Identifying Reasons for Participating in a Mental Health Court: An Exploratory Study

Background and Purpose: As the most frequent providers of community-based mental health services in the United States, social workers often find their clients with serious mental health disorders having frequent, repeated, and prolonged contact with the criminal justice system (National Association of Social Workers, 2007). In fact, three times more individuals with serious mental health disorders are held in jails and prisons than in psychiatric hospitals, and the largest providers of mental health services are now urban jails (Human Rights Watch, 2003). In response, mental health courts have developed to divert individuals from the criminal justice system to community-based treatment in lieu of traditional processing, sentencing, and supervision. Research on these voluntary diversion courts is just emerging and there has been no empirical inquiry evaluating what motivates court participants to opt-in to a mental health court. The purpose of this study was to identify factors that motivated participants to enter mental health court in order to better inform social work practitioners and mental health court programs when conducting referrals, outreach, assessment, and motivational interventions.

Methods: This study utilized a grounded theory approach (Strauss & Corbin, 1998). A convenience sample of 50 adult mental health court participants who had a diagnosed serious mental health disorder (schizophrenia, bipolar, or major depression) and were competent to provide informed consent were recruited through clinicians affiliated with three mental health court programs. Participants who elected to participate in the study were interviewed in-person and were asked to describe their motivations for participating in mental health court. Participants' statements were hand-recorded and transcribed into typed text verbatim. Data analysis followed the grounded theory approach that incorporates three main phases of analysis: 1) categorizing the data (open coding); 2) connecting categories (axial coding); and 3) focusing on a core category (selective coding). This systematic data analysis procedure resulted in a hypothesized “theory” identifying motivating factors for participating in a mental health court.

Results: All 50 participants were able to provide a detailed description of their reasons for choosing to participate in mental health courT. Participants were more often male (62%), unmarried (93%), white (60%), and ranged in age from 18 to 60, with a mean age of 38 years (SD=10.78). Participants enrolled in mental health court for four overarching reasons, including: a) improved legal outcomes or processes; b) better access to services or programs, c) external motivation and oversight; and d) the perceived chance to make a real change in their lives.

Conclusions and Implications: This study provides social work practitioners with previously undocumented information about court participants' motivations to become involved in this type of problem-solving therapeutic court. Practitioners may consider informing potential clients about the program's legal incentives, access to services and support, and the chance to change. Additionally, understanding what motivates court participation will help programs to employ motivational interventions to encourage treatment and continued court participation. Finally, this research provides preliminary hypotheses that can be quantitatively tested with a broader sample in future social work research.