Mental Health Court Team Members: Factors Influencing Mental Health Court Participant Outcomes

Background/Purpose

Problem-solving therapeutic mental health court (MHC) programs have been broadly established across the United States, Canada, Australia, and Europe to divert people with serious mental health disorders charged with crimes from incarceration and future criminal justice contact, increase participants’ well-being, and improve public safety. Although mental health courts have been shown to reduce recidivism and produce other positive outcomes for participants (Fox et al., 2021; Sarteschi et al., 2011), the mechanisms for these effects remain largely unclear and untested (Han et al., 2020).

Methods

This exploratory study utilized a qualitative grounded theory constructivist approach to identify and summarize factors experienced designated MHC team members (e.g., judges, attorneys, program directors, clinicians, case managers, probation) perceived as contributing to or detracting from improved participant outcomes. Nine focus group interviews were conducted with 51 team members working in 11 different MHCs across the U.S. Participants were asked to reflect and discuss court processes, policies, practices, and culture they had observed to facilitate change. All interviews were recorded and transcribed verbatim. For data analysis, ATLAS.ti software was used to store and code all focus group transcripts into emerging themes.

Findings

Study participants identified six broad factors believed to be responsible for supporting better participant outcomes including (1) court structure, (2) MHC team approach, (3) relationships, (4) communicating positive regard/procedural justice, (5) monitoring and accountability structure, and (6) meeting basic, treatment, and support service needs. Identified barriers influencing outcomes included (1) external factors (e.g., lack of access to basic needs supports such as housing and transportation), (2) extreme participant needs (e.g., acute psychosis, severe addiction), and (3) internal court processes (e.g., non-individualized responses, anti-therapeutic/procedurally just responses). Each of the themes and their implications for practice and future research will be presented.

Conclusion and Implications

This paper aligns with the conference theme by describing research that is community-driven and recentering via knowledge sharing by stakeholder team members. Most of the factors identified as contributing to better participant outcomes were approaches, attitudes, culture, and policies that are dynamic and could be implemented and improved upon by MHC programs. However, including broader samples and MHC participants themselves is needed in future research to further recenter and democratize knowledge so that those with lived experience of going through MHCs are also helping understand the mechanisms of impact from these diversion programs.