(see Poster Gallery) Constructions of Self-Transformation in Mental Health Court Defendants

Background and Purpose:

Mental health courts have offered an alternative to incarceration for court-involved individuals with serious mental illnesses (SMI) since the late 1990s. Utilizing a problem-solving court model, mental health courts pair defendants with a specialized team of court staff and service providers, mandating defendants to complete mental health treatment. Research on mental health court outcomes has shown relatively low rates of completion for defendants, due largely to issues with mandate compliance. Additional research highlights the importance of moving past simple compliance to deeper levels of engagement for mental health services to have their intended impact.

The purpose of this study was to identify the adaptive responses of mental health court defendants in response to court mandates. This study sought to examine the ways in which defendants adapt to programmatic demands to comply with mandates and avoid sanctions while balancing attention to their own psychosocial needs.

Methods:

The data analyzed for this paper are part of a comparative evaluation of probation and court programs in a large Midwestern county. This paper focused on mental health court defendants with SMI (n=31). Sample inclusion criteria were: adults aged 18 or older currently participating in mental health court with an SMI diagnosis, who were capable of providing informed consent. The research team conducted semi-structured interviews that lasted, on average, one hour. A thematic analysis approach was utilized, with primary emphasis on defendant perceptions and experiences participating in mental health courts. Utilizing triangulation and consensus-building in the qualitative coding process, researchers generated themes based upon their significance and prevalence in interview transcripts. Lastly, researchers developed thematic maps to visually demonstrate the relationship between themes.

Results:

Thematic analysis of interview data revealed that mental health court defendants engaged in meaning-making to adapt to the perceived programmatic demands of mental health court. Programmatic burdens, court-enforced accountability, and intrinsic rewards were themes that converged to form a distinct adaptive response: “construction of self-transformation narratives.” This response shows that defendants tended to interpret the intense burdens of participation as intrinsically rewarding and meaningful, leading defendants to see the expectations of mental health court as an opportunity to better themselves. As a result, defendants expressed more than simple compliance with court expectations; they also reported meaningful engagement with behavioral health treatment. This occurred as defendants adopted a narrative of being on a journey of self-discovery, change, and improvement.

Conclusions and Implications:

Self-transformation narratives emerged as a distinct adaptive response among mental health court defendants. How can self-transformation frames be better understood to facilitate long-term engagement in services? Is there a possibility that defendants superficially adopt these self-transformation narratives as a sophisticated form of program compliance? This study’s findings have important implications for how individuals with SMI may be best served in specialized mental health court programs, and the overall effectiveness of addressing behavioral health needs through the carceral system. The insights achieved through this exploration add to a growing literature on how to best serve and engage defendants with SMI.