Effectiveness of a mental health court in reducing criminal recidivism and violence

Am J Psychiatry. 2007 Sep;164(9):1395-403. doi: 10.1176/appi.ajp.2007.06101664.


Objective: In response to the large-scale involvement of people with mental disorders in the criminal justice system, many communities have created specialized mental health courts in recent years. However, little research has been done to evaluate the criminal justice outcomes of such courts. This study evaluated whether a mental health court can reduce the risk of recidivism and violence by people with mental disorders who have been arrested.

Method: A retrospective observational design was used to compare the occurrence of new criminal charges for 170 people who entered a mental health court after arrest and 8,067 other adults with mental disorders who were booked into an urban county jail after arrest during the same interval. A matching strategy based on propensity scores was used to adjust analyses for nonrandom selection into mental health court.

Results: Propensity-weighted Cox regression analysis, controlling for other potential confounding variables (demographic characteristics, clinical variables, and criminal history), showed that participation in the mental health court program was associated with longer time without any new criminal charges or new charges for violent crimes. Successful completion of the mental health court program was associated with maintenance of reductions in recidivism and violence after graduates were no longer under supervision of the mental health court.

Conclusions: The results indicate that a mental health court can reduce recidivism and violence by people with mental disorders who are involved in the criminal justice system.

Publication types

  • Case Reports
  • Comparative Study
  • Randomized Controlled Trial
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adolescent
  • Adult
  • Community Mental Health Services / legislation & jurisprudence
  • Community Mental Health Services / organization & administration*
  • Crime / prevention & control*
  • Crime / statistics & numerical data
  • Evaluation Studies as Topic
  • Female
  • Forensic Psychiatry / legislation & jurisprudence
  • Forensic Psychiatry / methods*
  • Forensic Psychiatry / statistics & numerical data
  • Humans
  • Male
  • Mental Disorders / epidemiology
  • Mental Disorders / psychology*
  • Middle Aged
  • Proportional Hazards Models
  • Regression Analysis
  • Retrospective Studies
  • Risk Factors
  • San Francisco / epidemiology
  • Secondary Prevention
  • Social Control, Formal
  • Survival Analysis
  • Treatment Outcome
  • Violence / prevention & control*
  • Violence / psychology