Designing More Effective Mental Health Courts

We find in the MacArthur Mental Health Court Study that public safety outcomes improve among mental health court participants when compared a “treatment as usual” (TAU) comparison sample. We also find that MHCs receive significantly more community treatment than the TAU sample. When comparing the criminal justice and mental health costs, we find that there is not as much benefit as we anticipated. We compare 3 years before and 3 years after entry into MHC with a comparable time period for TAUs and find an overall increase in combined costs for MHC participants with a notable cost shift from criminal justice to treatment costs. The increase, however, is not evenly distributed across the MHC sample. Higher user subsamples driving much of the observed pooled cost increase with 19%-40% of MHC enrollees actually having reduced costs after enrollment. The implications of these high user subgroups are discussed in terms of the impact on MHC design, enrollments, and procedures.