The National Science Foundation

Co-PI: Henry J. Steadman

Co-Researchers: Steven Hoover and Alicia Summers

One of the most important new developments in mental health law is the mental health court (MHC). MHCs, which are criminal courts with dockets exclusive to persons with mental illness, were created to help stem the tide of persons with mental illness revolving in and out of the criminal justice system. The primary mechanism by which this is done is to mandate outpatient community treatment in lieu of jail/prison sentences. Despite a dearth of empirical data on the courts, the number of courts is increasing rapidly. Today, 100 MHC in the United States exist (compared to one in 1997) and Congress recently appropriated seven million dollar towards the development of new courts.

A precondition of all MHCs is that participation is voluntary. However, it is unclear whether the courts ensure that participation decisions are indeed voluntary or view them as a mere formality. In addition, unlike other legal decisions, the concomitant components of MHC enrollment decisions being made “knowingly” and “intelligently” as well as voluntary are rarely discussed. It is currently unknown to what degree persons who are being asked to partake in MHCs understand and appreciate the decision before them. A common characteristic of the courts is to require defendants to plead guilty as a condition of enrollment. But, in addition to taking responsibility for the crime, entering into a MHC can include agreeing to attend and engage in outpatient treatment, to take prescribed medications, to find employment, and to adhere with all other orders from the judge, treatment providers, and probation officer. Non-compliance with these mandates can result in increased court supervision, jail time, expulsion from the MHC, and/or return to regular court processing and sentencing.

The study has three main objectives. The first objective is to determine the level of awareness of voluntary participation in MHCs among persons enrolled in the courts and the factors that influence level of awareness. The second objective is to determine the level of understanding of MHC requirements among persons enrolled in the court and the demographic, mental health, and criminal justice characteristics that associate with understanding. The third objective is to determine whether level of MHC comprehension (voluntary awareness and understanding) at entry predicts future success/failure in the court (e.g., compliance with court orders, treatment adherence, receipt of sanctions).

To meet our objectives, a two-phase study was designed. In Phase I, 200 defendants from two cooperating MHCs (one in the Northwest and one in the Northeast) were interviewed about adjudicative competence, perceived coercion, MHC awareness, understanding, and appreciation. In Phase II, outcome data were collected for a one year period following the Phase I interview. Outcome data, which came from objective record reviews, included success/failure measures such as number of re-arrests, days hospitalized, status review hearings mandated and attended, jail days, and graduation rates.