Racial Disparities in Outpatient Service Utilization in Mental Health Court Participants

Background and Significance: Mental health courts (MHCs) are diversion programs specialized for offenders with mental illness. A core component of MHCs is to link the participants with community treatment providers to decrease future arrests. A substantial amount of research has demonstrated that MHC participants receive more treatment than traditional court participants. However, little is known about racial disparities in mental health and substance abuse service utilization among MHC participants compared to traditional court participants. To address this gap in the literature, the proposed study aimed to examine racial disparity of mental health and substance abuse services in MHC and a comparison group.  

Methods: Data are from the MacArthur MHC Project which includes objective and subjective information from four MHC samples with comparison samples at each site. Interview data were collected at baseline enrollment and 6 months later. The sample consisted of 357 MHC participants and 384 treatment-as-usual (TAU) participants. Amount of mental health and substance abuse service utilization were measured 6-month before and after court enrollment/arrest. Guided by Andersen’s behavioral model of health service utilization, logistic regression analyses were conducted to examine the relationships among predisposing, enabling, and need factors and utilization of mental health and substance abuse services. To examine racial disparities in service use, interaction terms between race and significant predictors of service use were also examined.

Results: In the TAU group, Black respondents were less likely to use both mental health and substance abuse services compared to their White counterparts. However, no significant racial disparities were found within the MHC sample’s use of mental health or substance abuse services. Prior to the addition of interaction terms to the models, both Black and Latino respondents were less likely to use mental health services than White respondents. Only Black respondents were less likely to use substance abuse services than Whites. Further, MHC participants were more likely to receive substance abuse services compared to TAU participants. Following the addition of race-based interaction terms, models indicated that Blacks were less likely to use both mental health and substance abuse services compared to the White counterparts. In addition, respondents with more previous services and days in the community were more likely to use both mental health and substance abuse services compared to their counterparts. Significant interactions between race and study group (Black) were found in relation to use of substance abuse services, indicating that Black respondents in MHCs utilized more substance abuse services than their counterparts.

Conclusion and Implications: Study findings suggest that significant racial disparities exist in the service utilization of traditional court participants but not in MHC participants. Thus, MHCs may not only increase the possibility of using outpatient services but may decrease the racial disparity in those services for the participants. To provide adequate behavioral health services for offenders with severe mental illness, mental health professionals should identify sources of support, which can facilitate increased involvement in needed services.