Impact of Community Treatment on Arrest in Mental Health Courts

Background and Purpose: Mental health courts (MHCs) are one type of court diversion programs specialized for people with mental illnesses. The basic assumption of MHCs is that untreated mental illness is the main source of the criminal behaviors. Thus to reduce future arrest, a core component of MHCs is the provision of community treatment. Research has consistently found MHCs that MHCs successfully reduce criminal behaviors. However, despite the important link between community treatment and arrest, research on the components of treatment received by MHC participants is rare. Do MHC participants have better clinical outcomes compared to offenders with mental health in traditional courts? Do MHCs result in fewer arrests and have long term effects compared to the traditional courts? This study examines the impact of community treatment in MHCs on arrests as compared to the regular criminal justice system.

Methods: Data were obtained from the MacArthur MHC Project which includes nationally representative data from four MHCs (2 CAs, MN, and IN) and comparison samples from each site. Data were collected at baseline enrollment and 6 months later in the court. Objective arrest records were obtained from the Federal Bureau of Investigation (18 months before and after enrollment). The sample consisted of 311 MHC participants and 342 treatment-as-usual (TAU) participants. TAU participants had similar mental illness and criminal charges but were in the regular court system. Paired sample t-tests were conducted to compare clinical outcomes- treatment compliance (appointment and medication), treatment perception (perceived voluntariness and motivation), and treatment usage (mental health service and substance abuse service) and criminal justice outcomes (i.e., arrest) between groups (MHC and TAU) at the baseline and 6 months later. A fixed-effects Poisson regression was conducted to control for selection bias between the groups.  

Results: Preliminary analyses indicated that MHC participants showed significant increases in treatment motivation (β= .05, p<.05) and perceived voluntariness (β= .08, p<.01). In addition, MHC participants received fewer mental health services (β= -.57, p<.001) but more substance abuse services (β= .06, p<.01) compared to TAU participants. In terms of the impact of treatment on arrest, for the TAU group, only increased mental health services significantly reduced the number of arrests (β= -.01, p<.001). Yet, for the MHC group, increased medication compliance (β= -.23, p<.05) and mental health services (β= -.01, p<.05) decreased the number of arrests. The Fixed-effect Poisson regression indicated both groups (MHC and TAU) had reduced numbers of arrest over time (6 and 12 months), but only MHC participants have significantly reduced arrests 18 months later (β= -.30, p<.05).

Conclusion and Implications: Findings suggest that MHC participants have increased treatment perception and substance abuse usage compared to TAU group. Medication compliance and mental health service significantly reduce the arrest in MHCs. Although both groups have decreased arrests within the first year, MHC participants have significantly reduced arrests in the longer term (i.e., 18 months) compared TAU group. As a result, MHCs lead to positive outcomes for both clinical and criminal justice and the effects are more apparent in the long term.