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37 Law & Hum. Behav. 1 (2013)

handle is hein.journals/lwhmbv37 and id is 1 raw text is: Law and Human Behavior
2013. Vol. 37. No. 1. 1-9

© 2012 American Psychological Association
0147-7307/13/$12.00 DOI: 10.1037/h0093989

A Multi-Site Study of the Use of Sanctions and Incentives in Mental
Health Courts

Lisa Callahan, Henry J. Steadman, and
Sheila Tillman
Policy Research Associates, Inc., Delmar, New York

Roumen Vesselinov
City University of New York

Mental health courts (MHCs) have become widespread in the United States as a form of diversion for
justice-involved individuals with mental illness. Sanctions and incentives are considered crucial to the
functioning of MHCs and drug courts, yet with little empirical guidance to support or refute their use, and
there are no definitions of what they are. The use of sanctions and to a lesser degree incentives is the
focus of this article, with particular emphasis on jail sanctions. Subjects are participants (n = 447) in four
MHCs across the United States. Results show that jail sanctions are used in three of four MHCs, and other
sanctions are similarly used across the four MHCs. Participants charged with person crimes are the
least likely to receive any sanctions, including jail, whereas those charged with drug offenses are most
often sanctioned. The factors associated with receiving a jail sanction are recent drug use, substance use
diagnosis, and drug arrests; being viewed as less compliant with court conditions, receiving more bench
warrants, and having more in-custody hearings; and MHC program termination. No personal character-
istics are related to receiving sanctions. Knowing which MHC participants are more likely to follow court
orders and avoid sanctions, and identifying those who have difficulty adhering to court conditions, can
help guide court officials on adjusting supervision, perhaps avoiding reoffending and program failure.
Keywords: mental health courts, incentives, sanctions

Frustrated by the revolving door into the criminal court among
some defendants, criminal court judges took the initiative and
introduced specialty dockets and treatment courts as an alternative
to traditional criminal justice processing beginning in the late
1980s. The first treatment courts, drug courts, quickly proliferated
from the first in 1989 through today, currently numbering in the
thousands (National Association of Drug Court Professionals,
2011). Mental health courts (MHCs), though not as numerous as
drug courts, have become widespread with the first specialty
docket in Marion County (Indianapolis), Indiana, in 1996 and the
first official court starting in Broward County, Florida, in 1997.
Unlike drug courts, mental health courts receive no federal funding
with the exception of 23 Bureau of Justice Assistance start-up
grants in 2002 (Steadman & Redlich, 2005). Many states do not
provide funding for mental health courts, despite growing evidence
that mental health courts do, indeed, increase public safety out-
comes of participants (Steadman, Redlich, Callahan, Robbins, &
Vesselinov, 2011; McNiel & Binder, 2007; Moore & Hiday, 2006;
Herinckx, Swart, Ama, Dolezal, & King, 2005).
This article was published Online First May 7, 2012.
Lisa Callahan, Henry J. Steadman, and Sheila Tillman, Policy Research
Associates, Inc., Delmar, New York; Roumen Vesselinov, Department of
Economics, Queens College, City University of New York.
We thank John Monahan and the reviewers for their comments on this
article. This research was funded by the John D. and Catherine T. Mac-
Arthur Foundation Mandated Community Treatment Network.
Correspondence concerning this article should be addressed to Lisa
Callahan, 345 Delaware Avenue, Delmar, NY 12054. E-mail: lcallahan@

Mental health courts and drug courts share two common
goals to reduce criminal recidivism and to increase community-
based treatment for the participants. These goals are accomplished
through the power of the judiciary to hold both the individual and
the community responsible for program success. Both types of
treatment courts rely on a multidisciplinary team, headed by the
judge, to administer the diversion programs. The treatment court
participant must agree to court conditions that include treatment,
and the community must provide community-based treatment ser-
vices. To be sure, the philosophy of mental health courts and drugs
courts differ in that mental health courts adhere to a recovery
model where relapse is considered part of the treatment process,
whereas drug courts have built into their 10 Key Components an
abstinence (from drug and alcohol use) model (National Associa-
tion of Drug Court Professionals, 1997). An additional shared
characteristic of treatment courts is the use of sanctions and
incentives to assure adherence to court conditions such as treat-
ment compliance, attendance at status hearings, and abstinence
from substance use (Thompson, Osher, & Tomasini-Joshi, 2008;
Huddleston, 2005; Steadman, Davidson, & Brown, 2001).
The use of sanctions and to a lesser degree incentives in mental
health courts is the focus of this article. As an essential element
of mental health courts (Thompson et al., 2008), incentives and
sanctions are used with little empirical guidance to support or
refute their use and no definitions of what courts identify as a
incentive or an sanction. Mental health courts have an arsenal
of possible sanctions they can impose to enforce program condi-
tions ranging from a scolding from the judge, to increased
supervision such as more frequent reporting or hearings, to the last
resort jail. Incentives also allow the judge to reward participants
for compliance, and many include verbal praise, applause, gift

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