Costs Higher for Mental Health Court Participants

Saving money is one of the big selling points for mental health courts, but a six-year study finds that participants in mental health courts cost an average of $4,000 a year more than a matched group of jail detainees who received jail-based psychiatric services. The additional costs were due to the treatment received through the mental health court system and were not offset by criminal justice cost savings.

“The findings presented here call into question some of the assumptions of mental health court advocates who argue that participation in these courts will result in more cost-effective and efficient interventions for jail detainees who have a serious mental illness,” concluded Henry Steadman, Ph.D., of Policy Research Associates in Delmar, N.Y., in the September Psychiatric Services.

“There may be cost shifting, but there may not be cost savings,” added Steadman in an interview with Psychiatric News.

However, the increase in costs may not be a bad thing, said APA President-elect Reneé Binder, M.D., a professor and director of the Psychiatry and the Law Program at the University of California, San Francisco.

“That reflects increased mental health care utilization, especially for people with co-occurring substance abuse disorders and a criminal history,” Binder told Psychiatric News. Prior research (including Binder’s) has showed that mental health court participation decreases recidivism, jail days, new arrests, and violence. “So beyond the cost issue, the outcomes of mental health courts are valuable for public safety. It’s a good thing from the patient’s point of view and from a public-safety point of view.”

Mental health courts are a type of voluntary diversion program that allows some people with mental illness facing criminal charges to accept court-monitored, community-based treatment instead of going to trial or jail.

Steadman and colleagues tracked 296 mental health court participants and 386 matched jail detainees for three years prior to a target arrest and then followed them for three years after that point.

Both total and criminal justice costs for both groups rose in the three years prior to the arrest, with 86 percent of the average criminal justice costs coming in the year just before the arrest.

An abstract of “Criminal Justice and Behavioral Health Care Costs of Mental Health Court Participants: A Six-Year Study” can be accessed here. Swartz’s commentary, “How Do Mental Health Courts Work?,” is available here.