diagnostic category. MHCs have increased rapidly over recent years and taking stock of the empirical literature on the effectiveness of these courts in order to better inform public policy is critical. Thus, the present study employs meta-analytic techniques in order to present the state of the science in relation to MHCs.

Section snippets

Potential advantages

There are several possible advantages of MHCs. First, research suggests that MHCs link individuals to mental health treatment. Several studies have demonstrated this. Two Florida MHCs reported linking 82% and 73% of its participants to mental health services (Boothroyd, Poythress, McGaha, & Petrila, 2003). At the eight month follow-up, the latter figure dropped to 57% but MHC participants remained in a higher level of treatment when compared to individuals in the traditional misdemeanor court.

Data sources and search strategy

A comprehensive literature search was conducted through July 2009 of MEDLINE, PsychINFO, PubMed, ERIC, Social Science Abstracts, Social Work Abstracts, Social Science Citation Index, Sociological Abstracts, ProQuest Digital Dissertations database, Social, Psychological, Criminological, the Cochrane Library database and the National Criminal Justice Reference Service (NCJRS) databases. Other search strategies included searches by hand of journal article reference sections and a query of authors

Results

Eighteen studies, described in Table 1 met the inclusion criteria. Each study contained enough information to be reproduced by another set of researchers with the exception of Teller, Ritter, Salupo Rodriguez, Munetz, and Gil (2004). This study was unable to be fully assessed and scored for methodological quality because it was missing a considerable amount of information. While not enough information could be gathered from the study to rate its methodology it was considered a valuable study

Discussion

This is the first investigation to synthesize all of the available studies that could contribute an effect size for the purpose of evaluating the status of MHCs. According to this analysis MHCs were able to reduced recidivism by an overall effect size of -0.54. Using Cohen's effect size guidelines (Cohen, 1988), this result suggests that MHCs may be moderately effective treatments for reducing recidivism. The results also showed an MHC had the potential to positively impact clinical outcomes

Conclusions

This study attempted to determine empirically whether MHCs can reduce recidivism rates and improve clinical outcomes. Our findings suggest that MHCs are an effective intervention. Methodologically, many of the studies are not as strong as would be ideal thus limiting our conclusions. Evidence of the effectiveness of MHCs has important clinical implications for incarcerated individuals with serious mental illness as well as for society. Within the context of MHCs, the participants are viewed not

Acknowledgements

We would like to thank the many helpful program directors for their assistance. Without your help and kindness, it would have been difficult to compile this report.

References (55)

R. Boothroyd et al.
The Broward Mental Health Court: Process, outcomes and service utilization
International Journal of Law and Psychiatry
(2003)
N.G. Poythress et al.
Perceived coercion and procedural justice in the Broward County mental health court
International Journal of Law and Psychiatry
(2002)
*TrupinE. et al.
Seattle's mental health courts: Early indicators of effectiveness
International Journal of Law and Psychiatry
(2003)
Baranek, K. D. (2008). Mental health courts-Do certain factors influence the decision outcome of acceptance or...
The role of mental health courts in system reform
Mentally ill offender crime reduction grant program
(2004, October)
*BoothroydR.A. et al.
Clinical outcomes of defendants in mental health court
Psychiatric Services
(2005)
M. Borenstein et al.
Comprehensive Meta Analysis, Version 2
(2005)
M. Borenstein et al.
Introduction to Meta-Analysis
(2009)
*BouldenJ.M. et al.
Evaluation of the Jackson County Mental Health Court Program
(April 2007)

*ChristyA. et al.

Evaluating the efficiency and community safety goals of the Broward County mental health court

Behavioral Sciences & the Law

(2005)

J. Cohen

A coefficient of agreement for nominal scales

Educational and Psychological Measurement

(1960)

J. Cohen

Statistical Power for the Behavioral Sciences

(1988)

H. Cooper

Synthesizing Research: A Guide for Literature Reviews

(1998)

*CosdenM. et al.

Efficacy of a mental health treatment court with assertive community treatment

Behavioral Sciences and the Law

(2005)

S. Duval et al.

A nonparametric “trim and fill” method for accounting for publication bias in meta-analysis

Journal of the American Statistical Association

(2000)

*EckbergD.

Evaluation of the Hennepin County mental health court

(2006)

*FergusonA. et al.

Outcomes from the last frontier: An evaluation of the Anchorage mental health court

(2008)

W.H. Fisher et al.

Beyond criminalization: Toward a criminologically informed framework for mental health policy and services research

Administration and Policy in Mental Health and Mental Health Services Research

(2006)

J. Garcia-Campayo et al.

A meta-analysis of the efficacy of fibromyalgia treatment according to level of care

Arthritis Research & Therapy

(2008)

D. Glaser et al.

Evaluation research and decision guidance: For correctional, addiction-treatment, mental health, and other people-changing agencies

(1988)

*HerinckxH.A. et al.

Rearrest and linkage among clients of the Clark County mental health court program

Psychiatric Services

(2005)

V.A. Hiday et al.

Arrests two years after a well-established mental health court

Psychiatric Services

(2010)

KaplanA.

Mental health courts reduce incarceration, save money

Psychiatric News

(2007)

R.H. Lamb et al.

Treatment prospects for persons with severe mental illness in an urban county jail

Psychiatric Services

(2007)

N.A. Landenberger et al.

The positive effects of cognitive-behavioral programs for offenders: A meta-analysis of factor associated with effective treatment

Journal of Experimental Criminology

(2005)

R.J. Light et al.

Summing up: The Science of Reviewing Research

(1984)

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Assessing the effectiveness of mental health courts: A quantitative review

Abstract

Purpose

Methods

Results

Conclusions

Research Highlights

Introduction

Section snippets

Potential advantages

Data sources and search strategy

Results

Discussion

Conclusions

Acknowledgements

International Journal of Law and Psychiatry

International Journal of Law and Psychiatry

International Journal of Law and Psychiatry

The role of mental health courts in system reform

Mentally ill offender crime reduction grant program

Clinical outcomes of defendants in mental health court

Psychiatric Services

Comprehensive Meta Analysis, Version 2

Introduction to Meta-Analysis

Evaluation of the Jackson County Mental Health Court Program

Evaluating the efficiency and community safety goals of the Broward County mental health court

Behavioral Sciences & the Law

A coefficient of agreement for nominal scales

Educational and Psychological Measurement

Statistical Power for the Behavioral Sciences

Synthesizing Research: A Guide for Literature Reviews

Efficacy of a mental health treatment court with assertive community treatment

Behavioral Sciences and the Law

A nonparametric “trim and fill” method for accounting for publication bias in meta-analysis

Journal of the American Statistical Association

Evaluation of the Hennepin County mental health court

Outcomes from the last frontier: An evaluation of the Anchorage mental health court

Beyond criminalization: Toward a criminologically informed framework for mental health policy and services research

Administration and Policy in Mental Health and Mental Health Services Research

A meta-analysis of the efficacy of fibromyalgia treatment according to level of care

Arthritis Research & Therapy

Evaluation research and decision guidance: For correctional, addiction-treatment, mental health, and other people-changing agencies

Rearrest and linkage among clients of the Clark County mental health court program

Psychiatric Services

Arrests two years after a well-established mental health court

Psychiatric Services

Mental health courts reduce incarceration, save money

Psychiatric News

Treatment prospects for persons with severe mental illness in an urban county jail

Psychiatric Services

The positive effects of cognitive-behavioral programs for offenders: A meta-analysis of factor associated with effective treatment

Journal of Experimental Criminology

Summing up: The Science of Reviewing Research