Mental health courts (MHCs) were developed to address the overrepresentation of adults with mental illnesses in the U.S. criminal justice system through diversion into community-based treatment. Research on MHCs has proliferated in recent years, and there is a need to synthesize contemporary literature on MHC effectiveness. The authors conducted a meta-analytic investigation of the effect on criminal recidivism of adult MHC participation compared with traditional criminal processing.
Systematic search of three databases yielded 17 studies (N=16,129) published between 2004 and 2015. Study characteristics and potential moderators (that is, publication type, recidivism outcome, and length and timing of follow-up) were independently extracted by two of four raters for each study. Two raters coded each study for quality and extracted between-group effect sizes for measures of recidivism (that is, arrest, charge, conviction, and jail time; k=25). Results were synthesized by using random-effects meta-analysis. Heterogeneity and publication bias were also assessed.
Results showed a small effect of MHC participation on recidivism (d=–.20) relative to traditional criminal processing. MHCs were most effective with respect to jail time and charge outcomes compared with arrest and conviction, in studies measuring recidivism after MHC exit rather than at entry, and in lower-quality studies compared with moderate- and high-quality studies. Results showed significant heterogeneity in effect sizes across studies (I2=73.33) but little evidence of publication bias.
Overall, a small effect of MHC participation on recidivism was noted, compared with traditional criminal processing. Findings suggest the need for research to identify additional sources of variability in the effectiveness of MHCs.
Evan M. Lowder, Ph.D., Candalyn B. Rade, Ph.D., Sarah L. Desmarais, Ph.D.
Psychiatric Services, August 15, 2017