Life Changes Matter More Than Satisfaction or Sanctions/Incentives: Effect of Mental Health Court Experiences on Arrest

Background and Purpose: The over-representation of people with mental illness in the criminal justice system has been a long-standing issue in the U.S. To overcome the limitations of the traditional court system in treating offenders with mental illness, mental health courts (MHCs) program have been implemented to reduce recidivism. Current MHC evaluation studies have shown consistent and strong evidence of reducing recidivism among offenders with mental illness. However, little is known about the factors associated with these successful outcomes, particularly focusing on the participant’s experience in MHCs. Do the positive changes in life issues, as a direct benefit of the MHC participation, influence future crime? This study examines factors associated with positive MHC outcomes, particularly focusing on the participant’s experiences (program satisfaction, life changes, sanctions/incentives) during the program enrollment.

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 in the court or the criminal justice system and 6 months later. Objective arrest records were obtained from the Federal Bureau of Investigation (18 months before and after enrollment) to create the total number of post 18-months arrest after the program enrollment. The sample consisted of 355 MHC participants. Chi-square and ANOVA tests were conducted to compare crime-related (e.g., age of the first arrest, most serious crime, MHC outcome) and MHC experience factors (program satisfaction, life changes as a direct benefit of the program, sanction/incentives) between four MHCs. To control for over-dispersion variable (i.e., arrest) and site variance, a multilevel negative binomial regression was conducted to examine the effect of MHC experiences on arrest.

Results: On average, study participants had been arrested 1.37 times 18-months after they enrolled the MHC program. Bivariate analyses indicated significant site difference among study variables including the number of arrests, gender, racial/ethnicity, current relationship, public benefit, the age of the first arrest, number of arrest since 15, most serious crime, MHC outcomes, and court incentive. The multilevel negative binomial regression indicated that MHC participants with more sanctions are associated with increased number of arrest within 18-months (β= .19, p<.01) whereas positive life changes (e.g., daily problems, symptoms, family relationship) are associated with reduced recidivism (β= -.07, p<.01). Significant site difference was found at the level 2 (p<.05).

Conclusion and Implications: Results underscore the importance of actual changes in the offenders’ underlying issues through the MHC system to decrease recidivism. While MHCs define unmet treatment needs as contributing factors to criminal behaviors and try to provide the appropriate treatment for them, the key to solving the recidivism problem is not actually in the treatment of participants but may be in their actual life changes.