Dena Potter with the Associated Press has this article discussing the virtues and vices of mental health courts across the United States.  The folks Potter interviews have a range of opinions on the wisdom of these specialty courts: some endorse the idea as necessary and helpful while others remains skeptical of their use.   Indeed, there's a lot to be concerned about in terms of mental health courts, including the diminished role of defense counsel; having judges making clinical treatment decisions; transposing adjudication venues into mental health systems, and the rather anemic outcome studies we have to date. 

But as highlighted in the article, there's also the idea of criminalization of mental illness.  Typically, those who posit this view suggest that the behavior that lands folks with mental illness in jails nowadays would, in the past, have landed them in state psychiatric care.  And there's some truth to that.  Thanks in large measure to the changes in civil commitment statutes and legal precedent, its very difficult to sustain involuntary treatment.  What follows is what every mental health clinician who has worked in the public mental health system knows is painfully true: Life for many people with severe mental illnesses involves an endless revolving door of acute psychiatric admissions, discharge, treatment non-adherence, endemic drug use, contacts with the police and readmission - over and over again.

Yet what remains unclear is how much of the behavior which lands people with mental illnesses in jail is a product of their mental illnesses and how much is just bad behavior.  A few studies have suggested that the risk factors for incarceration among those with mental illnesses are the same as those without mental illnesses. Other studies suggest otherwise, although disentangling substance abuse from the primary mental illness in these populations is notoriously difficult.  These differences matter inasmuch as they support and detract from the criminalization hypothesis.

But what is much more evident is that addressing the root cause entails more than providing additional services.  While there are undoubtedly shortages of public mental health services in some areas, almost all of the studies that have critically examined incarceration among those with severe mental illnesses have noted that treatment adherence is a central, if not, defining issue.  More services might be the clarion call for many advocacy organizations, but those resources are likely to little to solve the problem unless they can maximize participation by those they are designed to help.