MHCs are growing rapidly across the nation. Research is beginning to shed light on outcomes like reduced criminal recidivism and increased access to services. However, little is known about how consumers experience treatment in the context of MHCs or what mechanisms contribute to outcomes. This study seeks to address gaps by investigating MHC consumers' experiences with MHCs and supervised treatment. The study also explores MHC consumers' perceptions of the mechanisms that promote outcomes highlighted in existing research.
Method: Qualitative methods are used to examine MHCs from the consumer perspective. Twenty-six MHC consumers took part in a 60-minute interview. They were asked about their experiences with the MHC, treatment, and perceptions of program effectiveness and agents of change. Participants were recruited from two mid-western, urban MHCs in operation since 2004 and 2005, respectively. Participant selection was based on MI diagnosis, severity of symptoms, criminal history, length of time in the program, and age. Data were analyzed using the grounded dimensional analysis strategy for grounded theory studies developed by Schatzman.
Results: 92% of MHC consumers interviewed report an overall positive experience with the MHC. Consumers identify five components of the program that they believe make it effective: program structure, judicial accountability, tools to manage illness, support, and access to quality treatments; each theme is illustrated with descriptions and quotes. Consumers report that the MHC changed their perceptions of the justice system such that they feel respected and heard when encountering the judge. In addition, many consumers find that involvement in the MHC helped them address the reasons they were involved with the law and obtain better services than they were able to obtain on their own.
Conclusions: Results provide the groundwork for understanding how and why MHCs impact criminal recidivism and service access, and it adds a perspective of a population whose voice is often unheard in the research literature. Results from this study are important to policy and practice. Understanding the mechanisms of change like support and program structure are essential in creating interventions. As MHCs grow, it is important to maintain and improve components that impact recovery. In social work, practitioners often face barriers when working with people who have an MI and are involved in the justice system. Understanding that consumers find accountability and concrete tools helpful in their recovery provides a framework that social workers can utilize in practice.