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Examining Mental Health Courts

  • February 19, 2021
  • Patients and Families

People with mental illness are more likely to be arrested, to be denied or unable to pay bail, and to have lengthier stays in jails compared to those without mental illness. An estimated 2 million people with serious mental illnesses are incarcerated each year. One approach increasingly being used to help address the problem is mental health courts.

For people with mental illness, mental health courts offer an alternative to the traditional judicial system. The general goals of mental health courts are to reduce recidivism and to improve psychiatric functioning. Individuals must meet specific legal and mental health criteria to participate and must also make a voluntary decision to choose the mental health court with supervised treatment instead of a traditional criminal court procedure. Participants receive community-based treatment and assistance with social services through existing community programs.

During the process, a judge oversees provision of mental health and social services and monitors the individuals’ progress with their treatment plan. When they successfully complete the program, participants may receive reduced or dismissed charges. If they do not follow their treatment plan, they may face consequences, such as more frequent monitoring, or may be dismissed from the mental health court. The specifics of how these courts operate vary from jurisdiction to jurisdiction.

Mental health courts were first established in the U.S. in the late 1990s and the number of has grown in the past two decades—there are now nearly 350 across the country.

Benefits and Concerns

There is evidence that mental health courts improve recidivism by engaging individuals with intensive treatment services, and the general consensus is that there is likely less recidivism among those completing mental health court programs, according to a recent Resource Document on Mental Health Courts from APA. The courts provide an opportunity for intensive treatment and incentive to stay in it, potentially leading to reduced recidivism.

However, research on the effectiveness of mental health courts is challenging and even after many years of research, “questions remain regarding how MHCs meet their stated goals of reducing recidivism and improving psychiatric functioning,” the APA report notes.

Among the criticisms of mental health courts are that mental disorders do not necessarily cause crime and that the existence of the courts may imply a link and worsen mental health stigma. Other concerns include the potential for mental health courts to perpetuate existing disparities in the criminal justice system and to “distract from confronting the root causes of systemic injustice that drive the significant racial and mental-health related disparities prevalent throughout the justice system,” according to the APA report.

The Bazelon Center for Mental Health Law argues that “mental health courts may divert individuals from jail or prison, but they do not solve the systemic problems that cause people with mental illnesses to be arrested and incarcerated in disproportionate numbers.” People with mental illness would be better served by ensuring timely access to needed services, Bazelon suggests.

The APA report concludes: “While not without controversy, mental health courts have emerged as important models of how criminal courts can potentially serve as therapeutic arms of the justice system for individuals with mental illness,” and suggests the need for ongoing research better understand the variables and to ensure equitable and just practices.

The Stepping Up Initiative

A National Initiative to Reduce the Number of People with Mental Illnesses in Jails

County and other local jails are often the de facto mental health hospitals for people who cannot access appropriate community-based mental health treatment and services.

Recognizing the critical role local and state officials play in supporting systems change, the National Association of Counties, the American Psychiatric Association Foundation and The Council of State Governments Justice Center launched the Stepping Up initiative in May 2015. Stepping Up is a national movement to provide counties with the tools they need to develop cross-systems, data-driven strategies that can lead to measurable reductions in the number of people with mental illnesses and co-occurring disorders in jails.

More than 425 counties have passed a resolution or proclamation to participate in the initiative.

For more information, including resource materials for counties, visit


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