Mental health courts have recently emerged as one means to reduce the number of persons with mental illness in the criminal justice system. Using a posttest only comparison group design, this study examined rearrest rates for 1 year post discharge among three groups meeting admission criteria for a municipal mental health court. The rearrest rate of defendants who successfully completed the program (N=351) was 14.5%, compared to 38% among defendants negatively terminated from the program (N=137), and 25.8% among defendants who chose not to participate (N=89). This positive result held even when controlling for a range of variables in a Cox regression survival analysis. Factors associated with rearrest are identified for each of the three groups.

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Mental health courts developed in the USA in the late 1990s as one means to reduce the involvement of people with mental illness in the criminal justice system. In response to the growth in number of mental health courts, the Council of State Governments led an initiative to identify essential elements of mental health courts to guide their development and implementation. This paper applies these essential elements to a municipal mental health court in a multijurisdictional, suburban county. While this court met most essential elements, they faced a number of challenges. The primary ones included not being able to advance from hearing municipal cases only to state misdemeanor and felonies, not having the resources to expand program capacity for municipal cases, and participants not being able to always access needed mental health treatment, rehabilitation, and support services. The paper concludes with implications for behavioral health administrators and direct service staff in implementing the essential elements of mental health courts.

Even though state departments of mental health have primary responsibility for the care, custody, and treatment of insanity acquittees, the impact of insanity acquittees on the public mental health system is generally lacking in policy discussions and as a topic for policy research. This issue has received increased attention in Missouri, where insanity acquittees now occupy half of the long-term public psychiatric hospital beds. This article examines the presence of Missouri's insanity acquittees on the state's public mental health system and includes the impact on goals, fiscal costs, inpatient and community psychiatric services, and inpatient treatment staff. As states consider managed care and other cost containment measures, it remains to be seen if the high costs associated with extensive use of hospitalization of insanity acquittees to promote public safety will influence policy changes to more community-based insanity acquittee systems.State departments of mental health are responsible for providing care and treatment for most insanity acquittees. A survey of organizations providing services to insanity acquittees found that 75% of facilities that primarily served insanity acquittees were operated by mental health agencies, and that 95.5% of facilities that worked with insanity acquittees as their secondary function (e.g., may have one ward of insanity acquittees) were mental health agencies (Steadman, Monahan, Hartstone, Davis, & Robbins, 1982).In addition to state mental health agencies serving most insanity acquittees, their level of involvement in the insanity acquittee system is usually extensive. For example, the Missouri Department of Mental Health (MDMH) is the primary actor in the state's insanity acquittee system. MDMH has the statutory responsibility to provide care and custody to insanity acquittees committed for inpatient hospitalization. MDMH also monitors insanity acquittees conditionally released into the community and administers the conditional release revocation procedures when appropriate. In addition, MDMH staff initiate most conditional release applications, and they testify against proposed conditional releases that they do not support.