Factors Related to Mental Health Court Particpant Outcomes: Views of Court Team Members

Background and Purpose:  Since the late 1990s, adult mental health courts (MHCs) have rapidly expanded across the United States, resulting in over 350 programs operating nationwide (Council of State Governments, 2016). While developing research has revealed positive outcomes associated with MHC participation including low levels of perceived coercion, reduced recidivism, and increased access to treatment (Sarteschi, Vaughn, & Kim, 2011), evidence about the programmatic aspects of MHC that might contribute to better participant outcomes has yet to be developed. Thus, the purpose of the current research was to empirically identify the components of MHCs that contributed to better participant outcomes from the perspective of designated court team members.

Methods: This exploratory study utilized a grounded theory approach (Strauss & Corbin, 2008) to conduct focus groups and individual interviews with MHC team members (i.e., judges, program directors/administrators, case coordinators/boundary spanners, probation/court monitors, prosecutors, defense, and treatment providers) to explore what, from their perspectives and experiences, made MHC work for its participants until reaching data saturation. Study participants were asked open-ended questions utilizing an organizing framework based on the 10 Essential Elements of Mental Health Courts (Thompson, Osher, & Tomasini-Josh, 2007). Interviews were recorded and transcribed verbatim for use in coding and data analysis. Data were analyzed following a grounded theory three-step systematic approach that included open, axial, and selective coding.

Results: Participants identified a variety of factors within the overarching themes of administration and planning; target population; timely participant identification and linkage to services; terms of participation; informed choice; treatment supports and services; confidentiality; court team; monitoring adherence to court requirements; and program sustainability viewed as contributory to better participant outcomes (e.g., reduced recidivism, improved clinical status, access to treatment, improved court accommodation).

Conclusions and Implications: MHC team members cited several programmatic factors that they believed to be central to court participant success, or why they believe that MHCs work. MHCs may wish to consider these identified factors in the development and evaluation of program policies, processes, and priorities. Future research should focus on testing potential relationships between identified facilitating factors and program outcomes as well as the dosages or conditions required to achieve desired results. Further, inquiry into identification of facilitating factors from the view of court participants is needed.