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Assessing the Effect of Mental Health Courts on Adult and Juvenile Recidivism: A Meta-Analysis

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Abstract

Mental health courts (MHCs) are increasingly used across the United States as a means of reducing contact with the criminal justice system for individuals experiencing serious mental health conditions. MHCs rely on diversion from incarceration to rehabilitation, services, and treatment to reduce recidivism and other negative outcomes among individuals with mental health disorders. While MHCs are a potential evidence-based remedy for the intensifying mental health and criminal justice crises in America, there is limited research indicating the overall effects these courts have on recidivism, and whether the effects vary across different sub-groups or research design and analytic features. Therefore, we present a meta-analysis of 38 effect sizes collected from 30 evaluations conducted from 1997 through 2020 on the impact of mental health courts on recidivism for adults and juveniles with mental health issues in the United States. Weighted meta-analytic results indicate that MHC participation corresponds to a 74% decrease in recidivism (OR = 0.26). Notably, the strength of MHC effects are similar for adult and juvenile participants, and stable across varied follow-up periods, study design features, and when prior criminal history, gender and race/ethnicity are controlled for in the analyses. Implications for the criminal justice system are also discussed.

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Notes

  1. Hedges’ g is roughly equivalent to Cohen’s d, as both effect sizes represent the difference in means (M) on an outcome for the treatment and control conditions, divided by the standard deviation (SD). However, as d= \(\frac{M1-M2}{SD}\) whereas g = \(\frac{M1-M2}{SDpooled}\), a slight upward bias in d may occur when sample sizes are small (i.e. n < 20) and greater variation in SD’s across samples may exist. Therefore, Hedges’ g utilizes a pooled SD weighted by sample size, and therefore produces a slightly more precise estimate of effects for small samples than Cohen’s d (Hedges, 1981).

  2. We used 1997 as a starting point of our search given that this is the year that the first MHC was implemented.

  3. This is operationalized as any specialized court-based diversion program for individuals with mental health conditions where support, services, and/or treatment are provided in lieu of incarceration and traditional court adjudication.

  4. In line with related meta-analytic research, we opted to include only peer-reviewed studies to increase the validity of the results, as unpublished or non-peer-reviewed studies may not reach the accepted bar of quality required for publication in the field, due to a lack of evaluation through the peer-review process. Moreover, selection bias is introduced when unpublished literature is included in the sample as it is impossible to ensure that all unpublished works are identified for inclusion.

  5. There number of effect sizes exceeds the total studies in the sample as certain studies contained multiple results, as they analyzed effects from multiple MHCs in the same publication.

  6. Standard error (SE) estimates were calculated when not provided for bivariate effects using the formula: 1√ N -3, and for multivariate effects, the SE is calculated using the formula: r/(b/SE) where r is the effect size and b/SE is the ratio of the unstandardized regression coefficient to its SE (see Pratt et al., 2014).

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  1. University of South Florida, Tampa, FL, USA

    Bryanna Fox, Lauren N. Miley, Kelly E. Kortright & Rachelle J. Wetsman

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Fox, B., Miley, L.N., Kortright, K.E. et al. Assessing the Effect of Mental Health Courts on Adult and Juvenile Recidivism: A Meta-Analysis. Am J Crim Just 46, 644–664 (2021). https://doi.org/10.1007/s12103-021-09629-6

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