Last updated: October 2010 www.ojjdp.gov/mpg

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Mental Health Courts 

A mental health court is a court with a specialized docket for certain defendants with mental illnesses 

(Almquist and Dodd 2009). Mental health courts divert select defendants away from the regular 

criminal courts into judicially supervised, community-based treatment to properly address their 

overwhelming health needs. In contrast to traditional courts, mental health courts have therapeutic 

goals, including increasing participants’ adherence to treatment and decreasing future involvement in 

the justice system (McNiel and Binder 2007). 

Mental health courts are problem-solving courts modeled after drug courts, which are voluntary in 

nature and concentrate on providing defendants with appropriate treatment through the use of 

graduated sanctions. Court staff and mental health professionals screen and assess individuals to 

develop appropriate treatment plans. Individuals who agree to the terms and conditions of supervised 

treatment must also attend regular status hearings to report to the judge on the adherence or 

nonadherence to the treatment plan. Adherence to court conditions may result in rewards and 

incentives, whereas nonadherence may result in sanctions. Treatment plans and conditions of 

supervision may be revised as needed. 

Scope of the Problem 

Mental illness in the juvenile justice system has become an increasingly obvious problem. A report from 

the National Center for Mental Health and Juvenile Justice found that 70 percent of youths in the 

juvenile justice system are afflicted with a mental health disorder, and 27 percent suffer from a disorder 

so severe it significantly impairs their ability to function (Cocozza and Shufelt 2006; Shufelt and 

Cocozza 2006). The true extent of the mental health needs of youth in the juvenile justice system is 

unclear, as most standardized screening instruments that diagnose such disorders are not administered 

until youth are adjudicated and put in an out-of-home placement. 

The Survey of Youth in Residential Placement found that 51 percent of youths in placement reported 

symptoms of depression and anxiety. In addition, when asked specific questions from the MAYSI 

Depressed–Anxious Scale (which determines whether a youth requires mental health treatment for 

these problems), 48 percent of youths scored within the “caution” or “warning” range on the scale 

(Sedlak and McPherson 2010). One-fifth of youths reported two or more recent suicidal feelings, and 

nearly the same amount (22 percent) reported past suicide attempts, which is nearly 4 times the rate 

reported by national samples of youths in the general population. However, the survey also showed 

that mental health services provided to youth in custody fall short of recommended practices. 

In response to the increasing population of defendants with mental illness, the popularity of mental 

health courts has grown in the last decade, despite little empirical evidence of these types of courts 

Suggested Reference: Development Services Group, Inc. 2010. “Mental Health Courts.” Literature review. Washington, D.C.: 

Office of Juvenile Justice and Delinquency Prevention. https://www.ojjdp.gov/mpg/litreviews/Mental_Health_Courts.pdf

Prepared by Development Services Group, Inc., under cooperative agreement number 2013–JF–FX–K002. Points of view or 

opinions expressed in this document are those of the author and do not necessarily represent the official position or policies 

of OJJDP or the U.S. Department of Justice.
Office of Juvenile Justice and Delinquency Prevention www.ojjdp.gov 2

obtaining successful outcomes (Steadman and Redlich 2006). In 1997 there were four mental health 

courts in the United States. By 2009 there were some 250 courts in operation; however, most of them 

are for adults (Almquist and Dodd 2009). The first juvenile mental health court was established in 2001 

in Santa Clara County, Calif. Today, there are more than a dozen courts operating in California, Florida, 

Ohio, and Washington, and several more are in development (Herman 2005).

Theoretical Foundation

Juvenile mental health courts, like juvenile drug courts, operate under a paradigm of therapeutic 

jurisprudence. The principles of therapeutic jurisprudence promote a nonadversarial, treatmentoriented approach when adjudicating juvenile offenders, while still upholding their due process rights 

(Winick and Wexler 2003; Porter, Rempel, and Mansky 2010). Operating under the paradigm of 

therapeutic jurisprudence, the main purpose of mental health courts is to treat and rehabilitate youth 

(i.e., treating mental health issues, reducing recidivism).

Juvenile mental health courts are designed to use a multidisciplinary team approach to develop and 

monitor treatment plans and compliance, as well as provide necessary treatment to youth. Team 

members could include district attorneys, public defenders, mental health providers, and case 

managers or probation officers (Cocozza and Shufelt 2006; Arredondo et al. 2001).

Characteristics of Juvenile Mental Health Courts

There is a lack of agreement regarding what constitutes a mental health court, leading to a difference 

among courts regarding several dimensions, including target population, accepted offenses, intensity 

of supervision, and program duration (Council of State Governments 2005; Behnken, Arredondo, and 

Packman 2009; National Center for Mental Health and Juvenile Justice 2005). The National Center for 

Mental Health and Juvenile Justice indentified and surveyed 11 existing juvenile mental health courts 

to provide an overview of the current courts in operation (Cocozza and Shufelt 2006). Findings from 

the survey provide an overview of the everyday operation of mental health courts that serve juveniles.

Most of the surveyed juvenile mental health courts accepted youths with a range of charges, from 

misdemeanors to felonies. While the courts did not necessary exclude youths based on current charges, 

the mental health eligibility criteria were more stringent. Half of the surveyed courts accepted only 

those youths suffering serious mental health illnesses, while other courts accepted youths who had any 

identified mental health issue. 

The caseload of the courts also varied. Some juvenile mental health courts operated with small 

caseloads (usually fewer than 10), while other courts were able to serve up to 75 youths at a time. The 

size of the docket depended on a variety of factors, including the size of the jurisdiction, the amount of 

resources available, and whether the court provided direct services or relied on existing providers. The 

length of time youths were involved with the court also depended on the court. For youths who 

complete the program, the length of court involvement ranged from 3 to 6 months in one court to a 2-

year minimum in another. The average length of involvement was between 10 and 18 months.

Most of the courts provided services to youths through relationships with existing community-based 

service providers. Therefore, services provided to youth mainly depended on the availability of services 

in a given community. Services provided to youth include individual, group, and family therapy; 

medications and medication management; case management services; and evidence-based services 

such as Multisystemic Therapy.
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Concerns/Issues

There are several benefits to juvenile mental health courts, including the advantages of a 

multidisciplinary approach to treatment, increased dispositional alternatives for judges, monitoring 

strategies that can increase compliance with treatment plans, and an increased awareness of the 

problem of the lack of mental health services (Cocozza and Shufelt 2006). However, numerous concerns 

have been raised, as the number of mental health courts—and problem-solving courts—continues to 

increase across the country. 

One main concern has to do with the problem of net widening. Juvenile mental health courts are 

designed to divert youths with mental health disorders from further processing in the juvenile justice 

system and provide them with appropriate and necessary treatment. But there is concern over the 

potential misuse of mental health courts. Parents or guardians may seek delinquency court jurisdiction 

for their children to receive services, even if their children are not delinquent. Law enforcement officials 

may be quick to arrest youths with mental health issues for minor, nonviolent offenses because they 

believe the specialized court will better address their issues (Behnken, Arredondo, and Packman 2009). 

This may lead to the inclusion of nondelinquent youth in the juvenile justice system. This in turn could 

lead to another concern over how to address youth with mental health issues in a specialized court. If 

jurisdictions rely on the courts to provide treatment to any youth with mental health issues, they risk 

criminalizing and stigmatizing youth who would not have been involved in the juvenile justice system 

to begin with. Involvement with the juvenile justice system should be seen as the last available option, 

instead of as an alternative method to ensuring that youth receive treatment services (Behnken, 

Arredondo, and Packman 2009). 

Another concern is the issue of coercion. Participation in mental health courts, as with most problemsolving courts, is intended to be voluntary. However, concerns have been raised about the ability of 

youths with mental health issues to make informed and voluntary decisions about their participation. 

States continue to struggle with how to determine the competency of juvenile offenders to understand 

the adjudication process and make decisions in that process (Hammond 2007). This may also affect the 

capability of courts to use sanctions to compel youths to adhere to their treatment plans (Porter, Rempel, 

and Mansky 2010). 

Finally, as with the development of other problem-solving courts, there is the unresolved argument 

whether mental health courts are really necessary. The juvenile justice system is oriented toward 

providing treatment and rehabilitation to juvenile offenders. Concerns have been raised whether 

specialized courts are needed in the juvenile justice system, given that youths are already provided 

with services (Cocozza and Shufelt 2006).

Outcome Evidence

Unfortunately, few studies have evaluated the effectiveness of juvenile mental health courts. The 

National Center for Mental Health and Juvenile Justice is currently undertaking a study of the 

Crossroad Program, which is a juvenile mental health court in Akron, Ohio.

The aforementioned Santa Clara County juvenile mental health court that was the first such court 

established in the United States is called the Court for the Individualized Treatment of Adolescents 

(CITA). The court functions from the premise that early and appropriate intervention allows mentally 

disordered juvenile offenders to receive humane and appropriate treatment (Behnken, Arredondo, and 

Packman 2009). CITA has several goals, including increasing public safety, reducing recidivism, 

increasing treatment engagement, and increasing effective use of existing community resources 

(Cocozza and Shufelt 2006). The court accepts only youths who had not turned 14 at the time of their 
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offense and have a serious mental illness, such as brain disorders or severe head injuries that may have 

contributed to their criminal activity. Youths who have committed certain violent felonies may be 

excluded from participating, as have been youths who had mental health diagnoses of conduct 

disorder, oppositional defiant disorder, impulse control disorder, personality disorder, or adjustment 

reactions.

The program evaluation looked at the effect of CITA to reduce recidivism rates in 64 study participants. 

The evaluation used a pretest/posttest design to compare the number and type of offenses committed 

by study participants during the 18 months preceding court admission with those committed during 

the 23 months following court admission. Data on youth from April 1996 to March 2008 was collected 

from the Santa Clara Mental Health and Probation Departments. The data included several factors, 

such as age, sex, race, sexual orientation, living situation, psychiatric disorder, mental health history, 

substance use history, and needs assessment upon CITA admission.

The data showed that before involvement with CITA, 99 percent of program graduates had recidivated 

at least once while on traditional probation. The sample had an average of two placements in a 

treatment facility, and 17 percent had been removed from parental care. Overall, the findings showed 

reductions in the frequency of serious, violent, and other delinquency behavior among youth who 

completed the CITA program. The outcome results showed significant reductions in the commission of 

violent offenses, such as assault or battery. There were also significant reductions in the thefts and 

vandalisms, including shoplifting, stealing, or destroying property. There were also reductions in 

vehicle theft, burglary, public disturbances, carjacking, and failing to appear in court, though the 

reductions were insignificant. However, there were minor increases in incidents of hit and run, running 

away from home, robbery, drug possession, and curfew violation, though the low baseline frequency 

of these events makes drawing statistically meaningful conclusions not possible.

Although the study did have several weaknesses—including a nonrandomized control group, a lack of 

a comparison or control group, and selection bias—it was the first evaluation of a juvenile mental health 

court. Overall, the evaluation found positive outcomes among CITA graduates. Future research should 

address the shortcomings of this study and look to explore further outcomes as well, such as rate of 

compliance with treatment plans or whether the program was implemented as designed.

References

Almquist, Lauren, and Elizabeth Dodd. 2009. Mental Health Courts: A Guide to Research-Informed Policy 

and Practice. New York, N.Y.: Council of State Governments Justice Center.

Arredondo, David E., Kurt Kumli, Larry Soto, Enrique Colin, Jill Ornellas, Raymond J. Davilla Jr., 

Leonard P. Edwards, and Eugene M. Hyman. 2001. “Juvenile Mental Health Court: Rationale 

and Protocols.” Juvenile and Family Court Journal Fall:1-21.

Behnken, Monic P., David E. Arredondo, and Wendy L. Packman. 2009. “Reduction in Recidivism in a 

Juvenile Mental Health Court: A Pre- and Post-Treatment Outcome Study.” Juvenile and Family 

Court Journal 60(3):23–44.

Cocozza, Joseph J., and Jennie L. Shufelt. 2006. Juvenile Mental Health Courts: An Emerging Strategy. 

Delmar, N.Y.: National Center for Mental Health and Juvenile Justice.

Council of State Governments. 2005. A Guide to Mental Health Court Design and Implementation. New 

York, N.Y.: Council of State Governments. 

Hammond, Sarah. 2007. Mental Health Needs of Juvenile Offenders. Denver, Colo.: National Conference of 

State Legislatures.

Herman, Madelynn. 2005. Mental Health Court Evaluations: An Annotated Review of the Literature With 

Commentary. Williamsburg, Va.: The National Center for State Courts.
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McNiel, Dale E., and Renée L. Binder. 2007. “Effectiveness of a Mental Health Court in Reducing 

Criminal Recidivism and Violence.” American Journal of Psychiatry 164 (9):1395–1403.

National Center for Mental Health and Juvenile Justice. 2005. Juvenile Mental Health Courts Program 

Descriptions: Processes and Procedures. Delmar, N.Y.: National Center for Mental Health and 

Juvenile Justice.

Porter, Rachel, Michael Rempel, and Adam Mansky. 2010. What Makes a Court Problem-Solving? 

Universal Performance Indicators for Problem-Solving Justice. New York, N.Y.: Center for Court 

Innovation.

Sedlak, Andrea J., and Karla S. McPherson. 2010. Youth’s Needs and Services: Findings From the Survey of 

Youth in Residential Placement. Bulletin. Washington, D.C.: U.S. Department of Justice, Office of 

Justice Programs, Office of Juvenile Justice and Delinquency Prevention.

Shufelt, Jennie L., and Joseph J. Cocozza. 2006. Youth With Mental Health Disorders in the Juvenile Justice 

System: Results From a Multistate Prevalence Study. Delmar, N.Y.: National Center for Mental 

Health and Juvenile Justice.

Steadman, Henry J., and Allison D. Redlich. 2006. An Evaluation of the Bureau of Justice Assistance Mental 

Health Court Initiative. Washington, D.C.: U.S. Department of Justice, National Institute of 

Justice.

Winick, Bruce J., and David B. Wexler. 2003. Judging in a Therapeutic Key: Therapeutic Jurisprudence and 

the Courts. Durham, N.C.: Carolina Academic Press.