People incarcerated in U.S. jails and prisons are more than twice as likely to have a mental illness than people in the general population. Researchers, advocates and local leaders are hungry for solutions to get more of these folks the treatment they need before they end up behind bars.

Mental health courts are one widely used approach. These courts — run by judges in regular courthouses — give certain people charged with crimes the option to complete treatment instead of incarceration. Over the last 30 years, some 600 counties across 40 states have launched mental health courts.

Proponents say these programs can be life-changing opportunities for people to receive much-needed treatment — and that they save taxpayers money. Critics argue that the legal system should stay out of the mental health treatment business and that these courts’ growth has outpaced the research on their effectiveness.

Journalists Grace Hauck and Josh McGhee spent months diving deep into mental health courts in Illinois. The two pored over research, requested data from all 31 mental health courts in the state, and talked with judges, lawyers, advocates, clinicians and participants. Their investigation for MindSite News and the Illinois Answers Project paints a picture of mental health courts as a “promising model with limited funds supporting small oases in an otherwise barren desert.”

Tradeoffs talked with Hauck to learn more about the key takeaways from their reporting:

• A promising model: Research in Illinois and across the country has shown mental health courts reduce the likelihood that someone will commit another crime. In Illinois, more than 6,000 people have participated in a mental health court over the past two decades, and about half of participants graduate. “For folks who are supportive of this, it’s kind of a no-brainer,” Hauck said, “because even if not everyone is getting through, it’s giving thousands of people access to treatment and resources that they didn’t have before.”
  
• Limited funds: In Illinois, courts use a combination of federal, state and local dollars to pay for staffing and some treatment. Looming Medicaid cuts are causing a lot of uncertainty and fear for mental health courts, Hauck said, since Medicaid often covers the bulk of treatment that courts order participants to receive. “[If] Medicaid is no longer an option, what mental health courts are able to offer people becomes far more limited,” Hauck said.
  
• Small oases in an otherwise barren desert: Access to mental health courts depends on where a person lives. In Illinois, only 25 of the state’s 102 counties have a mental health court, leaving 2 million people — about 1 in 6 residents — without access, primarily in rural and lower-income areas.
  
• Critics say courts are coercive and a distraction: Opponents of mental health courts worry programs coerce people into treatment — since the alternative to participation is often incarceration. They also argue that mental health courts intervene too late, distract from more proactive approaches and may encourage police to arrest someone in order to connect them with treatment.
  

Check out the full investigation, and listen to the episode or read the transcript. You’ll hear from a woman in Illinois who says mental health courts changed her life, and from Debra Pinals, a forensic psychiatrist who has spent 20 years studying and working in mental health courts.

Pinals told Tradeoffs that what Hauck and McGhee found in Illinois is true in the rest of the country as well, and I think she succinctly captured the key tension at play with mental health courts. “It’s complicated,” she said, “because we’re trying to make a court a therapeutic place, and that’s not how courts were designed.”

This reporting was originally produced by Tradeoffs, a nonprofit newsroom reporting on health care’s toughest choices. Sign up for their weekly newsletter to get their latest stories every Thursday morning. Tradeoffs reporting for this story was supported, in part, by the Sozosei Foundation.