Defining Success within Mental Health Courts: A Participant Perspective

Background and Purpose: Roughly 16% of people in jails and prisons have a diagnosable mental illness (MI). People with MI spend more time in custody, which often exacerbates symptoms, and are more susceptible to victimization by other inmates.  In response to the concern about the health and safety of people with MI and the financial strain of incarceration, mental health and criminal justice stakeholders advocated for mental health courts (MHCs). MHCs are specialized court-based programs which aim to address the underlying causes of criminal behaviors and produce therapeutic outcomes. Rather than incarceration, MHC participants receive intensive, supervised community-based treatments from an interdisciplinary team.

MHCs are proliferating nationally and internationally and so is the body of research on MHC effectiveness. While the aim of MHC is to produce therapeutic outcomes, researchers largely cite reductions in criminal recidivism (e.g., new arrests, time to new arrest) as indicators of success. Less often, changes in psychiatric symptoms and substance use are measured. In order to examine the extent to which MHC participation is associated with therapeutic outcomes, it is important to gain an understanding of participant experiences. Missing from the literature is participant perspectives on how MHC participation impacts their recovery and behaviors. The aim of this analysis is to develop an understanding of the perceived impact MHCs have on participants in order to build a foundation of knowledge regarding MHCs’ impact on recovery.  

Method: Twenty-six MHC participants took part in a 60-minute, audio-recorded, semi-structured interview. Participants were recruited from two mid-western, urban MHCs in operation since 2004 and 2005, respectively. Maximum variation, purposive sampling was used to obtain a sample of men and women with varying MI diagnoses, substance use severities, and criminal histories. Recruitment occurred through treatment providers and court personnel. Participants were asked about their experiences with the MHC, service engagement, perceptions of program effectiveness and mechanisms of change, and the changes they experienced since participating in MHC. Data were analyzed using thematic analysis.

Results: MHC participants perceive success in nuanced ways compared to researcher-defined successes. Although participants view reduced substance use and “staying out of trouble” as success, they also report that MHC facilitates longer periods of sobriety, recovery-oriented outcomes (e.g., able to define and work towards goals; engagement in life; feeling “at peace”), and improved relationships with family. Participants also perceived success through mood stability, increased patience and ability to care about others, and greater understanding of mental illness. Participants find involvement in 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 indicate that measures of success within MHC research should not be limited to recidivism and symptom severity as many other recovery-oriented and psychosocial factors are important to MHC participants. Further research is needed in order to discern if and how the MHC program itself led to the changes presented by participants. This analysis also adds a perspective of a population whose voice is often unheard in research literature.