Longitudinal Outcomes of an Urban Mental Health Court

Background: The importance of transition planning and service engagement for individuals with serious mental illness (SMI) has been demonstrated repeatedly in the research literature. Mental Health Courts (MHC) use a therapeutic jurisprudence model, similar to Drug Courts, to foster treatment engagement and decrease criminal involvement for those with SMI who interface with courts and jails. Effectiveness research is often hindered by the unstandardized and complex nature of the intervention, making it difficult to isolate the independent effects of the court on individual outcomes. One strategy for controlling environmental influences is using a longitudinal design that compares pre and post intervention behavior. This study of an urban MHC asks: 1) What characteristics are most predictive of completion? 2) Does involvement with the criminal justice or mental health system change from pre to post MHC?  3) Are there cost savings attributable to MHC? Methods: Multiple methods were used to assess this MHC focused exclusively on felony offenders. We report outcomes attained through matching individuals across several administrative databases (jail, CMH, court administrator, probation/parole, substance abuse treatment) in an effort to track the trajectories across three time periods: 1) year prior to admission, 2) during MHC, and 3) year after discharge. Among the 116 individuals admitted, 91% are unemployed; 76% are homeless; and 69% have a diagnosis of bipolar or schizophrenic disorder. To date, 66 have been discharged, with 29 individuals completing 1-year post discharge. Results: Hierarchical LR was used to predict successful completion; age, gender, mental health diagnosis, and risk score for propensity to engage in violence were entered. Those with low risk for violence were five times as likely to be a successful completer than those with high risk scores (OR 5.2; 95%CI: 1.07, 25.09). We found a decrease in mental health service utilization from the pre-MHC time period (M=46, SD=67) to post-MHC (M=15, SD=22). Similarly, there was a significant difference in pre to post MHC jail days (t(28)=5.8, p<.001). In the year prior to MHC there was an average of 116 jail bed days (SD=106); in the year after, 4 days (SD=13). A higher number of jail days was found for unsuccessful completers, however, the pre/post change remained significant. The reduction of 112 jail days per participant equates to $10,080 per admitted MHC participant in jail savings in the first year after MHC, or collectively $292,320 in savings for the first year after MHC (N=29). Conclusion: This longitudinal evaluation found significant decreases in jail and mental health treatment in the year after MHC, irrespective of completion status. Although decreasing high intensity mental health services is one of the goals of the MHC, and this has occurred, it is a bit problematic that in general all mental health service utilization declined in the year after MHC. Keeping these individuals engaged in treatment after MHC will likely be the catalyst for continuing positive gains and a goal for social workers in CMH. Cost savings attributable to MHC, particularly within the jail, should assist the community with sustainability of the model.