Cost Analysis of the Long-Term Outcomes of an Urban Mental Health Court

Purpose: Multiple studies have demonstrated decreased recidivism and increased treatment engagement for individuals with serious mental illness involved in Mental Health Courts (MHC).  However, limited availability of resources requires an analysis of the relationship between a program’s effectiveness and its costs. Although there is some evidence that drug courts produce a cost savings, there are no published cost analyses of MHC. Moreover, cost analyses of problem-solving courts are generally conducted when the participant remains active in the program and under court supervision, so that the impacts on future expenditures are not quantified. Our research questions: What are the cost savings associated with the long-term outcomes of MHC, when comparing participants to non-participants? Are there differences in costs based on a participant’s completion status? Method: An urban MHC, serving persons with a serious mental illness and felony, produced a sample of 105 discharged for more than one year: 40 successfully and 65 unsuccessfully.  A comparable sample, screened over a year ago, but not enrolled (n=45), were used as a comparison. Individual level outcome data acquired from several administrative databases was used to calculate outcomes, as well as direct and indirect costs, associated with treatment, arrest, and confinement in the 12 months post MHC. Transactional and institutional costs analysis (TICA) was utilized to accommodate the complexity of transactions participants engaged in across multiple publically funded organizations (i.e. CMH, courts, jails, etc.).  All standard costs were calculated in 2013 dollars and averaged across each of the three groups.  Results. No statistical differences between groups on age (M=37), proportion minority (50% - 54%), nor mental health diagnosis. Successful Group differed from both the Unsuccessful and Compare Groups (but they did not differ from each other) on number of days confined (F (2,149)=15.88; p>.001). Although the number of mental health treatment encounters did not differ between groups (F(2, 138)=1.59), the cost of those encounters did differ (F(2, 138)=3.78; p=.03). Total outcome costs for the Successful group ($17,113) significantly differed from the Unsuccessful ($32,237) and Compare groups ($39,978). Costs associated with a higher number of arrests/court processing for those in the Compare group created the largest differences with those who participated in MHC. Cost savings between Successful and Compare ($22,865 per person) equated to an overall savings of $914,856; savings between Unsuccessful and Compare ($7,741) resulted in a savings of $503,154.  Implications. The combined cost savings for participants in the one year post MHC period ($1,417,740) provides new information on the efficiency and sustainability of MHC treatment effects. Although smaller for those unsuccessful, there was a treatment effect irrespective of participant completion status. For practitioners and policy makers contemplating a MHC, it should be noted that these outcomes apply to felony offenders. Both MHC and drug courts have demonstrated more favorable outcomes for those with more serious risk. Finally, the nature of this outcome analysis does not take into consideration the cost of the MHC, as the goal is to determine if there is an avoidance of expenditures in the future as a result of intervention.