The issue of the mentally ill, particularly in their capacity as prisoners, is one that is receiving renewed attention from society. Mentally ill inmates are a group that is particularly vulnerable to the effects of imprisonment, particularly the aspect of imprisonment that is solitary confinement. The mentally ill have historically always been a part of the imprisoned society, and their plight is one that is often ignored.
This is simply for the reasons that there is a level of complexity and difficulty in finding solutions to imprisonment for individuals whose mental health would arguably be severely deteriorated if they were to be sent to conventional prison. Particularly due to the wide-ranging use of the SHU, or solitary housing units, various studies suggest imprisonment greatly deteriorates the mental state of even those that go in without any prior mental health issues, so the damage that they cause to the already mentally ill is arguably irreversible.
One of the only solutions that have been proposed to this issue is that of simply diverting and preventing the exposure of the mentally ill to the prison system through what are known as ‘Mental Health Courts’ or MHC’s. These courts in theory, after the defendant has made a reasonable case and been accepted into these programs, offer mandated treatment in place of the conventional prison sentence in an actual prison. This alternative has not yet been perfected, as it is a fairly new concept, and usually is only able to handle a fraction of the number of mentally ill individuals who commit crimes.
There is also the more moral question that people raise of the general concept that when a person commits a crime that person should be punished. But these criticisms aside, one of the most pertinent questions that should be asked is simply, do they work? Are these mental health courts effective in treating the illnesses of their patients and reducing the rate of recidivism to a significantly greater degree than conventional imprisonment?
A study measured two criteria for the participants of mental health courts, as opposed to those given treatment as usual (TAU), they were released from treatment and imprisonment respectively, and there were re-arrests and jail days after release. With the first criterion, the results found were promising for the fate of mental health courts,
“In the post–18-month period, however, the MHC sample (49%) is significantly less likely than the TAU sample (58%) to be arrested (P = .006).”
The second criterion, the number of days spent in jail, also made a promising case for the effectiveness of MHCs,
"For the MHC sample, there is a small increase in the number of incarceration days from the pre–18-month period (73 days) to the post–18-month period (82 days). For the TAU sample, however, there is a 105% increase in incarceration days (from 74 to 152 days). The difference in the post–18-month period between the MHC and TAU is significant (P < .001). Likewise, the difference is statistically significant for all 4 sites. In addition, the magnitude of change in incarceration days (9 vs 78 days) of the 2 samples is statistically significant (P < .001) and consistent across all 4 sites."
Therefore the question does not seem to be if MHCs work, they clearly do, but the matter is for whom they work for. This study did not randomly select participants, but selected them specifically based on types of crimes committed, number of arrests before this study and the types of mental illnesses they had. Based on this study, there is no argument that mental health courts are ineffective when employed to the right kind of people for which they will have positive outcomes. But the fact of the matter remains that they do not work for everybody; they are not an end-all solution to the problem of the mentally ill being incarcerated. However, they are one solution and they should be employed for those that would provide better outcomes.
This analysis adds to the growing body of literature suggesting MHCs are effective, but also that effectiveness varies as a function of individual and MHC-specific factors. Since every community has varied services and a distinct population, the factors emphasized in the development of an MHC program inevitably will be different. In addition, case processing from referral to acceptance or rejection of an applicant is not uniform across MHCs, in part, because each MHC has diverse resources to devote to the processing of criminal offenders.
Nevertheless, there is a need for continued research to identify ways to improve MHC effectiveness, given their widespread implementation across the U.S. and internationally. To the extent that evidence-based factors associated with reduced recidivism can be implemented, MHCs may better achieve the ultimate goal of reducing criminal justice contact among individuals with mental illnesses.