Racial/Ethnic Disparities in Community Behavioral Health Service Usage: A Comparison of Mental Health Court and Traditional Court Defendants

Date01 February 2018
Published date01 February 2018
Subject MatterArticles
CRIMINAL JUSTICE AND BEHAVIOR, 2018, Vol. 45, No. 2, February 2018, 173 –194.
DOI: 10.1177/0093854817739045
© 2017 International Association for Correctional and Forensic Psychology
A Comparison of Mental Health Court and
Traditional Court Defendants
Binghamton University, State University of New York
George Mason University
Mental health courts (MHCs) are diversion programs for offenders with mental illness. Research has demonstrated that MHC
participants receive more treatment than traditional court participants. However, little is known about racial/ethnic disparities
in community treatment utilization among MHC participants compared with traditional court participants. The present study
aimed to fill this gap. Data are from the MacArthur MHC Project which includes objective and subjective information from
four MHC samples with traditional court samples at each site. Within the traditional court sample, African Americans were
less likely than Whites to receive mental health and substance abuse services. However, significant racial/ethnic disparities
were not found for the MHC sample. In an interaction model, African Americans were still less likely to use substance abuse
services (but not mental health services) compared with the Whites. However, African American MHC participants utilized
more substance abuse services than their counterparts. Policy and practice implications are discussed.
Keywords: racial/ethnic disparities; mental illness; mental health court; behavioral health service utilization
Similar to other complex systems, the criminal justice system is ever-evolving. Change
often comes about in response to perceived and actual problems. For about the past 50
years, one of the largest problems the criminal justice system has had to contend with has
been an influx of offenders with mental health problems (Lamb & Weinberger, 1998; Torrey
et al., 2014). The criminal justice system was not designed, nor particularly equipped, to
handle this population. One of the more encompassing responses to this problem of the
AUTHORS’ NOTE: The authors wish to thank Dr. Henry J. Steadman and Policy Research Associates, as well
as Professor John Monahan and the John D. and Catherine T. MacArthur Foundation Network on Community
Mandated Treatment for generously supporting the original research. The present research was partially sup-
ported by a 2014 NARSAD Independent Investigator Grant from the Brain & Behavior Research Foundation.
Correspondence concerning this article should be addressed to Woojae Han, Assistant Professor, Department
of Social Work, College of Community & Public Affairs, Binghamton University, PO Box 6000, Binghamton,
NY 13902-6000; e-mail: whan@binghamton.edu.
739045CJBXXX10.1177/0093854817739045Criminal Justice and BehaviorHan, Redlich / Racial/Ethnic Disparities and MHCs
overrepresentation of offenders with mental health problems in our legal system has been
the creation of mental health courts (MHCs). MHCs are specialty, problem-solving courts
that aim to divert offenders with mental health problems from incarceration (jail and prison)
and into community-based treatment (Redlich, Steadman, Monahan, Robbins, & Petrila,
2006). A main premise underlying these courts is that the repeated cycling through the
criminal justice system that often plagues offenders with mental illness will be reduced with
the advent of community mental health, and often, substance use, treatment (Fisher, Silver,
& Wolff, 2006; Slate, 2003).
MHCs began to proliferate in the United States 20 years ago. And, for the most part,
MHCs have been found to reduce recidivism in comparison with similar offenders who
remained in traditional courts (e.g., Steadman, Redlich, Callahan, Robbins, & Vesselinov,
2011). However, the MHC intervention is not effective for all who receive it. As of late, a
focus of MHC research has been to investigate for whom and under what circumstances the
courts are effective (e.g., Redlich & Han, 2014; Steadman et al., 2011).
In the present study, a main goal is to examine how racial/ethnic background affects
receipt and type of community services in two samples of offenders with mental illness, one
processed through a MHC, and the other through the traditional criminal justice system.
There is a wealth of research demonstrating that in comparison with Caucasians, minorities
are significantly less likely to seek out, and benefit from, mental health and substance use
treatment (Alegria, Canino, Vera, Rusch, & Ortega, 2002; Leong & Lau, 2001). Although
several studies on MHCs have included or controlled for race/ethnicity in their models, to
our knowledge, little research has directly examined how race/ethnicity associates with
community treatment in the context of MHCs (but see, Ray & Dollar, 2013). Indeed, there
is a dearth of research on service utilization in MHCs. Rather, much of the research has
tended to focus on the effect of the MHC intervention on future arrests (although certainly
there is research on treatment utilization, which we review below). Thus, another goal of the
present research is to more fully investigate the factors (including race/ethnicity and type of
court) that influence receipt of community treatment. To accomplish our goals, we mine the
rich dataset of the MacArthur MHC project (Steadman et al., 2011), and utilize the Andersen
Behavioral Service Utilization Model (Aday & Andersen, 1998) as a guiding framework.
This model, initially developed in the late 1960s, focuses on the factors affecting the use of
health services (Andersen, 1995). Andersen divided factors associated with the usage of
health care service into three dynamics: predisposing, enabling, and need factors.
Predisposing factors include demographic characteristics, socioeconomic status, attitude,
and beliefs (Wolinsky, 1978). Enabling factors include items such as income, insurance
status, and sources of accessibility for care (Jahangir, Irazola, & Rubinstein, 2012). Last,
need factors represent the actual need for health care services (Andersen, 1995). Thus, this
factor includes health/mental health status, restricted activities during daily life, and symp-
toms. The Andersen Healthcare Utilization Model has been used for many types of treat-
ment, racial/ethnic groups, and settings over many decades (Andersen, 1995; Anderson,
Green, & Payne, 2009; Rivara et al., 2007; Schneeweiss & Avorn, 2005).
Racial/ethnic disparities in the criminal justice system at large are well-known
(Hammarström & Janlert, 2002; Thomas, Benzeval, & Stansfeld, 2005). For example, by

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