Mental health courts began in Broward County, Florida, in 1996. There are now more than 200 nationwide. This specialized court was developed to deal with people in the criminal justice system whose primary problem was mental illness. Defendants with mental illnesses were coming into court repeatedly with minor charges (e.g., shoplifting, vagrancy). They might be sentenced to jail for a short period of time only to be released and then rearrested some time later. In some situations there were short hospital stays in between. The real problem in this situation was the mental illness. Incarceration did not solve the problem. Short hospital stays only worked temporarily. This “revolving door” was not good for the patient/prisoner, was expensive for society, and did not solve the problem of the crimes committed by the person with mental illness.
Deinstitutionalization
The population of U.S. psychiatric hospitals peaked in 1955 at 640,000 people and then decreased by 90 percent by the early 1980s. This process was later called “deinstitutionalization.” There are three reasons often cited for deinstitutionalization: medication, money, and civil rights. In the 1950s doctors developed medication that was somewhat effective in the treatment of mental illness. At the same time, the cost of housing patients was so high that states were looking for any way to reduce their costs. In the 1950s the fiscal crisis of psychiatric hospitals was akin to the fiscal crisis of prisons today. State bureaucrats were willing to consider allowing people back into the community and closing hospitals if possible.
Finally, civil rights advocates had begun to complain that psychiatric hospitals were not only ineffective but actually more harmful than leaving the person in the community. Civil rights advocates recommended closing hospitals and treating people in the community. These three forces worked together to radically decrease the number of patients. Psychiatric hospitals closed. Some former patients were able to make a life for themselves in the community with the help of social services and community mental health centers. Unfortunately, others with mental illnesses were dealt with by the police, jails, and the court system.
How Mental Health Courts Work
Mental health courts are specialized courts that deal with defendants who have mental health problems. The court is one among many of the problem-solving courts, such as drug courts and domestic violence courts. In some mental health courts those charged with certain types of crimes (e.g., violence) are not allowed to have their cases heard. Most of the defendants in mental health courts have been charged with misdemeanors and low-level felonies. Mental health courts are a form of therapeutic jurisprudence. Therapeutic jurisprudence is an attempt by the legal system to help solve a problem rather than simply punish the defendants. It places attorneys and judges in different roles that are not adversarial as in traditional legal proceedings. Therapeutic jurisprudence also requires many other parties, such as medical staff and probation officers, to work together.
The goal of the mental health court is to deal effectively with the mental health problem so that the person with mental illness has a better life and is not a burden on the criminal justice system. In order to participate in mental health court the defendant has to be willing and has to agree to follow all the rules. There are regular status hearings to determine how the participant is doing. The court is informal, but those who fail to adhere to its terms are dealt with by the judge. Those who are making progress are praised. In the mental health court there are several players: the judge, doctor, probation officers, housing authority representatives, family members, advocates, and any other members of the mental health and criminal justice systems who play a role in treating a person with mental health problems. Mental health courts, like other problem-solving courts, have criteria for the completion of the program or “graduation.”
Benefits and Problems of Mental Health Courts
Mental health courts have several advantages. The first is that those who need mental health treatment can receive it. The second benefit is that the criminal justice system can free itself from having to deal with people who are not really criminals but instead in need of medical care. Police officers can spend more time dealing with criminals, and those who operate jails will have more room and probably fewer suicides. The third benefit revolves around money. Mental health courts are not very expensive compared with the costs of police and jails. Coordinating treatment for a person with a mental health problem will probably be cheaper than having that person make use of jails, psychiatric hospitals, emergency rooms, and police officers.
Empirical Evidence of Success
Mental health courts have been examined with respect to the recidivism rates of their participants. There is empirical evidence that mental health court participation decreases participants’ chances of being rearrested. Virginia Hiday and Bradley Ray examined 99 defendants from a North Carolina mental health court, controlling for potential confounding variables. The majority of mental health court participants (90 percent) had been charged with a misdemeanor. Hiday and Ray examined their rearrest rates for two years after their graduations (or dropping out of the court program) and the arrest rates for the two years prior to the defendants entering mental health court. Court graduates had a rearrest rate of only a fraction (odds ratio = 0.12). Even those who started but failed to complete the mental health court had fewer arrests after program participation than before. Hiday and Ray’s research builds on that of Dale McNeil and Renee Binder, who had similar findings. One potential limitation of Hiday and Ray’s research is that most of the mental health court participants were misdemeanants. This research shows that at least among those charged with misdemeanors, mental health courts are successful in decreasing rearrests.
Concerns About Mental Health Courts
There are problems, however, with these courts. One of the biggest complaints is that the population they serve is so narrow that these courts are not helping the bulk of defendants with mental illnesses. Most mental health courts only allow low-level offenders, so many offenders (e.g., those charged with felonies) have no chance of being treated through this program. Also, mental health court participants may be supervised for many more months than they would have been if they had simply pled guilty in criminal court. A mental health court participant may be supervised for two years instead of spending 30 days in jail for a misdemeanor. Some legal advocates have said that this is not rational or fair to defendants.
Perhaps the major complaint about the mental health court is if there is a need for one at all. Why should people with mental health problems have to go through a mental health court to be treated? Some have suggested more hospital beds should be provided for mentally ill persons; or more community mental health centers should be built, as they were supposed to be constructed when deinstitutionalization started; or the number of social workers should be increased to help persons with mental illness navigate their communities without ending up in jail. Some critics claim that mental health courts relieve the mental health community from developing a better plan to help persons with mental illness. In any event, the number of mental health courts is increasing and this specialized court is popular. Researchers will need to examine the effectiveness of mental health courts.
Conclusion
Mental health courts are a form of therapeutic jurisprudence designed to solve the mental health problems of defendants. Mental health courts bring together many players, such as the judge, attorneys, probation officers, and mental health workers, to improve defendants’ mental health and hopefully decrease future involvement with the criminal justice system. Empirical evidence reveals that mental health courts decrease arrest rates for those who complete the program as well as those who participate in the program but fail to complete it. Some advocates believe that mental health courts exist only because the mental health system has failed. Those advocates have suggested making more mental health treatment available before a person gets involved with the criminal justice system.
Bibliography:
- Hiday, Virginia and Bradley Ray. “Arrests Two Years After Exiting a Well-Established Mental Health Court.” Psychiatric Services, v.61/5 (2010).
- McNeil, Dale and Renee Binder. “Effectiveness of a Mental Health Court in Reducing Criminal Recidivism and Violence.” American Journal of Psychiatry, v.164 (2007).
- Phillips, Daniel W. “Mental Health Courts: Helping or Hurting Consumers?” New York City Voices, v.11/1 (2006). http://willslist.org/newyorkcityvoices_ archive/2006winter/2006winter10.html (Accessed October 2013).
- Thompson, Michael, Fred Osher, and Denise Tomasini-Joshi. Improving Responses to People With Mental Illnesses: The Essential Elements of a Mental Health Court. New York: Council of State Governments Justice Center, 2007.
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