Putting Therapeutic Jurisprudence

into Practice: The Growth,

Operations, and Effectiveness of
Mental Health Court*
Lurigio, Arthur J., Snowden, Jessica, Justice System Journal

This article focuses on a court innovation for criminally involved people wh

o are afflicted withserious mental illnesses, such as schizophrenia, bipolar d
isorder, or major depression. Itdescribes a recently developed strategy for d
ealing with the challenges of working with mentallyill individuals during th
e pre- and post-adjudication stages of the criminal justice process:mental h
ealth court (MHC). The article also discusses the historical and legal underp
innings ofthese courts, their growth, and the defining elements and operati
ons of the earliest MHCs, whichare best viewed as evolving models of practi
ce. Finally, the article reviews studies of MHCoperations and effectiveness a
nd suggests future directions for MHCs.
Fundamental changes in mental health laws and policies have brought crim
inal justiceprofessionals into contact with the seriously mentally ill at every
stage of the criminal justiceprocess. Police arrest people with serious menta
l illnesses (PSMI) because few other options arereadily available to handle t
heir disruptive public behavior or to obtain for them muchneededtreatment or housing (Teplin, 2000). Jail and prison administrators
often struggle to treat andprotect the mentally ill, judges grapple with limit
ed sentencing alternatives for PSMI who falloutside of specific forensic cate
gories (e.g., guilty but mentally ill), and probation and paroleofficers scram
ble to obtain scarce community services and treatments for PSMI and atte
mpt tofit them into standard correctional programs or to monitor them wit
h traditional casemanagement strategies (Lurigio and Swartz, 2000). When

the mentally ill are sentenced tocommunity supervision, their disorders co

mplicate and impede their ability to comply with theconditions of release a
nd compound the difficulties of prisoner reentry (Council of State andLocal
Governments, 2002).
Other PSMI enter the criminal justice system because they have engaged in
serious criminalbehavior that is often - but certainly not always - related to
their untreated psychiatric andsubstance-use disorders. Indeed, the growth
of specialized police and diversionary programs thataddress low-level crimi
nal behavior (e.g., disorderly conduct) by deflecting the mentally ill awayfro
m the criminal justice system and into the mental health system has likely r
educed the actualcriminalization of the mentally ill (Lurigio, Smith, and Ha
rris, in press). Nevertheless, the lack ofaccessible and affordable mental hea
lth care in this country has contributed to thetransinstitutionalization of the
mentally ill, who are more likely to receive psychiatric treatmentin a jail or
prison than in a hospital (Council of State Governments, 2002; Lamberti, 2
007).
PSMI often reside in highly criminogenic and impoverished environments t
hat exert pressureson them to engage in criminal behaviors. The factors tha
t characterize these environments (e.g.,joblessness, gang influences, failed e
ducational systems, and residential instability) also affectpoor persons with
no serious mental illness (Sliver, Mulvey, and Swanson, 2002). Draine et al.
(2002) suggest that PSMI have many types of problems because of the soci
al settings or contextsin which they typically live (poor and disadvantaged c
ommunities). Homelessness, crime,undereducation, and unemployment ar
e endemic to such neighborhoods. A large percentage ofpoor persons experi
ence these difficulties - irrespective of whether they have mental illness orn
ot - which render them more susceptible to criminal activities and victimiza
tion (Lamberti,2007).
This article describes a recently developed - but fast-growing - strategy for
dealing with thechallenges of PSMI during the pre- and post-adjudication s

tages of the criminal justice process:mental health court (MHC). This court
innovation is for criminally involved individuals who areafflicted with serio
us Axis I diagnoses, such as schizophrenia, bipolar disorder, or majordepre
ssion - chronic brain diseases that cause extreme distress and interfere with
social andemotional adjustment.

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