Resource Document on Mental Health Courts - Approved by the Joint Reference Committee, October 2020

Sep 12, 2026

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Resource Document on Mental Health Courts explains the operating model of problem-solving courts grounded in therapeutic jurisprudence. It outlines why mental health courts emerged in 1997, their primary goals of reducing recidivism and improving psychiatric functioning, and the “ten essential elements” used to structure screening, eligibility, informed consent, and individualized treatment. The document describes legal and clinical entry/completion criteria, informed voluntary participation, collaboration across justice and care systems, and monitoring through incentives and sanctions. It also reviews evidence on effectiveness, noting methodological limitations, mixed recidivism findings, and generally stronger support for recidivism reduction than for psychiatric symptom improvement.

LanguageEnglish

CategoryGeneral

FormatPDF

Pages9

Reading Time3 min

AccessFree to download

Introduction

Purpose and concept of mental health courts

Origins and primary goals

Operations and eligibility

Ten essential elements and program structure

Entrance and completion criteria

Informed voluntary participation

Treatment, sanctions, and monitoring

Community-based treatment services

Incentives and sanctions

Effectiveness and research findings

Do mental health courts work?

Recidivism evidence

APA Resource Document Resource Document on Mental Health Courts Approved by the Joint Reference Committee, October 2020 "The findings, opinions, and conclusions of this report do not necessarily represent the views of the officers, trustees, or all members of the American Psychiatric Association. Views expressed are those of the authors. " --APA Operations Manual. Prepared by the Council on Psychiatry and Law Introduction Mental health courts (MHCs) are one of a range of “problem-solving courts” operated on the premise that the criminal law can be used to therapeutic ends to the benefit of both individual defendants and society as a whole, a concept known as therapeutic jurisprudence (Winick 2003) . Other examples of problem-solving courts include homelessness courts, veterans’ treatment courts, and domestic violence courts. Many psychiatrists are unfamiliar with MHCs despite their rapid expansion in recent years. The purpose of this resource document is to describe the concepts behind and operations of MHCs and review their role and effectiveness. MHCs arose in the United States in 1997 to address the over-representation of incarcerated individuals with mental illness, recognizing that these individuals were more likely to be arrested, to be denied or unable to pay bail, and to have lengthier stays in jails compared to those without mental illness (Landess 2017) . The primary goals of MHCs are generally to reduce recidivism and to improve psychiatric functioning. In 2007, the Council of State Governments on behalf of the Bureau of Justice Assistance helped establish guidance by promoting “ten essential elements” for MHCs that included screening and eligibility for participation; informed consent; individually-tailored treatment plans in lieu of more traditional criminal justice approaches such as arrest or incarceration; collaboration between the criminal justice, mental health, and substance use systems involved in the court program; and monitoring and engagement by the court, including by the use of incentives and sanctions, to optimize the chance of participants’ success (CSG, BJA, 2007) . In August of 2015 there were over 450 adult MHCsin the United States (SAMHSA GAINS 2015) . Each MHC has legal and clinical criteria that potentially eligible defendants must meet for entrance, as well as legal and clinical criteria required for completion of the program (typically known as “graduation”) . Generally, MHCs will examine the types of charges faced by defendants to help determine who can be included as a potential participant. Across the country, qualifying criminal charges are usually misdemeanors but can also include felony charges, sometimes even violent felony charges. Enrollment can occur as early as the time of arraignment to later in court case processing after a period of jail detention. The legal context of the jurisdiction in which the MHC resides is critical, as changes in legislation with respect to the classification of crimes will likely impact the MHC policies. Clinical criteria vary from a potential participant’s self-report of mental illness to a formal diagnostic assessment indicating a serious psychotic or mood disorder according to the Diagnostic and Statistical Manual of Mental Disorders (DSM) (Steadman 2006, CSG 2009) . Also, the underlying offense may be related or unrelated to the potential participant’s symptoms of mental illness. Participants who meet eligibility criteria must also make an informed and voluntary decision to choose the MHC instead of a traditional criminal court procedure. This generally requires that the participant be competent to make such decisions (e.g., adequately understand the charges against them and the consequences of entering a guilty plea) . Unlike drug courts, which typically require the defendant to plead guilty, many MHCs accept defendants prior to their entering a plea (Council of State Governments, 2008; Strong, Rantala, and Kyckelhahn, 2016)

FAQs

What is the purpose of mental health courts and the concept behind them?

Mental health courts operate as problem-solving courts intended to use criminal law therapeutically. The approach aims to benefit individual defendants while supporting society through improved psychiatric functioning and reduced recidivism.

What criteria determine entry and completion in a mental health court program?

Each court uses legal and clinical criteria for eligibility and separate criteria for completion, often referred to as graduation. Eligibility typically depends on the types of charges and clinical factors such as mental illness assessment aligned with DSM diagnoses.

How do mental health courts handle participation and monitoring?

Eligible participants must make an informed and voluntary choice to enter the MHC instead of traditional court processing, and many courts accept defendants prior to a plea. Monitoring commonly combines court appearances with probation or designated MHC staff, supported by incentives for progress and sanctions for noncompliance.

Sep 12, 2026

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