The Efficacy of Mental Health Courts

• Author: Richard D. Schneider - Hy Bloom - Mark Heerema
• Pages: 182-204

182

chapter seven

The Eff‌icacy of Mental Health Courts

A. INTRODUCTION

Within the past decade, the number of mental health courts operating

within North America has risen dramatically. Having only emerged in the

mid-1990s, these courts currently exceed 100 within North America alone.

One might surmise that the explosion in numbers is, in part, due to an es-

tablished and conclusive body of research evidencing the eff‌icacy of these

courts. Unfortunately, this has not been the case. In surveying the litera-

ture available on mental health courts, we quickly realized that evaluations

of mental health-court programs have not emerged with the same sense of

urgency as the courts themselves. It is an undeniable reality that, as mental

health-court programs continue to emerge within North America, there exist

little hard data to support their effectiveness.1

Throughout the course of this chapter we investigate three basic queries re-

lating to the eff‌icacy of mental health courts:

(1) What can be gleaned from the existing research on mental health

courts?

2) What are the barriers to conclusive research?

3) How should mental health courts proceed in light of existing research?

1 This sentiment often f‌inds expression in literature on mental health courts. For a recent

example, see Henry J. Steadman, “An Evaluation of the Bureau of Justice Assistance Men-

tal Health Court Initiative” (2006) (U.S. Department of Justice) [unpublished] at 2, “De-

spite little to no empirical data that MHCs [mental health courts] are successful in obtain-

ing their goals, the courts are proliferating at a fast rate.”

Chapter Seven: The Eff‌icacy of Mental Health Courts 183

In Section B of this chapter, we explore the research presently avail-

able on mental health courts. At a very general level, the literature tends to

compromise descriptions of a basic program, reporting on such matters as

the origins of a particular mental health court, the number of defendants

screened, the make-up of the mental health-court team, et cetera. Thus, the

typical questions that the research seems to be answering are “What is the

mental health court?” and “What does it look like?” as opposed to “Does it

work?”2

Most studies of mental health courts are site-specif‌ic, focusing solely on

one particular mental health court, with few studies adopting a multicourt or

multijurisdictional focus. While studies of individual mental health courts

have been insightful, their utility has been limited by the high degree of

variance that exists among mental health courts. The highly unique nature

of each mental health court renders any claim for class-based eff‌icacy arising

from these studies to be tenuous and venturesome. As well, there is tremen-

dous variance within courts in that the programs prescribed tend to be tai-

lor-made for each accused. This leaves us with a frustrating situation where

“process” rather than “content” is the variable most easily accessed.

It is evident that researchers have done well at describing the function-

ing of mental health courts, but they have struggled to answer whether

these courts individually or collectively have succeeded. Put differently, we

have learned what mental health courts are and what they look like, but we

have not learned if, and how, they work. However, in many ways this reality

should not be surprising. In Section C, we explore some of the barriers that

prevent researchers from conducting more determinative evaluations. From

practical issues such as scarce f‌inances, to def‌initional issues such as how to

characterize “success,” to theoretical issues such as the tenets of therapeutic

jurisprudence, a host of factors renders mental health courts particularly dif-

f‌icult to evaluate.

The challenge for mental health-court stakeholders is how best to pro-

ceed in light of existing research on mental health courts. Without question,

the lack of studies addressing the eff‌icacy of these courts is troubling, espe-

2 See, for example, Eric Trupin & Henry Richards, “Seattle’s Mental Health Courts: Early

Indicators of Effectiveness” (2003) 26(1) Int. J. L. & Psychiatry 33 at 33:

Publications on MHCs [mental health courts] have been primarily limited to descrip-

tions of MHCs and their implications from legal, health, and social policy perspectives.

There remains a virtual absence of empirical data elements in published accounts,

with the exception of basic program statistics, such as number of defendants screened,

adjudicated, and supervised.