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What Mental Health Courts Are Teaching Us About Rehabilitation

An early look at a Pacific Standard story that's currently only available to subscribers.


Mental health courts sound like a great idea—just like the drug courts that inspired them. Maia Szalavitz looks at five studies about mental health courts—and what they’re teaching us about rehabilitation.

Szalavitz's Pacific Standard story is currently available to subscribers and will be posted online on Wednesday, November 25. Until then, an excerpt:

Mental health courts sound like a great idea—just like the drug courts that inspired them. People with psychiatric disorders often have difficulty controlling their behavior; if you treat them effectively, you’ll reduce crime and the need for prison terms. With at least 1.1 million inmates in the United States suffering from mental illness, expanding access to mental health courts could potentially reduce mass incarceration.

Introduced in the U.S. in the 1990s, these courts are procedurally similar to drug courts. Defendants charged with crimes linked to psychiatric problems are evaluated and given a treatment plan, which is overseen by a judge.

In some mental health courts, defendants plead guilty and receive suspended sentences. If they complete the program, the sentence is not imposed; if not, they do the time. In others, charges are suspended until the defendant completes the program, then dropped when they satisfy treatment requirements. Those who don’t comply are simply returned to the regular court system to face the original charges.

But as with drug courts, the devil is in the details. Fewer than 400 mental health courts exist, and the variety of their approaches makes it difficult to draw general conclusions. Research is only beginning to examine whether they work, what the drawbacks are, and what practices are most effective.

Fairly or not, the judicial system sees people with mental illnesses as less culpable than those with addiction, which makes mental health courts less punitive than drug courts—even though an extremely high proportion of their participants also have addictions. These courts are more forgiving of lapses and less likely than drug courts to use jail terms as sanctions for non-compliance, recognizing that incarceration is likely to exacerbate symptoms and interrupt medical treatment.


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