National and state-level trends in the availability of mental health treatment services tailored to individuals ordered to treatment by a court: United States, 2016, 2018, and 2020.

Abstract

We sought to identify trends and characteristics associated with the availability of tailored mental health services for individuals involved in the criminal justice system and ordered to treatment by a court, nationally in the US and by state. We used National Mental Health Services Survey to identify outpatient mental health treatment facilities in the US (2016 n=4744; 2018 n=4626; 2020 n=4869). We used clustered multiple logistic regression to identify changes over time as well as facility- and state-level factors associated with the availability of specialty court-ordered services. Slightly more than half of the outpatient mental health treatment facilities offered specialized services for individuals ordered to treatment by a court, with wide variation between states. Nationally, there was a significant increase in the odds of offering court-ordered treatment in 2020 compared to 2016 (aOR=1.16, 95% CI=1.06-1.27, p<0.01). Notable associations included offering integrated substance use treatment (versus none, aOR=2.95, 95% CI=2.70-3.22, p<0.0001) and offering trauma therapy (versus none, aOR=2.05, 95% CI=1.85-2.27, p<0.0001). The availability of mental health services for individuals ordered to treatment by a court is growing nationally but several states are lagging behind. Court ordered treatment is a promising strategy to improve health and reduce reliance on the carceral system as a healthcare provider. At the same time, we express caution around disparities within behavioral health courts and advocate for equity in access to incarceration alternatives.