Criminal Justice and Behavioral Health Care Costs of Mental Health Court Participants: A Six-Year Study

• Published in: Psychiatric services (Washington, D.C.) Vol. 65; no. 9; pp. 1100 - 1104
• Main Authors: Steadman, Henry J, Callahan, Lisa, Robbins, Pamela Clark, Vesselinov, Roumen, McGuire, Thomas G, Morrissey, Joseph P
• Format: Journal Article
• Language: English
• Published: Arlington, VA American Psychiatric Association 01.09.2014
• Subjects: Adult; Biological and medical sciences; Case-Control Studies; Criminal Law - economics; Criminal Law - organization & administration; Diagnosis, Dual (Psychiatry) - economics; Follow-Up Studies; Humans; Medical sciences; Mental Disorders - economics; Mental Disorders - therapy; Mental Health Services - economics; Mental Health Services - organization & administration; Prisoners - statistics & numerical data; Psychology. Psychoanalysis. Psychiatry; Psychopathology. Psychiatry; Social psychiatry. Ethnopsychiatry; Social environment; Human; Justice; Criminality; Health economy; Mental health; Health behavior; Cost analysis; Public health
• ISSN: 1075-2730; 1557-9700
• DOI: 10.1176/appi.ps.201300375

Advocates of mental health courts (MHCs) contend that the courts offer a more humane and cost-effective way to meet the treatment needs of persons with mental illness in the criminal justice system. The authors report on a multisite, case-control investigation examining the economic part of that argument, comparing costs for criminal justice and behavioral health treatment for MHC participants and a matched sample of detainees who received psychiatric services in jail. Criminal justice expenses were less for the MHC participants, but the possibility that the savings would be offset by treatment savings was not borne out. ObjectiveThis study examined whether there were differences in costs for mental health court (MHC) participants and a matched comparison group for three years after a target arrest.MethodsData from the MacArthur Mental Health Court Study, the first multisite study of MHCs, were used to compare behavioral health treatment and criminal justice costs for MHC participants and a matched group (using coarsened exact matching) of jail detainees who were not enrolled in an MHC but who received jail-based psychiatric services in the same cities. Cost data for three years before and after a target arrest were calculated separately for each year and for each participant at three sites of the multisite study—296 MHC participants and 386 matched jail detainees. High-cost MHC participants were identified.ResultsTotal annual costs for MHC participants averaged $4,000 more for all three follow-up years. The additional costs resulted from treatment costs, which were not offset by criminal justice cost savings. The highest-cost MHC participants were those with diagnoses of co-occurring substance use disorders and those who had more arrest incarceration days before their target arrest. Separate analyses determined that the higher average costs were not the result of outlier cases.ConclusionsParticipation in an MHC may not result in total cost savings in the three years after enrollment. To become more efficient and to serve participants with the greatest needs, MHCs need to more effectively define the target group for intervention.