Faculty | Research

Changing lives: mental health courts

Illustration by Matt Chase

One afternoon in a courtroom gallery, Monique* waited for her case to be called for the last time. After two years on probation, Monique was about to graduate from mental health court. What followed was a ritual full of praise.

“I want to congratulate you!” the judge said. “I know it has been hard. You persevered through the difficulties, and you continued on. The court is happy!” 

The judge stepped down from the bench and shook Monique’s hand, congratulating her and giving her a certificate of completion while everyone in the courtroom clapped. 

Monique’s day in court was not standard criminal justice but a court innovation for people suffering from mental illness. Mental health courts are part of a broader problem-solving court movement designed to address underlying issues that can result in criminal behavior. 

There are more than 300 mental health courts in the U.S. today, with two in downtown Seattle (supporting the entire King County region). Both Seattle courts started in 1999 and were part of the first wave of treatment courts in the country. 

It began with drug courts in the late 1980s and early 1990s that have since proliferated across the country in various forms. Mental health courts specifically address the connection between mental illness and those involved in the criminal justice system, like Monique. 

While typical courts have an adversarial model with prosecutors and defense attorneys working on opposing sides, mental health courts adhere to a collaborative approach where teams are committed to offering rehabilitation and therapy to a defendant. 

Two years before her graduation, Monique faced charges for assault and harassment. Before mental health courts, she probably would have gone to jail for approximately 90 days. 

With little to no support services, her jail time likely would probably do little to curb any future contacts with the law, contributing to the “revolving door” of criminal justice. Instead of the traditional route, Monique was diverted to a voluntary treatment court. Given her prior hospitalizations for mental illness, sobriety issues, and willingness to engage in treatment, she met the eligibility criteria to opt in to mental health court. 

Her choice to participate in mental health court meant Monique avoided jail time and cleared her criminal court record if she successfully worked through treatment and other court conditions. 

The number of people with mental health disorders in prisons and jails grew over time as criminal justice policies changed, mental health institutions closed, and welfare and other social safety nets decreased as the cost of living increased. In 2017, the U.S. Department of Justice reported that 44% of jail inmates and 37% of prisoners had a history of mental health problems; with 26% and 14% respectively meeting the threshold for serious psychological distress. 

Many also have substance abuse problems which further complicate their mental health needs. Inmates with serious mental illness on average stay in jail longer, have higher recidivism rates, incur more costs, and spend more time in solitary confinement. 

While not all clients who participate in a mental health court are successful, in many cases these programs do change lives. Data shows that mental health courts reduce the rates and severity of someone committing further crimes even as they reduce court costs, especially for felony problem-solving courts. However, more data on the cost effectiveness of mental health courts is needed to evaluate the social and fiscal costs and benefits of these courts.

At its best, treatment courts can be responsive to social problems — mental illness and criminality, safety, homelessness, low-income housing — and potentially improve the quality of life for a vulnerable section of the population. When led by a knowledgeable and empathetic judge and a strong team, these courts provide a model for a more humane, treatment-oriented criminal justice model that lowers recidivism rates, reduces stigma associated with mental illness, and increases the quality of life for clients. 

While problem-solving courts are no panacea for problems in the criminal justice system or mental illness in our society, evidence-based reforms that build on the strengths of the mental health court model and address some of its weakness are important steps forward. 

Professor of Sociology Karen Snedker is the author of Therapeutic Justice: Crime, Treatment Courts and Mental Illness, which examines the social processes by which mental health courts operate. Participant stories illustrate both the potential and limitations of these courts. Snedker’s areas of research include mental health, homelessness, crime and violence, and neighborhood effects. Her other published works appear in sociology, geography, demography, public health, and crime academic outlets.

Professor Snedker’s courses at SPU focus on criminal justice, urban sociology, law, homelessness, mental illness, and she teaches introductory sociology courses for the general curriculum. Snedker also works on campuswide efforts to engage the SPU community in addressing homelessness.

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