Wait Times for Mental Health Court Program Entry: A Survival Analysis of Time from Referral to Program Entry

Background: The goal of mental health courts (MHCs) is to reduce the amount of time persons with mental health problems who commit minor criminal offenses spend in jail. This is accomplished through provision of mental health treatment and set goals as established by the MHC, including securing housing, gaining employment and maintaining sobriety. However, many persons eligible for MHC participation spend exceedingly long periods of wait time in jails prior to entry. These long wait times have negative consequences for individuals with mental health problems, including a lack of access to mental health treatment. However, to date there is only scant, cross-sectional research available to examine characteristics associated with wait times to MHC entry. To address this gap, we examined administrative records of a newly formed MHC in the southeastern United States to establish associations with wait time to MHC entry.

Methods: Data for this study include the administrative records of all individuals who entered the MHC between the years 2013 and 2017 (N = 70). Data was collected on the specific dates of MCH referral and program entry. Additional measures included the year the individual was referred to the program, mental health service needs upon MCH entry (LSI-R), gender, race/ethnicity, DSM-5 diagnosis, history of substance use, whether the individual’s initial criminal offense was a probation/parole violation (opposed to any other criminal offense), and whether the individual had completed and graduated the MHC prior to 2017. To examine characteristics associated with time to MHC entry, we utilize a multivariate survival analysis, using days from program referral to program entry as our dependent variable.

Results: The sample of individuals were primarily male (68%) and White non-Hispanic (68%). Over half had a DSM-5 diagnosis of Bipolar (either type I or II). About 89% had a history of substance use, 47% had an initial criminal offense that was a probation/parole violation, and 4% were MHC graduates. The multivariate survival analysis showed that individuals with higher mental health service needs waited significantly fewer days to program entry than individuals with lower mental health service needs. Additionally, White non-Hispanic individuals waited significantly fewer days to program entry than non-White individuals. Last, individuals who were MHC graduates waited significantly more days to program entry than individuals who were not current MHC graduates.

Conclusion:  Findings from this study suggest that wait times to MHC entry are based in part on level of service need and sociodemographic characteristics including race/ethnicity, but that a faster entry time may not translate into a more rapid program completion. While the MHC studied here has only been in operation for the past 4 years, these findings suggest future research in this area is needed to explain the mechanisms, including potential program level policies, which are associated with these findings. Social workers, especially those working in criminal justice settings, can benefit from this research through petitioning for additional resources for diversion-based programming, including MHCs, and continue advocacy for the socially just treatment of persons with mental illness involved in the criminal justice system.