Who succeeds in mental health courts? : identifying predictors related to program retention and legal recidivism

The purpose of this research was to examine “who” was best served by a mental health court (MHC) by identifying the characteristics of participants that were predictive of six-month post opt-in program retention and non-recidivism. Participants were 148 available adults who had recently enrolled in 1 of 4 west coast MHCs, were diagnosed with an Axis I schizo-spectrum disorder, bipolar disorder, or major depression, were legally competent, and provided informed consent. This court-based exploratory study used structured in-person interviews to administer standardized measures to collect demographic, socioeconomic, criminal history, psychiatric, substance use/misuse, health, motivation to change, and therapeutic alliance characteristic data. Additional data were provided by the MHC study sites. Participants ranged in age from 18 to 64 (M = 36.56, SD = 11.81) and most had less than a high school education (M = 11.46, SD = 2.49). Participants were more typically male (61%), white (58%), unmarried (93%), unemployed (92%), had a prior felony (57%), and were diagnosed with schizophrenia (49%) and a comorbid substance use disorder (68%). At 6-month follow-up, 72% of the participants remained enrolled in MHC and 55% remained arrest-free. Results from chi-square and independent sample t-test analyses showed significant differences in the years of education, GAF scores, number of contacts with a mental health professional, and strength of therapeutic alliance with the MHC judge between retained and not retained participants. A significant logistic regression model identified that more years of education, a higher number of contacts with a mental health professional, and a stronger therapeutic alliance with the MHC judge were significant predictors of participants’ program retention. Additionally, significant differences were found between recidivating and non-recidivating participants’ age, ethnicity, education, income, housing, prior criminal history (e.g., prior charges, arrests, and jail days), GAF scores, BPRS scores, AUDIT scores, DAST scores, and comorbid substance use disorder. Another significant regression model identified being older, more educated, white, and having income other than SSI/SSDI were predictive of non-recidivism. MHC programs may use these findings to better assess potential participants, provide more targeted treatment and other related support services, and consider ways to strengthen their working alliance with participants.