Recognition and understanding of goals and roles: The key internal features of mental
health court teams
Mary Gallaghera,⁎, David Skubbyb, Natalie Bonfinea, Mark R. Munetzc, Jennifer L.S. Tellerc
aKent State University, Kent, OH, USA
bThe University of Akron, Akron, OH, USA
cNortheast Ohio Medical University, Rootstown, OH, USA
a b s t r a c ta r t i c l ei n f o
Available online 8 November 2011
Mental health court
The increasing involvement of people with mental illness in the criminal justice system has led to the formation
of specialty programs such as mental health courts (hereafter MHCs). We discuss MHCs and the teams serving
these courts. Specifically, we examine team members' perceptions of MHC goals and their own and others'
roles on the MHC team. Using a semi-structured interview instrument, we conducted 59 face-to-face interviews
with criminal justice and mental health treatment personnel representing 11 Ohio MHCs. Findings from our
qualitative data analyses reveal that MHC personnel understand individuals' roles within the teams, recognize
and appreciatetheimportanceofdifferent roles,and sharecommongoals.MHCs couldfosterthis level of under-
standing and agreement by working to recruit and retain individuals with experience in or willingness to learn
about both the criminal justice and mental health systems. Future research should explore the impact of MHC
team functioning on client outcomes.
© 2011 Elsevier Ltd. All rights reserved.
As the number of individuals with mental illness who are involved
programs or dockets designed to strategically address the needs of this
population (Munetz & Griffin, 2006; Steadman, 2005). Mental health
courts (hereafter MHCs) are one such program. The broad goal of
MHCs is to improve the lives of individuals with mental illness who be-
come involved in thecourt system by linkingthem tocommunity men-
tal healthtreatment and helpingthem avoid further involvementinthe
diffusion of MHCs andsimilardiversion programs in countriesthrough-
out the world, including the United States, Canada (Slinger & Roesch,
2010), England and Wales (James, 2010), Australia (Richardson &
McSherry, 2010), and Sweden (Svennerlind et al., 2010).
Although MHCs were embraced and widely implemented long be-
fore any evidence of their effectiveness existed (Schneider, 2010), a
growing body of research indicates that they are achieving their objec-
tives of reducing the involvement of individuals with mental illness in
the criminal justice system and linking them to needed mental health
treatment in the community (e.g., Cosden, Ellens, Schnell, & Yamini-
Diouf, 2005; Frailing, 2010; Hiday & Ray, 2010; McNiel & Binder,
2007; Moore & Hiday, 2006; Palermo, 2010; Steadman, Redlich, Griffin,
Petrila, & Monahan, 2005). However, the majority of MHC studies to-
date have only examined single courts, though there are a few stud-
ies that have investigated two or more MHCs (e.g., Goldkamp &
Irons-Guynn, 2000; Griffin, Steadman, & Petrila, 2002; Palermo,
2010; Redlich, Steadman, Monahan, Petrila, & Griffin, 2005; Redlich,
Steadman, Monahan, Robbins, & Petrila, 2006; Redlich et al., 2010;
Trupin & Richards, 2003).
Since MHCs have proliferated without a clear implementation
model and have been broadly defined (Steadman, Davidson, & Brown,
2001), MHC practices and structures are negotiated within each indi-
vidual jurisdiction (Redlich et al., 2010). As a result, eligibility require-
ments, procedures, team structure, and other features tend to vary
across MHCs (Council of State Governments., 2005; Thompson, Osher,
& Tomasini-Joshi, 2008). Given this variation in court processes and
characteristics, findings from single-MHC studies – or even studies
that include a few MHCs – may not generalize across jurisdictions. To
understand how MHCs operate most efficiently and effectively and to
investigate the ways in which contextual factors impact MHC imple-
mentation, researchers must be able to make cross-program compari-
sons (Trupin & Richards, 2003). A preliminary step in making such
comparisons is to identify the key internal processes that operate with-
in MHCs. The present study, like most others, focuses on MHCs in the
United States (Slinger & Roesch, 2010). Specifically, we explore how
MHC team members from 11 Ohio MHCs define and recognize the
goals of MHC and their respective roles on the team to better under-
stand how internal team features may impact MHC operations. The
ways in which personnel interpret the goals of MHC and define their
International Journal of Law and Psychiatry 34 (2011) 406–413
⁎ Corresponding author at: Department of Sociology, PO Box 5190, Kent State
University, Kent, OH 44242, USA. Tel.: +1 330 672 8359; fax: +1 330 672 4724.
E-mail addresses: firstname.lastname@example.org (M. Gallagher), email@example.com
(D. Skubby), firstname.lastname@example.org (N. Bonfine), email@example.com (M.R. Munetz),
firstname.lastname@example.org (J.L.S. Teller).
0160-2527/$ – see front matter © 2011 Elsevier Ltd. All rights reserved.
Contents lists available at SciVerse ScienceDirect
International Journal of Law and Psychiatry
own and others' roles (and the relationships between them) on the
team are important internal characteristics of MHCs that may impact
team members' role performances, interactions, and the overall effec-
tiveness of the MHC. For example, breakdowns in communication
among MHC team members could affect their interactions with clients
in ways that may impede the clients' progress and recovery. In other
words, team members' perceptions of the goals of MHC and their role
orientations within it may directly affect team dynamics and indirectly
affect client outcomes.
Some MHCs are entirely court-based with treatment provided by
court personnel, but most MHC teams are comprised of a mixture of
mental health treatment personnel (i.e., social workers, counselors,
and psychiatrists) and criminal justice personnel (i.e., judges, magis-
trates, attorneys, and probation officers). Traditionally, mental health
and criminal justice roles and associated orientations have been quite
distinct (Coggins & Pynchon, 1998). Customarily, mental health pro-
fessionals are primarily concerned with treatment of illness, with
public safety as a secondary concern, and the use of police influence
a last resort. Criminal justice professionals are primarily concerned
with public safety, use police influence routinely, and consider treat-
ment needs as a secondary concern. MHCs attempt to merge these
Nearly two decades ago Keilitz and Roesch (1992) suggested that
a “paradigm shift” was needed to improve justice and mental health
systems interactions. They called for a shift away from a strict empha-
sis on legal doctrine to a systems approach in which the complex “in-
terrelated steps, tasks, and processes in the interactions of the justice
and mental health systems” were emphasized (p.1). Steadman (1992)
observed that a number of successful programs at the interface of
mental health and criminal justice systems all had in common an in-
dividual with the skills necessary “to smoothly, albeit carefully, cross-
walk the three, often competing, systems of corrections, mental health
and the courts. These positions amounted to what the organizational
literature had termed boundary-spanners” (Steadman, 1992, p. 76). The
presence of a boundary-spanner on a MHC team may decrease the
likelihood that conflict will occur between individuals with different
professional backgrounds. Although recent interviews with stake-
holders in a MHC indicated that they believed the nonadversarial
team approach was one feature of MHC that made it effective (McNiel
& Binder, 2010), empirical evidence of fluid working relationships,
effective communication, and decision-making of MHC criminal justice
and mental health treatment personnel have yet to be demonstrated
(Waters, Strickland, & Gibson, 2009).
1.1. Current study overview
The questions guiding this research are: How do mental health
treatment and criminal justice personnel describe the goals of MHC
and understand their own and others' roles on the MHC team? And
how might shared or divergent understandings of goals and roles im-
pact team functioning? To answer these questions, we use qualitative
research methods to assess how MHC team members with potentially
different roles and orientations toward crime, punishment, mental ill-
ness and treatment work within the same organizational structure.
Specifically, we conduct case studies of team dynamics in 11 Ohio
MHCs using key informant interview methods. We chose this method
because it is well-suited for our research goals of obtaining informa-
tion about the perceptions of stakeholders and the interactions
among them, beginning to specify important components of the in-
ternal dynamics of MHCs, and investigating the degree to which
MHC implementation varied across sites (Sofaer, 1999). Given that
roles related to the criminal justice and mental health systems are
traditionally distinct, an examination of how they coalesce within
MHC teams will provide insight into the processes by which these
interprofessional teams work together to define and achieve common
goals in the face of different, and sometimes competing, orientations.
We believe that our analyses will also contribute to the development
of conceptual models of MHCs by identifying ways in which the de-
gree of shared goals and internal integration of roles may impact
team functioning and, ultimately, client outcomes. We go beyond
most previous research by examining 11 well-established MHCs in
the context of a single study, and thus, have a greater ability than
studies that have examined fewer MHCs to begin to elucidate the
general patterns of MHC team dynamics.
2.1. Mental health court team dynamics
Factors that influence MHCs include those external to the court as
well as internal characteristics such as team members' personalities,
interactions (Wolff & Pogorzelski, 2005), and views about MHC pro-
cesses and outcomes (McNiel & Binder, 2010). It is important to ex-
amine and understand the internal dynamics of MHCs, because if
there is something unique about the way a particular team interacts
that influences client outcomes, studies not considering those pro-
cesses may misattribute client outcomes to other aspects of the
court intervention (Wolff, 2000).
All MHC teams are comprised of several individuals from different
professional backgrounds, each with different knowledge bases, areas
of expertise, goals, and interests. Patterns of interaction among MHC
team members that are characterized by respect and cooperation
may facilitate positive and productive working relationships. Con-
versely, patterns of interaction characterized by tension and conflict
could potentially hinder a team's ability to effectively communicate
and work together toward developing and meeting common goals.
Attention to team members' perceptions of MHC's goals and the
meanings and duties associated with the roles they hold within it
will enable us to identify important components of the interactions
between MHC team members and how they are shaped by the profes-
sional positions that they hold.
For most teams comprised of individuals from various profes-
sions, problems within the team will reflect the problems of the
disciplines to which team members are connected (Lichtenstein,
Alexander, McCarthy, & Wells, 2004). On the surface, mental health
and criminal justice goals and professional roles may seem incom-
patible (Coggins & Pynchon, 1998; Lamb, Weinberger, & Gross, 1999;
Munetz & Teller, 2004), but we know relatively little about how they
may come together in practice. We would expect problems that arise
as MHC team members interact to reflect many of the same challenges
facing the criminal justice and mental health treatment systems at
large. However, adherence to principles of therapeutic jurisprudence
may help the MHC team coalesce around a shared vision. Therapeutic
jurisprudence is a concept that was introduced by Wexler and Winick
dures, and the roles of lawyers and judges produce therapeutic or
antitherapeutic consequences” (p. 981). A recent study conducted by
Ray, Dollar, and Thames (2011) demonstrates that one aspect of
therapeutic jurisprudence in MHC is judges' more frequent use of
reintegrative shaming (i.e., condemning unacceptable behavior while
showingrespect and forgiveness tothe offender) asopposed tostigma-
tizing shaming (i.e., condemning unacceptable behavior while showing
framework, MHCs “become dual agents, representing both treatment
and justice concerns” (p. 431). So if an entire MHC team embraces the
concept of therapeutic jurisprudence and the associated practices, can
the team be assumed to function conflict-free and know how to modify
each member's traditional professional role to maximum effect?
While accepting therapeutic jurisprudence as an organizing con-
cept may be relatively easy for a MHC team, operationalizing this
dual agency is likely to be more difficult. For instance, courts expect
M. Gallagher et al. / International Journal of Law and Psychiatry 34 (2011) 406–413
clinicians to provide information that will help meet the objectives
of serving justice and resolving disputes, but offering that informa-
tion may compromise therapeutic processes and goals (Candilis &
Appelbaum, 1997; Strasburger, Gutheil, & Brodsky, 1997) by hindering
clinicians' ability to maintain the usual neutral, non-judgmental stance
toward clients, and potentially jeopardizing the effectiveness of treat-
ment (Candilis & Appelbaum, 1997; Gutheil & Hilliard, 2001). There-
fore, it is important to consider and address issues that arise when
mental health professionals are involved in treatment and court-
related aspects of their clients' lives (Strasburger et al., 1997), as well
as boundary issues that arise when criminal justice professionals have
to contend with both legal and mental health-related issues faced by
the individuals they encounter in court.
2.2. Professional roles and boundaries
Individuals possess job role identities that are comprised of per-
ceptions and evaluations of themselves as occupants of particular
professional roles. Professional roles are associated with certain sets
of attitudes, behaviors, and tendencies that are shaped by the disci-
plines with which they are connected (Lichtenstein et al., 2004).
Given that the nature of the roles of criminal justice personnel in
MHC are different from the traditional criminal justice role require-
ments, it may bethatcriminal justicepersonnel experienceincongruity
between the way they see themselves in their respective occupational
roles and the new tasks they must perform in the context of MHC
(Keys & Furher, 1987). The presence of inconsistencies between role
definitions and role requirements can undermine job success and satis-
faction and potentially compromise organizational efficiency and effec-
tiveness (Keys & Furher, 1987). Role inconsistencies, then, could
impede cooperation and collaboration on MHC teams and potentially
lead to poor client outcomes.
While the majority of MHC personnel have either criminal justice
or mental health treatment backgrounds, some may have experience
working within both systems. Other individuals may be boundary-
spanners who use their diverse knowledge and experience to facilitate
cross-system communication and cooperation (Steadman, 1992).
Steadman (1992) proposed that successful diversion programs in-
variably included a boundary-spanner. However, it is not clear that
every MHC or other interprofessional team will have an identifiable
Some suggest that certain professional boundaries are becoming
increasingly obsolete in the context of partnerships such as MHC.
For example, Carnwell and Carson (2005) state that “it is reasonable
to suggest that current models of partnership, which are organized
around current professional identities, will give way in the long term
to ‘problem specific’ professions” (p.5). MHCs are problem-oriented
partnerships because they developed in response to the complexities
associated with criminal justice involved people with mental illness
with little regard for their mental health needs (Carnwell & Carson,
2005). A partnership between the criminal justice and mental health
systems seems to be a viable strategy to address this problem, but the
success of such a partnership may require a shift from the traditional
orientations of each system (Carnwell & Carson, 2005) toward orien-
tations that are more consistent with therapeutic jurisprudence.
Interprofessional teams, by their very nature, may pose challenges
to traditional, socially valued role definitions and boundaries between
professions, and there is some debate about the relative benefits of
clear, rigid boundaries between professional roles versus blurred,
permeable boundaries (Brown, Crawford, & Darongkamas, 2000).
Interprofessional working can be beneficial in that it may promote
the exchange of ideas and erode differences in professional identities,
but there is also evidence that it may solidify boundaries and impede
cooperation (Brown et al., 2000; Walker, 2003). Within a MHC team,
mental health treatment and criminal justice roles and their associated
perspectives may conflict. Despite the existence of boundaries and the
potential for discord, MHC teams are expected to develop and adhere
to a common set of goals.
2.3. Goal consensus on interdisciplinary teams
Research on team knowledge spans several academic areas and
has considered concepts such as team mental models, information
sharing, and cognitive consensus (see Mohamed & Dumville, 2001 for
a review). Common to all of these literatures is an interest in the ways
in which teams, especially those comprised of members with clearly
differentiated roles, work to develop shared perspectives and goals in
the context of collaborative partnerships (Mohamed & Dumville,
2001). A potentially challenging task for interdisciplinary teams is to
develop an orientation or philosophy that incorporates the variety of
professional viewpoints and approaches that are represented on the
team (Lankshear, 2003).
Here, a distinction between the nature of interaction within multi-
disciplinary versus interdisciplinary teams is useful. In multidisciplin-
ary practice, team members are merely aware of and tolerate one
another, but interdisciplinary practice is characterized by active coor-
dination across disciplines (Ray, 1998). For teams to move from mul-
tidisciplinary to interdisciplinary practice there must be common
ground upon which they share knowledge, professional interests,
and instincts (Ray, 1998). The basis for developing and maintaining
those shared understandings may reside in an interdisciplinary team's
ability to come to a consensus about and mutual commitment to team
MHC team members' agreement on common goals is likely to pro-
duce what Walker (2003) referred to as “collective responsibility,” or
a recognition that the viability of MHC depends on achieving core ob-
jectives and goals (p.193). Researchers agree that “collective efficacy,”
or team members' beliefs that efforts of the group as a whole are es-
sential to accomplishing shared goals, and that each member can and
will do his or her part to contribute to that effort, is also essential for
successful interdisciplinary collaboration (Johnson, Wistow, Schulz, &
Hardy, 2003, p. 70). This sense of mutual responsibility develops over
time through the standardization and routinization of team practices,
through decision-making processes, and through the formation of
shared team goals (Walker, 2003; Waters et al., 2009). Theoretically,
each MHC team will fall somewhere along the continuum from inter-
disciplinary to multidisciplinary practice. In other words, MHC teams
will differ in the extent to which they share a common understanding
of the goals of the team as a whole.
3. Data and methods
To address our questions about the ways in which mental health
treatment and criminal justice personnel understand the goals of
MHC and recognize their own and others' roles on the MHC team
(and related questions that are beyond the scope of this paper), we
first surveyed all MHCs and mental health boards in Ohio. Using
these data, we developed a semi-structured interview instrument
informed by a review of literature concerned with internal dynamics
of multidisciplinary teams and group decision-making. The interview
guide was structured to address theoretically important aspects of
team dynamics, but questions were open-ended to give respon-
dents the opportunity to expand on certain ideas, share personal
accounts, and provide additional information that they felt was
Because we were interested in MHCs that had operated long
enough to have obtained some degree of standardization of pro-
gram procedures, we identified MHCs in Ohio which had program
M. Gallagher et al. / International Journal of Law and Psychiatry 34 (2011) 406–413
completers.1Fifteen of the 25 MHCs in Ohio at the time of our study
met that requirement: 12 municipal (misdemeanor) courts and
three common pleas (felony) courts. We interviewed personnel
from 13 of the 15 courts.2During the interview process, personnel
from one of the municipal courts and one of the common pleas
courts indicated that they did not consider themselves to be or op-
erate as “true” MHCs. Those courts were excluded from the present
analyses. Results presented here are based on data from the remain-
ing 11 courts.
Face-to-face interviews with three to eight members of each MHC
team were conducted between July 2007 and July 2008. To identify
potential interviewees, we contacted the presiding judge of each
court who then either suggested team members to be interviewed
or designated an individual to coordinate interviews. We interviewed
59 court personnel; 29 criminal justice professionals and 30 mental
health professionals. After complete description of the study to the
participants, written informed consent was obtained.
All 59 individuals whom we interviewed were designated mem-
bers of each MHC team, although some concurrently held other posi-
tions (e.g., a MHC case manager could have a caseload that included a
mixture of individuals who were and were not participating in MHC).
While the exact position titles and number of personnel who occupied
each position varied across courts, our sample represents a diverse
group of positions from each court. Specifically, we interviewed 10
judges (17% of all interviews),3two magistrates (3%), five probation
officers (8%), two chief probation officers (3%), one bailiff (2%), one
defense attorney (2%), one prosecutor (2%), one assistant prosecu-
tor (2%), 18 case managers (31%) (at least one from each MHC), nine
MHC supervisors/team leaders/coordinators (15%), two assistant MHC
coordinators (3%), two case manager supervisors (3%), three forensic
Alliance on Mental Illness (NAMI) representative (2%). Interviews
lasted between 25 and 98 min, with an average interview time of
3.2. Interview instrument
The interview consisted of three sections: (1) court operations,
(2) internal dynamics, and (3) opinions and attitudes related to MHC
(Shoaf, 2003). The first section included questions related to the re-
spondents' perception of the primary goals of MHC, responsibilities,
roles, duties, and opinions about the general processes and structure
of the MHC. The second portion of the interview focused on respon-
dents' perceptions of collaboration between individuals and agencies
associated with the MHC and interpersonal relationships and commu-
nication between personnel. The final part of the interview concerned
the respondents' opinions and attitudes related to MHCs in general.
All interviews were tape-recorded and transcribed. After tran-
scriptions were reviewed for accuracy by members of the research
team, data were organized and indexed into files by court. Responses
to the questions regarding the goals of the mental health court, team
members' responsibilities, communication, cohesiveness and shared
norms, cooperation, and conflict among team members were then
compiled into a single document for analysis. Three of the authors in-
dependently coded and sorted the data and identified themes (Weiss,
1994). Upon completion of the coding process, we discussed our in-
dependent analyses of the data and discovered much overlap in our
interpretations and identification of emergent themes.
Our analyses revealed several themes of which we will concen-
trate on two: (1) Members of MHC teams recognized their own
roles as well as the roles of their colleagues and (2) recognized and
internalized the common goal of serving clients' needs. We present
results associated with these themes, as we believe they constitute
the foundation upon which subsequent themes concerning team
members' role performances emerged.
4.1. Recognition of roles
One overarching theme that was apparent throughout our inter-
views with MHC personnel was that interviewees recognized and ap-
preciated the diverse roles of MHC team members. This recognition
materialized in three ways. First, team members understood and
were clear about the nature of their own professional roles and duties.
Second, individuals attempted to understand the roles and responsi-
bilities of other team members. Third, individuals respected the pro-
fessional opinions of other team members.
4.1.1. Understanding one's own role
We found that mental health professionals saw their position
within the team as having two primary functions; one, as an advocate
for the client and two, as one who reminds other team members of
the importance of treatment. When asked about their main responsi-
bilities to the court, many case managers and therapists mentioned
acting as an advocate for the client. One case manager stated, “I'm
an advocate. I stand up with and for the client in front of the Judge.
I ensure that weekly communication is made with the court about
the client's status.”
Mental health professionals also reported that they found them-
selves needing to remind other team members of the goals of the
court and the duties of MHC personnel. One Forensic Supervisor
I really try to focus on the case management piece even though
clients and staff are aware that there's the court issue and that
they are under the court's jurisdiction. We still try to remind them
that the main purpose of the program is treatment, because it's
easy sometimes for the Case Manager to slip into the Probation
role, and I discourage that.
Some criminal justice personnel also felt like they needed to re-
mind others of their duties. Others saw themselves as coordinators
of the program or “the glue that keeps everybody together,” as one
Bailiff stated. Often, individuals in these coordinating positions served
as links, if not truly boundary-spanners, between criminal justice and
mental health personnel on the team. The following statement made
by one MHC Team Coordinator clearly illustrates her boundary-
spanning role on the team:
And so my job was really about selling this program. So it's like a
program manager or a program coordinator, but really it's also a
marketing person. My job is to market this program and make
sure everyone is happy…It's my job to protect this program as
well as the participants, and I think we do a pretty good job of it.
But more often than not, it's a lot of making sure that people un-
derstand one another and spanning that boundary between
1Typically, the courts had been in existence at least 2 years. During the interview
process, we discovered that one of the courts did not have any completers prior to
the interviews. However, the court was well-established and anticipated successful
completers within the next few months, so it was retained in our sample.
2We were able to establish initial contact with all 15 courts, but after numerous
follow-up attempts via phone and email over the course of several weeks, we were un-
able to arrange interviews with two of the courts.
3We also interviewed the 11th judge, but the interview was conducted informally,
and therefore, not recorded, transcribed, or counted as one of the 59 completed
M. Gallagher et al. / International Journal of Law and Psychiatry 34 (2011) 406–413
team members and saying, “Come on you guys, this program's
much bigger than us.”
In addition to general coordination of the entire team and con-
necting disciplines, many criminal justice personnel saw their roles
as being a link to the judge for other team members. Judges, in partic-
ular, were in a unique position,simultaneously actingasadministrators
and members of the MHC teams. Still, the judges we interviewed
primarily saw their role as the final authority within the team, as
the following judge's comments illustrate:
I guess my role is I'm the overseer. It's my ultimate responsibility
that the right thing is done for this person and the right thing is
done for the community and victims…
Or as another judge stated: “I'm the parent. I'm the rule maker.”
While Judges saw themselves and were viewed by the other team
members as having the final say in decisions made by the MHC team,
they frequently solicited and considered the opinions and recommenda-
tions of mental health professionals before making final decisions re-
garding current or potential participants. The Judges clearly recognized
thattheyneeded thebestinformationpossibleabouta clienttomakein-
formed decisions. One Case Manager remarked about the Judge on her
of action for this person…” Furthermore, Judges themselves were quick
to acknowledge that they relied heavily on the treatment team for
advice just as much as the treatment team relied on their legal exper-
tise and authority. The following Judge's comment is representative:
They feel they need the ‘stick’ that I provide, but they provide me
with the knowledge of what's going on with the person. To me,
the key of specialty courts is I really get the information I need
and determine how to deal with people that violate.
Although Judges viewed themselves as members of the team and
took the opinions of other team members into consideration, they
also recognized their role as the final decision maker for the team.
4.1.2. Understanding others' roles
Respondents also reported awareness of and appreciation for the
orientations of other personnel on the MHC team. One MHC Monitor
clearly understood the Probation Officer's role:
So the P.O. (Probation Officer) has responsibility to the courts, and
I mean, she has a lot on her hands, you know? They do a violation
and commit a new crime; she has to deal with that. And I may say,
‘why lock them up?’ ‘But I have to, I'm the P.O., I have to lock them
up!’ [Laughs]. So there's differences in that opinion.
One Magistrate acknowledged the differing opinions and roles
within the court:
I think we work well as a team. We have different views on things.
Obviously, you have a perspective from the Judge's standpoint,
from my standpoint as the Magistrate, from the Counselors, from
the mental health board individuals that do the funding to the…
like I said, the Counselors who are day-to-day with these people.
We have different roles.
In fact, many respondents felt that the presence of and balance
between the different perspectives were important and beneficial
to the court, as illustrated by the following statement made by one
From a behavioral health perspective we don't work with punish-
ment, but we do very focused behavioral modification efforts to
help people change their behavior. That's what the court actually
does. There's a punishment for unacceptable behavior. And so they
reinforce that, the consequences of that. And we on the other hand
help people to realize the rewards of corrected behaviors. So, in
that sense there's a partnership with the court.
Overall, respondents reported that they not only acknowledged
the presence of two different perspectives on the MHC team, but
also that they welcomed and valued both. MHC team members were
aware of the differingorientationsof criminal justiceand mental health
treatment personnel, but believed them to be beneficial. Specifically,
they felt that the presence of team members with different points of
view gave the team a more balanced perspective, benefited the client,
fostered partnerships between the court and treatment personnel,
and led to a more democratic decision-making process for the team.
From this, a third sub-theme emerged that illustrated team members'
understanding of their own and others' roles: mutual respect for
and recognition of each other's professional expertise.
4.1.3. Mutual respect
Our findings indicated a mutual respect among team members re-
garding decisions that were made during MHC team meetings. Every
team we interviewed met as a group at least once a week (usually the
day before or morning of MHC) to discuss clients' progress. Many of
the MHC team members we interviewed described team meetings
as a context in which they felt free to express their opinions and
hear the professional opinions of other team members. For example,
one Team Leader often solicited the recommendations of Probation
So I'll ask people, ‘What's your opinion? What do you think? What
are your recommendations?’…‘Are there any problems from
probation's standpoint that we can expect to come up in court
tomorrow? What are they? What are your recommendations
There was evidence that MHC team members deferred to one
another, depending on the nature of the issues posed by a given sit-
uation and the type of professional expertise required to address
them. As one Forensic Case Manager explained:
If it's a criminal law type decision, if they say this is what they have
to do, we pretty much say well, you know, that's what you have to
do. That's what you've got to do. By the same token, if we say that
this person needs this kind of treatment or needs to be in this kind
of class or whatever, they usually defer to us and say, ‘Well, you
guys know what's best for them.’ So normally that's the way it
The data clearly showed that MHC team members deferred to one
another when the situation called for expertise in a different area, and
mutual respect was widespread among personnel.
4.2. Recognition of goals
The second overarching theme that emerged from the analysis
was MHC team members' recognition of the goals of helping clients
in their recovery from mental illness and reducing criminal justice re-
cidivism. This recognition was due partly to subthemes related to the
selection of similarly-minded individuals onto the MHC team, and
team agreement on and commitment to goals.
4.2.1. Selection into (and out of) being a team member
Selection into and out of the team was an important contextual as-
pect of the professional relationships inside MHC teams. First, we
found that individuals were sometimes self-selected onto MHC teams
M. Gallagher et al. / International Journal of Law and Psychiatry 34 (2011) 406–413
because of their prior experience as criminal justice and mental health
professionals or a predisposition to work with people with mental ill-
ness or other special populations. For example, one Case Manager said,
“I'll preface that with the fact that what I do for a living, I have an
absolute passion for. I'm made to do this job…”
Second, we found that interviewees believed that they and their
colleagues needed to begin with and maintain a certain mindset to
be an effective MHC team member. They felt that they had to be will-
ing to get personally involved with clients and, as one Case Manager
suggested, “invest the time and energy to try to make a difference”
in the clients' lives. Several interviewees acknowledged this predispo-
sition to be involved with persons with mental illness as an essential
feature of a solid MHC team. They suggested that there was no place
for team members who did not “buy into” MHC's goals or possess the
willingness to adapt. As one Judge stated,
There is this kind of natural type of natural selection process that
goes on. It's that some people come and go very quickly. They
just get in there saying, ‘This isn't working for me.’ And then for
some people, it's obvious, just don't fit in and they leave very
In general, we found that individuals were self-directed onto the
MHC team because of their working knowledge of criminal justice
and therapeutic perspectives, their predisposition to accept the pro-
gram's goals, and their readiness to act on those goals on behalf of
the client. Further, individuals were sometimes selected out of the
team based on their own assessment or the assessment of others
that they were not an appropriate “fit” for the MHC team.
4.2.2. Everyone's on the same page
Given the processes by which similar-minded individuals are se-
lected onto the MHC team and the extensive planning that often
goes into the development of MHCs (Thompson et al., 2008), it is
not surprising that we found that most participants believed that
they and their colleagues agreed on the goals of the court. They un-
derstood that the main goals were to keep persons with mental ill-
ness out of the criminal justice system and link them to needed
mental health services in the community.
Team members' agreement on the court's goals was widespread.
Some indicated, however, that although the goals were generally
agreed upon, the manner in which they went about reaching those
goals differed. As one Forensic Supervisor said, team members get
the “big picture,” but “the interpretation of how things are to be
done is sometimes in question, and that's why and when I intervene
as a Supervisor to keep us on track with what the agenda is.” One
Magistrate stated, “I think that everyone has the same goal in mind,
just different ways of getting there.” Generally, we found that while
individuals' treatment and legal recommendations for specific clients
may have differed, they shared the same goals.
5. Discussion and conclusions
5.1. Current study contributions
This paper presents results associated with two themes that
emerged from our analyses of interviews with MHC personnel.
MHC team members (1) understood their own roles and the roles
of others on the team and (2) recognized and internalized the com-
mon goal of serving the clients' needs. We found that both mental
health treatment and criminal justice professionals understood the
general goals of MHC and were committed to working together to
meet those goals. Most respondents recognized their own and
their colleagues' professional roles and appreciated the professional
expertise of all team members which manifested itself in the re-
spect for and willingness to defer to the legal recommendations of
criminal justice personnel and the treatment recommendations of
mental health personnel.
Consistent with a study of healthcare teams comprised of individ-
uals from different professions (Scholes & Vaughan, 2002), we found
that traditional boundaries between MHC team members could be
overcome if each member sought to exercise professional expertise
and shared the aspiration to do what is best for the client. Important-
ly, our findings demonstrate that even on MHC teams that include
members with distinct and sometimes conflicting orientations, pro-
fessionalism and fidelity to the goals can dissolve potential barriers
and foster a willingness of team members to work around obstacles.
We also found that MHC team members are aware of the impor-
tance of setting clear program goals. Most of the courts we studied
had reasonably clear goal statements that all or most team members
understood and agreed upon; however, research suggests that the
process of getting to that level of agreement can be contentious. De-
veloping clear goals can be problematic because of challenges that
arise during the course of attempting to understand and negotiate
the different perspectives that each organization brings to collabora-
tion (Huxham & Vangen, 2000).
Our respondents indicated some degree of tension associated with
identifying goals and, more specifically, differences of opinion about
the particular means through which to accomplish goals, but did
not characterize negotiations or their general interactions as difficult
or problematic. The fact that all of the MHCs in our sample had been
in operation long enough to have successful program completers
might explain why developing and understanding goals seemed less
problematic than prior research has suggested. Nevertheless, it is
likely that “…the nurturing process must be expected to be required
indefinitely” (Huxham & Vangen, 2000, p. 800), and indeed, the indi-
viduals we interviewed seem to be continuously engaged in that pro-
cess on their respective MHC teams.
Our data show that the relatively smooth process by which most
of the MHCs in our sample “nurture” collaboration between criminal
justice and mental health treatment personnel was facilitated by
boundary-spanners or individuals with extensive knowledge of and
experience working in both systems. They interacted with staff in
their own specialty area and were able to develop and maintain inter-
actions with others through their sound understanding of and exten-
sive experienceworkingwithinallsystemsinvolved (Steadman,1992).
While boundary-spanners were not present on all of the MHC teams
in our study, several teams had individuals who occupied that role.
Those teams acknowledged that the boundary-spanner facilitated
understanding and cooperation between criminal justice and mental
health treatment personnel. On teams that did not have a boundary-
spanner, misunderstandings seemed more common.
Interviewees also spoke about other factors they felt contributed
to team consensus about the goals of MHC. Consistent with previous
research (e.g., Scholes & Vaughan, 2002; Waters et al., 2009), they
mentioned the importance of individual personality characteristics.
Research suggests that for individuals to work effectively within a
multidisciplinary team setting, they must adhere to a nonadversarial
team approach (McNiel & Binder, 2010), be able to adopt the shared
team culture, have an openness of communication and mutual re-
spect for team members, and contribute equally to team practices
(Scholes & Vaughan, 2002). This is a process that occurs over time,
and can only occur when each member of the group understands
the others' contributions and motives (Scholes & Vaughan, 2002). It
may be that there was a certain ideal mixture of personalities on
some MHC teams that facilitated their understanding of one another's
roles and the development of and commitment to a shared vision.
Many MHC team members reported that they were drawn to
working with special populations such as those found in MHC, and
tended to select themselves into their respective jobs based on their
M. Gallagher et al. / International Journal of Law and Psychiatry 34 (2011) 406–413
beliefs that they possessed the necessary talents and strengths. These
factors likely contributed to the clear understanding of their own and
others' roles and responsibilities as well as team consensus about
5.2. Implications for mental health courts
Consistent with the views of stakeholders in a San Francisco felony
MHC (McNiel & Binder, 2010), participants in our study saw expanded
and ongoing training of staff as essential for improving MHC function-
ing and effectiveness. Based on those findings, we suggest that those
interested in starting a MHC should attempt to assemble a team of
highly talented and motivated professionals who all ascribe to the mis-
sion of MHC. It seems imperative that MHCs recruit personnel with ex-
perience in or a willingness to learn about both the criminal justice
and mental health systems. Additionally, willingness to assert one's
own professional opinions and to listen to and respect the opinions
of others are desirable characteristics that should be sought out in
new MHC team members and fostered in existing team members.
These strategies will build trust, communication, and mutual respect
among team members, which will improve the operation of MHCs
and may impact client outcomes.
5.3. Limitations and future research directions
Although our study provides several important insights into the
internal features of Ohio MHCs and their potential implications, our
findings may not apply to other states. We were not able to include
in our sample all MHCs in Ohio nor were we able to interview all in-
dividuals associated with each MHC team included in this study.
While we were able to interview personnel who occupied a diverse
range of positions on each MHC team, we were not able to schedule
interviews with personnel from two of the 15 MHCs that met our cri-
teria for inclusion in this study. However, our sample is still far more
comprehensive than most studies of MHCs to date. Additionally, we
drew upon data from each of the 11 courts to identify emergent
themes, which provided us with some degree of confidence that
they are salient issues for MHCs in general, or at least for the majority
of established MHCs in Ohio. We do not know the exact reason why
we were not able to maintain follow-up contact with two of the
courts, but one plausible explanation is that they were deterred by
the time commitment associated with participating. To address that
issue, future research might utilize data collection procedures that
are less time-intensive than face-to-face interviews as a strategy to
potentially increase participation and overcome schedule limitations
(for both the respondent and researcher).
A second limitation is that our data only include information from
the perspective of MHC teams. As McNiel and Binder (2010) suggest,
future research should also consider the perspective of MHC partici-
pants. Data on clients' perceptions of team members' interaction
with them and with each other would allow researchers to assess
the extent to which MHC personnel and clients have similar under-
standings of and opinions about interaction among team members
and between team members and themselves. For instance, recent re-
search suggests that judge's interactions with both MHC participants
and team members shape MHC team functioning and participants'
outcomes (Wales, Hiday, & Ray, 2010).
A final limitation is that the nature of our qualitative data re-
stricts our ability to systematically link MHC features with client out-
comes. Given that program characteristics vary across MHCs (Wolff &
Pogorzelski, 2005), future research should consider ways to quantify
key MHC components to enable empirical investigations of the degree
to which particular aspects of MHCs and their internal team dynamics
and processes are associated with client outcomes.
This paper is based on work supported by an Ohio Criminal Justice
Services Justice Assistance Grant (2007-JG-E0R-6583) and Ohio De-
partment of Mental Health Transformation State Incentive Grants
(TA-09-10-03-01, TA-08-24-03-02, TA-08-22-03-02, TA-08-22-03-
01) (co-Principal Investigators Christian Ritter and Mark R. Munetz).
The authors would like to thank Virginia Aldigé Hiday for her helpful
comments on an earlier draft of this paper. We would also like to
thank the courts, their personnel, the interviewers (Kristen Marcus-
sen, Brent Teasdale, Pam Tontodonoto, and Jeffrey D. Monroe), and
The Ohio Supreme Court Advisory Committee on Mental Illness and
the Courts for their assistance with the project. Lastly, we thank Staci
Kennedy and Jamie Klintworth for their assistance in scheduling and
transcribing the interviews.
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