Abstract
A growing trend in the criminal justice system is the move toward problem-solving courts, including mental health courts. Using case studies of two mental health courts in a West Coast city, this article seeks to explore how mental health courts may operate by reducing stigma among clients. From observations of the court process in mental health courts and qualitative interviews with mental health court professional staff and mental health court clients, ritual process emerged as a powerful theme that underscores the management of social stigma. Drawing on Collins’s interaction ritual framework, the study demonstrates the benefits of rituals and how the focus on rituals in mental health courts is toward nonstigmatizing ends. Courtroom rituals work to reduce social stigma, manage spoiled identities, and attempt to reintegrate and restore the social self. Failed rituals and the subsequent reinforcement of stigma are also explored, which demonstrates that the posited effects of the ritual process are conditional.
Introduction
The problem of mental illness in the criminal justice system has become unavoidable, with growing media attention on mentally ill offenders highlighting the importance of the issue. In fact, the burgeoning number of people with mental health diagnoses under the supervision of the criminal justice system has become a crisis with local, regional, and national implications. The U.S. Department of Justice (2006) 1 reports that 56 percent of inmates in state and 45 percent of inmates in federal prisons have mental health problems, of which 24 percent and 14 percent, respectively, had a recent clinical diagnosis or treatment by a mental health professional. The proportion is even higher among those incarcerated in local jails, where 64 percent of jail inmates report mental health problems, over 20 percent had a recent clinical diagnosis or treatment by a mental health professional, and 60 percent report recent mental health symptoms (U.S. Department of Justice 2006). An additional problem is that among the incarcerated mentally ill population, approximately three-quarters of those incarcerated in state or local prisons are also substance abusers or are substance dependent (U.S. Department of Justice 2006).
Mental health problems and co-occurring conditions such as drug abuse and dependence frequently render traditional criminal justice methods inappropriate or, at least, ineffective, contributing in large measure to the “revolving door” problems in the criminal justice system (Kushel et al. 2005). Furthermore, critics contend that punitive criminal justice policies are especially cruel, discriminatory, and ineffective toward those with impaired competence and heightened vulnerability. Public opinion, too, indicates a lack of faith in traditional criminal justice approaches in managing the mentally ill (Berman and Feinblatt 2005). Hence, there is a growing need for a reorientation of the criminal justice system, especially the courts, in how they deal with mentally ill defendants. Specialized courts or problem-solving courts focus around a specific issue or specialized population. Drug courts were the first problem-solving court model arising in 1989 in an attempt to combat, or at least reduce, the connection between drug abuse and criminal behavior (Nolan 2003). Since then, a range of problem-solving courts have been introduced, including community courts, domestic violence courts, and veteran courts. One of the most promising of these innovations is specialized mental health courts (hereafter, MHCs).
MHCs focus on mentally ill defendants and have been largely modeled on drug courts (Griffin and DeMatteo 2009). Clients in MHCs are generally combating mental health issues as well as substance use and often confront periods of homelessness and extended unemployment. According to the most recent estimates by the Substance Abuse and Mental Health Service Administration’s National GAINS center, there are 348 MHCs across the country. Others put the numbers slightly higher at over 400 in total with 346 adult MHCs and 51 juvenile MHCs (Goodale, Callahan, and Steadman 2013). While there is considerable variation (Fisler 2015) in the courts in terms of eligibility criteria and types of offenses handled (felony vs. misdemeanor), MHCs have several features in common and usually mandate that the accused have a demonstrable mental health diagnosis often based on DSM-IV criteria 2 (Almquist and Dodd 2009; U.S. Department of Justice 2000). MHCs also operate on separate dockets and have a designated staff, including judges (McNiel and Binder 2007; Redlich et al. 2006). Participation in MHCs is voluntary (Redlich 2005). There is a wide variety of how MHCs deal with charges upon entrance into the court. Many MHCs require guilty pleas (Redlich et al. 2005), and in some cases, charges are dismissed upon successful completion of the court. Clients are on probation during the MHC process with frequent reviews, usually either weekly or monthly, at the beginning of participation (Redlich et al. 2006).
MHCs diverge from the traditional model of criminal justice in some key ways. First, MHCs are therapeutic or treatment courts and thus committed to rehabilitative and therapeutic ends. This is directly related to the broader philosophical orientation of therapeutic jurisprudence and seeing judges as “therapeutic agents” (Wexler 1990; Wexler and Winick 1996). Second, MHCs are premised on non-adversarialism. This “teamwork” model includes new social positions as well as new social roles for the same players as different parties work together across the traditional demarcations of prosecution and defense. Members of the team include the usual players—defense lawyers, prosecutor attorneys, judges, and probation officers—but they also include members such as defense social workers and court liaisons/monitors. The latter serve in a neutral position as they act as a liaison between defendant and court personnel and also serve as a gatekeeper into the court—making key recommendations regarding eligibility and amenability. Collaboratively, team members participate in joint decision making related to treatment and punishment (Goldkamp and Irons-Guyun 2000; Watson et al. 2001). A treatment orientation with a team of professionals attempts to resolve the root causes of criminal involvement by connecting clients to resources, treatment, and housing and providing social support while also weighing concerns for public safety.
Despite the very swift emergence and diffusion of MHCs, research on the process in these courts and their effectiveness has lagged behind. Studies examining problem-solving courts, including MHCs, are increasing in quantity but are largely focused on evaluation and outcomes. Initial studies suggest that there is reason to be hopeful about the future of MHCs based on outcomes, though the data are usually limited (Griffin and DeMatteo 2009; Lurigio and Snowden 2009). Research suggests that participation in MHC leads to better outcomes for defendants and society, including lower rates of criminal reoffending, less serious crimes if a defendant reoffends, and longer amount of time to first arrest (Anestis and Cacbonell 2014; Burns, Hiday, and Ray 2013; Cosden et al. 2003; Hiday and Ray 2010; McNiel and Binder 2007; Moore and Hiday 2006; Steadman et al. 1999; Trupin and Richards 2003). Quantitative reviews of MHCs report that MHCs “may be moderately effective treatment for reducing recidivism” (Sarteschi, Vaughn, and Kim 2011:18) but are cautionary as the factors associated with lower rates of reoffending are “characteristics associated with recidivism generally, regardless of mental health status” (Fisler 2015:10)
Researchers also report clinical implications of participating in MHC, including faster access to treatment in the community (Keator et al. 2012) and perceptions of recovery among MHC participants who characterize their experience as noncoercive (Pratt et al. 2013) and fair (Kopelovich et al. 2013). What is less known are the mechanisms by which MHCs work and for which defendants they prove most effective. Scholars call for research into “process oriented moderator variables” (Sarteschi et al. 2011:18) and “court organization and functioning” to better understand “best practices” (Castellano and Anderson 2013:170). This article responds to these identified gaps in the literature.
Adding to a small but growing list of qualitative research, this article addresses the process of MHCs in order to identity possible mechanisms of effectiveness (Canada and Watson 2013; Dollar and Ray 2015; Miller and Johnson 2009; Munetz e al. 2014; Poythress et al. 2002; Ray, Dollar, and Thames 2011). It is through detailed examination of court process and actors that rituals emerged as an important theme. This article analyzes qualitative data, including court observations and in-depth interviews with MHC professional staff and MHC clients, to explain how rituals add to our understanding of MHCs and their effectiveness. Moreover, the data show that the focus on treatment and therapeutic ends based on teamwork leads to a shift in punitive components of court that can be illustrated through the social practices and rituals of the court. It is through these rituals, when successful, that the production of stigma are reduced and the repair of the client’s identities begins. This article addresses the literature on rituals through Collins’s (2004) interaction ritual chains theoretical framework, then moves to a discussion of stigma and shame within the criminal justice system, and finally illustrates the role of rituals and stigma reduction in MHCs.
Rituals and Ritual Outcomes
The study of rituals has a rich history in sociology. From a Durkheimian perspective, rituals can be understood as social practices embedded with meaning and tied to a value or belief system. Inherently collective, they provide opportunities for emotional expression and are symbolic of group membership. Durkheim ([1912] 1995) focused on rituals of a religious nature, but his larger questions concerned group solidarity outcomes. Initiation rituals into the group were emphasized; often, these were sacred rites that induct individuals into a religious (or cultic) group. Durkheim’s insights into how rituals constitute solidarity by affirming membership and reinforcing norms are clearly relevant in other spheres of social life.
Today, other social theorists have applied Durkheimian concepts to understand general ritual practice in group life. Collins’s (2004) interaction ritual chains brings together insights from Durkheim’s work on religion and solidarity and Goffman’s ([1967] 1982) discussion of “interaction rituals” that are characteristic of our social encounters. Collins (2004:218) claims that even outside the realm of religion, rituals still “hold society together” because “we are constantly being socialized by our interactional experiences throughout our lives.”
For Collins (2004), there are four possible ritual outcomes: (1) group solidarity, (2) emotional energy, (3) symbols of social relationship (“sacred objects”), and (4) feelings of morality (also a sense of violations). Collins’s four ritual outcomes are similar to Johnstone’s (2001:30) summary of the four “primary social functions” of Durkheim’s religious rituals. For Johnstone, these beneficial functions are “disciplinary” and contribute to social order, “cohesive” and relate to strengthening social solidarity, “revitalizing” and remind participants of their shared history, and “euphoric,” attempting to bring out emotion. These four functions represent social benefits that rituals can produce. Collins’s ritual outcomes are not exclusively religious oriented and thus are easily applied to the case of MHCs. Moreover, Collins breaks with functional assumptions by arguing that rituals outcomes are conditional and that failed rituals can provide dissensus. This article applies Collin’s theory to rituals in MHCs. In MHCs, successful or failed rituals are related to the level of stigma or shame involved in the ritual process.
Stigma and Shame in the Criminal Justice System
The significance of stigma and shame in the criminal justice system is longstanding. It is perhaps more acute in the case of the specialized population of offenders who are mentally ill, some of whom are diverted to MHCs. MHC clients suffer from several sources of social stigma—any of which can become a master status—including mental illness, criminality, and possibly substance abuse/addiction, poverty, and homelessness. Goffman (1963) defined stigma as “spoiled identity” that must be constantly managed. MHCs can reinforce social stigma or work to assuage them. Prior research suggests that the experience of being in MHCs adds to the stigma of mentally ill individuals (Watson et al. 2000). Others contend that the very existence of MHCs is part of the problem: “Mental health courts create stigma by segregating people by illness and then defining their uniqueness and irresponsibility in terms of the illness” (Wolff 2002:434). However, ritual processes can be used to address social stigma and manage spoiled identities by attempting to reintegrate and restore the individual to his or her previous social self (Goffman [1967] 1982).
The theory of reintegrative shaming (Braithwaite 1989) is relevant to ritual processes in MHCs. Braithwaite’s (1989:12–13) groundbreaking account of reintegrative shaming emphasizes a crucial difference between shame and stigma, focusing on the former and not the latter: The distinction is between shaming that leads to stigmatization—to outcasting, to confirmation of deviance as a master status—versus shaming that is reintegrative, that shames while maintaining bonds of respect or love, that sharply terminates disapproval with forgiveness, instead of amplifying deviance by progressively casting the deviant out.
Productive shaming—shame that does not turn into stigmatization—integrates the individual into society, stressing the importance of the larger community context (Braithwaite 1989). This is often illustrated by court ceremonies where the focus is on the negative behavior itself and not the individual. For example, “The offender should be shamed or punished with dignity rather than stigmatized as a monster or outcast” (Braithwaite 1989:11).
Previous work by Dollar and Ray (2015) explicitly applies Braithwaite’s theory of reintegrative shaming to one MHC. In their analysis, they explore the practice of MHCs and apply four key components of reintegrative shaming (Makkai and Braithwaite 1994)—respectful disapproval, disapproving the behavior rather than the individual, rejecting deviance as a master status, and ceremonial decertifications of deviance. Their data suggest that reintegrative shaming is relevant to the workings of MHCs and successful outcomes. In another study comparing stigmatizing and reintegrative shaming, Ray and colleagues (2011) find that MHCs are more likely to use reintegrative shaming than traditional courts.
In addition to reintegrative shaming, the idea of procedural justice (Canada and Watson 2013; Kopelovich et al. 2013; Poythress et al. 2002; Ray and Dollar 2014) has been proposed as a possible mechanism to explain success and positive experiences in MHC. Using qualitative and quantitative data sources, Canada and Watson (2013) highlight the role of procedural justice—having a voice, being treated with dignity, perceiving concern, and perceiving fairness in the process—in two MHCs. Ray and Dollar (2014) explicitly link successful stigma management post-exit of MHC to client’s experiences of procedural justice within MHC. MHC clients who characterized their experiences in MHC from a stigmatization shame perspective (e.g., humiliation and rejection)—the kind that Braithwaite warns against as not being reintegrative—were most likely to manage their stigma with withdrawal and secrecy. Research suggests that stigma and stigma management are linked to reintegrative shaming and perceptions of procedural justice. Relatedly, Miller and Johnson (2009) discuss prosocial status of clients in problem-solving courts, whereby the court process and specific court actors work toward taking a negative status (and a threat) and transforming the client to a community member. The amount of reintegrative shaming—as opposed to stigmatization—should negatively impinge upon the formation of a prosocial status.
Insights from Braithwaite (1989:14) are cautionary in that formal punishment in the criminal justice system provides opportunities for “degradation ceremonies with maximum prospects for stigmatization.” Reintegrative shaming is not an automatic outcome but in fact quite the opposite; it comes about from intentional processes that are focused on integration and not stigmatization. Rituals that reduce stigma and focus on reintegrative shaming stand in contrast to much of the research on rituals, which are often characterized in terms of “deference and demeanor” (Goffman 1956) that are social practices used to create or reinforce status inequalities among actors. “Degradation ceremonies” (Garfinkel 1956) in which the total identity of a person is characterized negatively and portrayed as an outsider (criminal and/or mentally ill in this case) are associated with stigma. In addition, Erikson (1962:311) highlights the role of ceremonies that change a person’s status in the criminal justice system: “It is a sharp rite of transition, at once moving him out of his normal position in society and transferring him to a distinct deviant role.” In contrast, reintegrative shaming promotes “ceremonies of repentance” that “have even more integrative potential than degradation ceremonies” (Braithwaite 1989:156). The ceremonial decertifications of deviance discussed in the criminal justice literature (Dollar and Ray 2015; Makkai and Braithwaite 1994; Ray et al. 2011) become ritualized in MHCs.
This article centers on Goffman’s seminal work on stigma while integrating insights from Braithwaite’s discussion of reintegrative shaming and subsequent recent applications (e.g., Dollar and Ray 2015) while applying a novel theoretical application from Collins’s (2004) interaction ritual chain theory to the case of MHCs. Through an examination of the ritual process, some elements of reintegrative shaming are illustrated. Moreover, failed rituals and the subsequent reinforcement of stigma are described.
Data and Methods
Study Design and Site
Two MHCs in a large West Coast city are the focus of this research study (hereafter referred to as Municipal MHC and Regional MHC). Municipal MHC and Regional MHC are the research sites for several reasons. Both courts represent first-generation MHCs. Both courts are located in the urban downtown corridor, with a notable and visible concentration of homeless, some of whom are also mentally ill. The urban context links contemporary issues about quality-of-life campaigns (e.g., social disorder and “broken windows”) to incarceration and mental health services and treatment. Thus, these courts are at the forefront of this trend toward alternative models of criminal justice and are uniquely situated to serve as case studies for the growth, change, and development of MHCs.
Despite some variation in MHCs in general and within these two courts, Municipal and Regional MHC are similar in key ways. Both courts refer to defendants as “clients,” seeing language as an important start toward more therapeutic ends. They are comparable in terms of eligibility criteria and amenability assessment. Both courts require that clients have a demonstrable mental health diagnosis (usually Axis I based on DSM-IV criteria) and that the alleged criminal activity is related to or caused by mental illness, consistent with other MHCs (U.S. Department of Justice 2000). In both courts, clients volunteer by opting into the court process. The client must be amenable and thus willing to participate in treatment; most clients usually have a history (often extensive) of mental health treatment. As is typical of problem-solving courts, both courts hold a pre-court meeting to which all the professional staff—except the judge 3 —are present one hour before court begins to discuss in detail the court calendar; it is during the pre-court meeting where the teamwork model is in action. Both courts also have a similar probationary period of approximately two years (with the potential to graduate early based on compliance).
They differ—as many MHCs do—in the types of offenses handled. Municipal MHC only deals with misdemeanor offenses while Regional MHC court also accepts felony charges (although they are reduced to misdemeanors before officially entering the court). While Municipal MHC takes cases from the city—largely driven by the downtown core—Regional MHC takes cases from the larger county and neighboring areas. Thus, an examination of these two MHCs will allow for a better understanding of the broader issues surrounding MHCs with local and national implications within a singular urban context.
Beyond administrative and efficacy goals, the substantive goals of MHCs are threefold: (1) reduce criminal recidivism, (2) improve public safety, and (3) increase mental health treatment and well-being of mentally ill clients. Notably, most of the MHC professional staff referred to these goals in qualitative interviews. These goals are similar to those stated by other MHCs in the country (U.S. Department of Justice 2010), but the focus on social support, services, and quality of life of mental health clients in these courts does stand out.
Qualitative Data and Analysis
This article draws on two forms of qualitative data based on the two MHC sites. First, the article employs fieldwork data, including detailed court observations of court proceedings. Both Municipal MHC 4 and Regional MHC 5 are open to the public. Observations from Municipal MHC occurred periodically (usually one time per week) between 2010 and 2015, including a three-month period in 2013 with observations of the pre-court meeting for a two-week period. Observations from Regional MHC occurred periodically (usually one time per week) in 2013 and daily for a three-month period during the summer of 2013. These data help to characterize and describe the court process and situate the role of rituals. Second, the article draws on qualitative interviews with MHC professional staff and MHC clients. All portions of the project have been approved through the University of Washington’s Human Subjects Division (No. 452199) and Seattle Pacific University Institutional Review Board; Seattle Pacific University accepted the University of Washington’s approval of this research.
This article relies on insights gleaned from a total of 30 interviews conducted with MHC personnel (14 from Municipal MHC and 16 from Regional MHC) 6 and six MHC clients from Municipal MHC. Interviews lasted approximately 60 minutes and were audio-recorded. Interviews with court personnel took place in a Municipal or District Court office or conference room. Interviews with clients took place at a local coffee shop. All statements are confidential, and statements from professional staff are referred to in all published work by their professional role (e.g., defense attorney) and not linked to the court in which they work. 7 The interviews probed questions on many aspects of the court process, but the research presented here focuses on stigma and shame in the MHC process. 8 Each transcribed interview was carefully coded and sorted based on themes. Themes are created during the coding process (Bailey 2007) 9 and were derived from previous studies, the project’s theoretical framework, and emergent themes from the interviews themselves. This procedure is common in qualitative sociological research and seen specifically in the area of criminal justice (Ewick and Silbey 1998). All interviews were conducted and coded by the author.
Both the court observation data and qualitative interviews illustrate the ways in which rituals play a role in how MHCs promote treatment outcomes and how key actors within the court work toward these therapeutic ends with MHC clients. Court observations reveal how MHCs serve as a counter to the traditional punitive and stigmatizing criminal justice practices.
Rituals in Mental Health Courts
From observations of the court process in MHCs, rituals emerged as a powerful theme that underscores the management of social stigma. MHC proceedings—a situational environment—serve as an interesting case to apply Collins’s (2004) theoretical insights. Collins details the four conditions or ingredients necessary for interaction rituals: (1) group assembly, (2) barrier to outsiders, (3) mutual focus of attention, and (4) shared mood. Collins highlights the important of bodily co-presence—physical proximity and contact—in the ritual experience; in fact, Collins goes so far as to state that “ritual is essentially a bodily process” (p. 53).
Applied to the MHC, the courtroom and the subsequent hearings are the setting and the form of group assembly. The situation is the key dialogue between the client and the legal parties (especially the judge). The primary participants are the client, judge, defense attorney, prosecuting attorney, and other member of the MHC team. Members of the audience are secondary participants; they watch and listen to the exchanges and offer approbation or confer disapproval. Clients have a series of court proceedings and exchanges, and it is these hearings that provide for social identity and group attachment. There is a slight barrier to outsiders because it is really only insiders who choose to be present in the ritual space of the courtroom. Although the court is open to the public, there is a physical barrier to the outside, which makes it feel more private. This is especially true in Municipal MHC as there are two sets of doors to enter from the outside corridor. The mutual focus of attention is the hearing and the related dialogue. There is often a shared mood in the happenings of the court. Part of the shared mood is the nervousness and sometimes impatience in waiting for one’s hearing or that of a friend or family member, although the mood can be transformed into a mood of elation, relief, or defeat depending on the subsequent court actions and exchanges. Observational data and interview data illustrate that there are different rituals in MHCs, and they do indeed produce different types of social benefits. Each of the benefits will be addressed in turn as well as the impact of these rituals toward non-stigmatizing ends.
Group solidarity
First, rituals can create or enhance group solidarity (Collins 2004). Durkheim ([1912] 1995:386) states that “It is through them [the rituals] that the group affirms and maintain itself.” Rituals can be cohesive by bringing people together and highlighting their commonalities (Johnstone 2001). Ultimately, cohesive rituals strengthen group connectedness. In the case of MHCs, there might not be an established sense of solidarity to reinforce but rather a sense of collectivity that can be created. For Durkheim and others, the initiation into a new social order is often a focus of rituals. In the case of MHCs, this is also true. For Durkheim ([1912] 1995), the initiation of certain members into a new status or group involves uniformity, subordination to the social order, and self-discipline.
Entrance into MHC has the appearance of an initiation ritual in the Durkheimian sense. Although clients are not in the criminal justice system by choice, they must volunteer or “opt-in” to MHC. The decision-making process for the clients and the MHC team often takes several weeks or in some cases months to determine eligibility and amenability. Opting into MHC means agreeing to a demanding and time-consuming set of conditions and expectations (including a treatment regimen, group meetings, case manager appointments, frequent status hearings, and frequent contacts with probation, a social worker, and the court liaison) in return for additional resources and sometimes a reduced or suspended sentence upon completion of the court program. Thus, clients must discipline themselves to follow the rules of the court or receive negative sanctions. Entry into the court assigns the clients a new identity in three areas: as a participant of the MHC, as a member of the team, and as a functioning (e.g., law-abiding from this point on) member of society. The fact that initiation into the MHC is voluntary allows clients agency (albeit within some notable constraints)—the first step in the process of reducing stigma—in subordinating himself or herself to the MHC.
The uniformity of the initiation ritual depends on the disposition of the judge. Based on court observation data in both courts, there is variation in judicial style, presence, and “buy-in” to the mission of MHC, especially in Municipal MHC. Although there is not a singular initiation ritual, there are some commonalities, especially the client’s subordination. Subordination is inherent to participation in MHCs given the power of the court. However, this subordination is not self-denigrating or abasing. Consider the following typical exchange upon a client’s entry into MHC: Judge: Welcome to MHC! This is a treatment court. We understand it will be hard. We will ask a lot of you but the team is here to provide support along the way.
The ritual of initiation is helpful, focusing on group involvement and social support in the court process instead of inflicting more stigma or shame.
There are other examples of how rituals in MHC can be cohesive and stigma reducing beyond initiation into the court itself. Once in MHC, clients must submit to periodic reviews that start off more frequent (e.g., weekly or bimonthly) and become less frequent (e.g., 6 weeks or more) as familiarity with the court increases as long as compliance is maintained. During routine status hearings, clients are assessed in terms of their level of compliance. Even in the case of a violation of the court conditions, the exchanges around sanctioning can be productive of group solidarity and connect the client in violation with other clients in the court. For example, “court watch”—having to watch the entire MHC calendar—is often used as a negative sanction when a client is out of compliance with the court’s conditions. Court watch encourages clients to make connections between themselves and others in court that can enhance a feeling of connectivity. A probation officer clarifies the role that court watch can play in linking a client’s trajectory to other people’s experiences in the court and how others manage mental health and substance use treatment: It [court watch] does two things. One, if the client is sitting in court from 1-4 they’re not doing anything bad! They are not drinking, they are not out there engaging in any crime. There is also this cool thing. . . . You sit in court and you watch these people. So there is the actual observation part where you are seeing all these different people, from walks of life and different experiences in different levels of their recovery and how they’re dealing with the court. You see the people who are newbies and are still struggling with their addiction and their stability and stuff and maybe the client goes “Oh yeah I remember when I was there and look I have come a long way.” Or they see someone who’s two years into their probation and they go “wow” and they tell their story and they [the client] go “Wow, maybe that’s where I can get to!” So you see where you have been and maybe where you can get to.
This statement suggests that court watch can also be reinvigorating for clients. It can help a client get back on the right course. It might also remind a client that there are others like him or her but at different points in the process of treatment. All of this can lead to reintegration and reduction of stigma.
In addition to court observation data, informal conversations with clients provided insights about how rituals played out in the court process. One such conversation with a client occurred during court after he had been in court the previous day for court watch. He explained, “I do not know where I would be without mental health court!” He talked about how his experience in MHC changed his life trajectory and the relationships made in court encouraged him not to give up. He mentioned the trouble he had with accepting his mental illness. As a young man, he assumed that his mental health symptoms were developmental and related to lifestyle issues (substance use), not realizing it was mental illness. The court helped him accept that it was mental illness and make changes. Multiple observations of this client were collected due to the frequency of court appearances in MHC. It was clear in his hearings—through his responses to the positive affirmations from MHC staff (especially the judge) with smiles and optimism and connections with other clients—that at least some part of the court review process (and even its sanctions in the case of court watch) refreshed him. He revealed that these positive exchanges gave him the strength to continue the fight toward staying clean and comply with his treatment regimen. He described the connection to the MHC team and the social support they provided as central to his success. This exemplifies the repair of this client’s spoiled social identity in the court’s ritual process. The amount of group solidarity produced by ritual processes may be linked to the amount of emotional energy exerted or experienced.
Emotional Energy
Successful rituals produce emotional energy (Collins 2004), even euphoria (Johnstone 2001). Positive displays of emotion appear to enhance the social well-being of clients. This ritual function may be especially important in cases of extreme difficulty or disappointment (of which MHC certainly qualifies) as positive rituals can offer hope in dark situations. As described by a probation officer: But there is also this other thing that happens [during court watch] that I think is really neat. Where you are in this room and there is this shared energy. You have these connections, you watch these attorneys, you make eye contact with them. There is an exchange there, and even if there is not direct communication, there is still an opportunity to increase familiarity. The city attorney maybe didn’t interact with that client at all—presumably didn’t. But feels like they [city prosecutor] are now closer to that client simply because that client sat 15 feet away from them for a couple of afternoons one week. And I think there is something special to that that is really valuable.
The ritual performance generates collective emotions, experiences, and communal morality. And rituals such as this serve to remind individuals of their social bonds. The “shared energy” as described by the probation officer in the ritualized process in MHCs reaches beyond just the intended client to establish community with others in the room. There is also a reduction in social distance between legal actors and the client, which may allow for greater repair of spoiled identities.
“Graduation,” or exiting the court on successful completion of the program, can be a very powerful ritual with a lot of emotional energy. During a graduation, a client receives a certificate, the judge comes down from bench and shakes the client’s hand—a noticeable reduction of physical and social distance—and then the audience applauds. Often clients hug MHC professional staff, and words of praise are offered from most members of the team. Clients are also often joined by family, friends, case managers, and others there to witness the event. Sometimes clients captured the moment with a photograph. Consider one such graduation in Municipal MHC: It [the case] is coming to a close. He has been in compliance. He has had some ups and downs. . . . He’s been a pleasure to work with. We will not see him back in court. Dismiss charges. Congratulations! Congratulations! I am happy to hear all of the positive comments. Thank you. . . . It really did get me into shape. I have done everything that I can do to make sure those things do not happen again. This [the court] has kept me going in a good direction. In the beginning I did not want to do this [MHC] but as time went along it was clear that it was helping me. Thank you. Congratulations! (presents certificate) Thanks to everybody. I thought it was corny [when others got a certificate] but now it feels really good. I will be seeing you. . . . No I won’t! (laughter) But if I see you on the street I will say “hi.” Thanks.
The statement by this client highlights another feature of MHC rituals: the repair of spoiled identities. Stating that he will say “hi” if anyone from the court sees him on the street is an acknowledgment of all that the client has achieved; he is now a regular member of society, unburdened by stigma. The client is suggesting that MHC team members do not need to look away in embarrassment—nor does the client need to look away in shame—if they see each other in public. He is now a restored citizen, with the rights, responsibilities, and importantly status that implies. Graduation also reduces the social distance and status differentiated between the client and the professional staff symbolized by the handshakes, hugs, and ritual displays of affection.
Upon graduation, another client shares her experience and appreciation with the team, explaining, “Thanks to the court. For helping alcoholics with mental illness. Getting [me] on the right track. I now take light into the room instead of being in court.” In reflecting upon her graduation ritual a few weeks earlier, in an interview, another client stated that she was not able to speak; she characterized the graduation as “very tearful” and the team members as a “kind of family.” This family metaphor was echoed by a probation officer: “It is like some people kind of get adopted by the whole team.” The client also commented that “they [MHC team] took the time to care about me.” Given her life experiences and lack of social support and stability, this was both surprising and necessary for her success. In court as she graduated, the judge stated, “We want the best for you. We are so happy to see you graduate!” The lead prosecutor echoed the same congratulations and added “I’m so proud of you!” The rituals and the social relationships that they represent made a profound difference in some clients’ lives, as illustrated by this client’s account.
Clients crave the emotional closure of graduation. A client found not competent to stand trial on misdemeanor charges wanted some of the ritual that is afforded to competent MHC clients upon the end of the court conditions and/or dismissal of charges. In this case, the client requested, “I am glad this is my last day in court. All of you are the best! Can I have an [sic] applause for my dismissal?” The judge abided with his request, and the court applauded. On his way out of court, he touched one of the court liaisons on the back and said “Thanks,” which also reflects the social relationships that were made. Although this was not intended to involve the group or have bodily co-presence, it does have a similar effect as the previous rituals.
A similar level of excitement and emotional energy was seen in other cases. After receiving congratulations from the team and the judge at graduation, a particular client stated: I am really grateful to the court and probation. I talked to a lot of people, they told me to do the time and not to spend two years on probation. But the time I spent in jail motivated me not to go back. [Treatment Provider] was a big help and support. And probation . . . they were great to work with. Thanks to the court and all the lawyers who contributed to this. I did not do this by myself.
As she exits the court, a probation officer said, “You are always welcome back but never come back!” In an interview a week after her graduation, this client clarified why the ritual was so powerful for her; she recalled that everyone was focused on her graduation—even those in the audience waiting for their case to be heard. There was no texting or milling around, which is often the case in MHC. These graduations are not isolated incidents or spontaneous ceremonies but rather planned rituals with specific social functions. In sum, graduation ceremonies are intentional rituals that showcase emotional energy and a collective experience. They also emphasize the social relationships that were created and in some cases will be missed.
Symbols of Social Relationships
Third, rituals can symbolize social relationships. Sacred objects are often a part of this type of ritual. Collins (2004:44) states that “Rituals generate symbols; experience in rituals inculcates those symbols in individual minds and memories.” The graduation certificate—as seen in the previous examples of graduation—given to an MHC client in successful completion of his or her probationary period symbolizes the connection to the MHC, team, and other clients. It also highlights the clients’ success, which can be powerful in repairing their often fractured sense of self and perception by others.
A symbolic example of the social relationships with a sacred object is a business card (with artwork), which is given for achievements in Regional MHC. For example, when a client is doing well, the team decides to give him or her a business card during a scheduled review hearing for an important achievement. The business cards are decorated with artwork from prior MHC clients with encouraging messages. The intent of the business card is to praise the client and encourage the client to keep on the same road and work hard. However, judging from the court observations of the ritual associated with the presentation of the business card, the cards are also about inspiring a sense of connection (with the MHC team and possibly other clients). The card further illustrates the social relationship between clients and court staff. When the MHC team—mostly driven by defense attorneys—recommends that a certain client receive a business card, they inform the judge prior to court. Then, during the session when the client’s case is reviewed, the judge comes down off the bench and hands the client the card, once again establishing that the bodily co-presence is important.
Consider the following exchange between a judge and a client who, despite his mental and social challenges associated with personal independence and chemical dependency issues, came to court on his own on the bus: Judge: I am very impressed that you came to court by yourself [by bus]. This is a big deal! When someone does something particularly well, the team asks me to give a card. This card is perfect: It says “on the express bus to recovery.”
Everyone claps, which amplifies the emotional energy of the ritual. The exchange highlights the importance of personal contact and physical proximity between the client and the MHC team, particularly the judge, in the ritual of the court. The importance of the physical movement of the judge from an elevated status position from the upper bench to the physical level of the client cannot be overstated. Moreover, it showcases the social relationship—both the expectations of that relationship and the praise for fulfillment of court expectations. But even in the case of negative sanctioning, if done appropriately, it can build or redirect social relationships and reintegrate the client into the court program and broader community.
Feelings of Morality
Fourth, rituals can produce feelings of morality. Durkheim ([1912] 1995:386) states that rituals “are as necessary to the good order of our moral life as food is to the nurture of our physical life.” Rituals can also be disciplinary and preparatory (Johnstone 2001). Most of the examples of disciplinary rituals are around issues of compliance and noncompliance.
Reviews are a large part of the rituals in MHC. The review process imposes self-discipline, highlighting constraints and boundaries, which is necessary for success within the structure of MHC. When a client is in compliance, it reinforces the positive side of social order for all in court. When clients are rewarded for being in compliance with the courts’ expectations, the rituals associated with that reward are clearly positive. For example, those clients who are in complete compliance are considered “express reviews,” though this distinction is more formalized in Regional MHC than in Municipal MHC. Ideally, clients in full compliance are heard first on the court calendar and are reviewed quickly. Violations and negative sanctions are heard last. The defense attorney, the prosecuting attorney, and the judge all give accolades to the client for fulfilling the expectations of the court and encourage the client to continue in the same direction. Thus, it is intended as a reward for being in full compliance and represents an opportunity to have the client hear positive affirmations of his or her behavior. In addition to recognizing clients in full compliance, it also serves to show those in the gallery awaiting their hearing what the moral expectations of the court are and that they can be satisfied. All parties offer praise in theses exchanges.
Reviews can be revitalizing if they provide positive reinforcements for clients and motivate and inspire them to continue on their path (managing their mental health and in many cases also chemical dependency issues). Even negative sanctions, when oriented toward working together, advancing positive change, and focusing on the aspects that the client is doing well on (not just focusing on the violation), can serve to refresh rather than discourage a client in his or her treatment plan and participation in the court. A probation officer provided an example of the importance of framing behavior in the review ritual: Say for example a client was supposed to be at 10 treatments or group meetings/therapy sessions in the past month (since his last review) and he missed 6 of them. I can come before the court and talk about the dates and times of the 6 violations and lay them out in order—one by one—or I could state that the client successfully went to 4 court required treatment sessions. While this is not ideal and he needs to be going to all of them, he is making progress. I think he is having trouble organizing all of them so we will work together to put them on his calendar so that he can make more meetings consistently by his next hearing.
When a client is out of compliance, there is a discussion among the team members about sanctions in an attempt to restore order. The goal is not so much to punish as it is to help clients get back on the right moral road. The MHC teams have creative responses to violations of court conditions and mostly follow “jail as a last resort” approach, as seen in the following account: Judge: I am not thinking of what happens today as punishment. I want to get you back on track. I am worried that we are losing your focus and motivation. If I wanted to punish you I would put you in jail and I am not going to do that.
In this case, the judge orders an alcohol monitoring bracelet and asks the client to write a two-page reflection paper about treatment and what the client needs for the court to be useful.
In a similar case, a probation officer asks the court to avoid jail as a sanction to a client’s relapse, “My initial inclination was to recommend jail which I am resisting at this point. What I am requesting is that she be found in violation of abstinence.” In this case, the probation officer spent a long time detailing the client’s previous success in complying with the court’s conditions and recommended increased day reporting, random drug tests, and work crew. This is an example of how treatment courts tend to be holistic and personal and take a non-punitive approach. The prosecutor did support probation’s proposed course of action but did note on the record that the probation officer was “being very generous in his recommendation.” The judge acknowledged that the client was in compliance for a long time and noted that the court appreciates that the client came forward and reported the incident. The judge largely followed the recommendation and did not impose any jail days. He comments that probation could easily “just say jail and not work with the situation.” The judge commented about how thoroughly probation is thinking about the client’s case and underscored that great care was being taken. The fact that this judge, who is not a sitting judge in MHC, took the time on the record to recognize this reinforces how much the therapeutic orientation of the court deviates from mainstream courts. In this case, members of the team were working hard to keep the client out of jail and in school; the team was focused on therapeutic ends, repairing tainted identities, and unburdening clients from some of their social stigma.
A probation officer argued for a clearly therapeutic approach (a non-punitive focus) of the court especially in the case of sanctions: “I’d be going for some kind of harm-reduction plan rather than saying revoke ’em and get ’em out of here, they’re not going to be successful.” The probation officer went on to say that there are different sanctions to try “to kind of lift up a client’s motivation, inasmuch as we could.” Thus, the level of stigma or shame in the response to being out of compliance is linked to the philosophy of therapeutic jurisprudence and its application through a harm reduction orientation. Of course, this philosophy also has to be expressed directly from the bench. The extent to which a judge acknowledges the challenges of managing mental illness and in many cases chemical dependency impacts the sanctioning process. In talking with a client about complying with court-mandated drug tests, the presiding judge offers this account: Better to give the UA [urinal analysis] and deal with the UA [results]. But if you refuse you might get kicked out [of court]. We are a treatment court. We don’t get shocked when someone has a dirty UA. We work to get people back on track.
Other judges have clearly stated that they expect clients to make some mistakes. On court watch, another client observed, “People can come to court as they are. . . . People are trying to live a normal life. People are getting a chance to improve their lives.” In one instance, when a client was revoked from MHC for failing to comply, a probation officer reminded the judge that the role of the court is “not to punish someone for trying and failing mental health court.” In another case, in encouraging a client to try again to achieve sobriety, a judge remarks, “Getting sober and staying sober is hard work.”
How the court actors respond to a violation of the court’s conditions is related to restoring social order and boundary maintenance of the norms and expectations of the court for the client and all clients (e.g., those in the audience). These rituals are also directed toward providing assistance to help clients be more successful in the future as opposed to punishing them for their past violations. Disciplinary rituals can restore the client and reintegrate him or her into the moral community of citizens with rights and responsibilities, particularly by establishing self-control and accountability as a part of a treatment process. At times when a response to a violation is punitive, in most cases it has both treatment/therapeutic and punitive elements. For example, when a client was on court watch, she reported to the judge, “This had me thinking. Especially when a guy was taken to jail. I don’t want that to be me!” Court observation can remind clients of the rewards and consequences for following the court conditions. Another client in an interview stated, “When someone messed up in court . . . I thought I do not want that to be me. I did pay attention to see what was going on [with other clients].” Court watch can serve to reinvigorate or refocus clients to stay on track or to get back on track.
Impediments to Successful Rituals
These data show that there are many cases of positive rituals in MHCs, but there are limits to the performance and benefits of these rituals. Collins (2004:51) looks at failed rituals and argues that they do not enhance group solidarity; in fact, poorly conducted rituals can backfire and not produce communal solidary but “strong ritual abhorrence.” Collins also warns that when lacking creativity or spontaneity, rituals can become stale and “empty formalities” (p. 50) and failed rituals are “energy draining” (p. 53) and bore and alienate participants; this can be especially true in the case of forced rituals. When the ingredients that Collins describes are not there, the positive ritual outcomes do not occur. First, too much focus on rituals can backfire within this population. Too much talking in court can be distracting, heighten stress, and reduce the positive effect of rituals. In qualitative interviews, some MHC team members revealed that they often try to warn judges to avoid lengthy discussion and limit extended therapy-like dialogue, but judges are not always amenable to these suggestions or aware of the impact of their extended exchanges on the clients or the audience.
In some cases, rituals did not work. Based on court observations, when there is a lack of focused attention on the situation, in particular on the key dialogue between the client and the legal parties (especially the judge), the effect of the ritual can be reduced for the intended clients and also for the court observers. This is often the result of too much milling around and side conversations among MHC professional staff, jail personnel, and visiting lawyers, which impedes a common focus of attention and shared experience. This can also occur when the MHC staff is sitting in the jury box or on the side pews in the gallery looking at their phones. These barriers preclude the general assembly. It can also come from clients or observers in the gallery who are conversing or getting up and down and exiting the courtroom. It can also occur, according to a probation officer, when the court is too loud or scary: “It’s noisy, and it’s scary, it’s scary for people to see other people go to jail.” In these cases, two of the ritual ingredients that Collins (2004) identifies—mutual focus of attention and shared mood—are compromised, which weakens the ritual experience. In other cases, there is a lack of group involvement in the ritual, thereby limiting the breadth of group assembly and bodily co-presence among court participants that Collins rightly characterizes as key to successful ritual interaction.
In some cases, the intended ritual was an abject failure. The use of inappropriate sanctions can have a negative and stigmatizing effect on a client. When talking about the challenges of sanctioning, one probation office talked about how important it was to give the appropriate sanction. The probation officer offered the following assessment of a judge who ordered a client to write an essay about his noncompliance: That [when judges do order an essay] undermines what we are doing here. The idea of it was good and I understand that you are trying to keep the guy out of jail . . . I do like it for certain clients because I think certain clients can really benefit from it. But they have to have a certain level of cognitive ability, they have to have a certain level of reflective ability, and they have to have a certain level of writing ability. Otherwise it is garbage. That is the other thing, they can reflect and be smart but if they can’t write very well, then you are almost creating this different thing, this different stress, this different dynamic . . . where now they’re feeling badly because now they are supposed to submit this writing thing to the guy with a JD [Juris Doctorate]. Then they feel badly about it and that is not at all what we want to be doing.
It is clear from this interview statement that the ritual was intended to have a positive impact on the client. However, if given to a client without the capabilities to succeed, the activity reinforces stigma and adds additional sources of shame for the client, in this case, not being able to write a coherent essay.
Indeed, based on court observations, the biggest impediment to ritual success arises from poor judicial leadership or judicial participation. Several MHC staff detailed the crucial role of the judge in the potential for ritual success both in terms of time management and management of stress. The lack of judicial control of the tempo of the court and the court calendar can also impede ritual success: “[The judge] doesn’t really control the calendar well in terms of keeping it moving.” Also the level of stress is key: “the original court, to have it be a non-stressful environment. It’s stressful for people to sit for four hours.”
Rituals are more successful when judges take the lead from the team. There is a widely varying degree of judicial “buy-in” to MHC. Without it, there is no ritual success—and less success for the court in general. For example, when a judge is not praiseworthy of client efforts or acknowledges achievements or milestones and does not exude some excitement, then the emotional energy of the rituals is never achieved. If the judge does not come off the bench—which is placed up high and set apart from the rest of the court—and shake hands with a client at graduation or if other MHC professionals are not physically present, then the ritual can fail. This sometimes happens when the court is presided over by a visiting MHC judge, but it also happens with seasoned judges who are assigned to MHC but do not treat presiding over MHC as a distinct and important job. However, according to MHC team members, judges can negatively impact the court process in general and more specifically the performance of rituals. In interviews, it was noted that if judges are ill prepared—but unaware of this shortfall—to handle the population, the court’s positive impact is diminished. One recounted that “judges, a lot of times, don’t really know how to handle mentally ill people—to not let them escalate and to keep everything really short.”
In a few cases, judges are overly critical and personally judgmental, which can prevent a positive ritual from happening. For instance, the following exchange was rare but highlights the damaging heavy-handed approach that judges can sometimes take. In this case, the judge uses a hostile and stigmatizing tone, and rather than focusing on the negative behavior—as in the case of a reintegrative emphasis—the judge chose to demonize the client personally: Why are you hanging around with him? I do not think he is good for you. I don’t think that my boyfriend choice is a legal issue. Well I am just suggesting that you be more careful about who you choose to spend time with for the sake of your recovery and stability.
After this exchange, the client was clearly offended by the line of questioning and hostile tone from the judge. This exchange highlights the crucial distinction that Braithwaite (1989) made between shame and stigma; in this case, the judge went from shaming to stigmatizing. It is often a fine line between providing supportive advice and paternalism. In this case, the judge crossed that line and hindered the chance for a positive exchange with the client that day. Although the judge tried to reframe the comment in terms of compliance issues and success in the court, it fell flat and seemed insincere. In this case, a paternalistic tone reinforces subordination through degradation and emphasis on asymmetrical relations. Participants in the court and team members were obviously uncomfortable by this exchange.
Interviews with MHC clients reveal another dimension of ritual failure. In addition to judicial buy-in, clients must also be invested in the court and their success. Fundamentally, if a client does not buy in to the ritual, they will not have as much impact as voluntary and spontaneous participation does. In some cases, a client’s oppositional orientation to the court itself impeded any potentially positive ritual effect. In an interview, one such client detailed how she did not need the court. Despite her success in the court and early graduation, she expressed verbally “that it [the MHC] gave me nothing.” In court—even at her graduation—she exhibited no emotional impact of the court’s ritual process. The effect of the court’s rituals fell flat with this client for several reasons. First, coming into the court was based on a contested charge by the client; she did not believe the case was legitimate, and thus her experience was tainted. Second, although suffering from a serious mental illness, she was otherwise well equipped to function in society independently; she had social support from family and friends, housing, an advanced education, and job prospects. For those few who do not need the emotional side of the court, it is foreseeable that the rituals—and perhaps the entire court process—will have a reduced impact. This client’s experience was not typical in MHC: Most clients did not dispute the charge and had no housing or unstable housing and limited or no social support. In general, clients in MHC benefit from and in some cases really desire the social support that the MHC team can offer. However, the ritual does not work if the client is mentally unstable and thus unable to focus on participating in the process.
Discussion
Qualitative data from two urban MHCs and interviews with MHC team members and clients reveal the powerful role of rituals in the workings of and experiences in MHC. Court observations of the ritual process are more in line with insights from reintegration ceremonies (Braithwaite 1989; Braithwaite and Mugford 1994; Dollar and Ray 2015; Ray et al. 2011) than degradation ceremonies (Erikson 1962; Garfinkel’s 1956). In line with Braithwaite’s reintegration ceremonies, a person is understood to have multiple identities, and the focus is on the event or behavior, and as such, the individual is not problematized or viewed under one negative master status. Unlike Garfinkel’s (1956) discussion of a reduction in status or emphasis on an already low status or Erikson’s (1962: 311) notion that criminal deviant status is “almost irreversible,” efforts are made in MHCs to restore some level of lost social status and move toward a prosocial status (Miller and Johnson 2009). This is partly what makes some MHCs distinct from both traditional courts and other problem-solving courts: There can be a transformation to elevated status because of the therapeutic orientation of MHCs and rituals that emphasize morality and social inclusion.
Rituals as Non-Stigmatizing
Several elements of Braithwaite’s (1989) reintegrative shaming are relevant in the case of MHCs. In particular, non-stigmatizing tactics are used to motivate and redirect clients toward success in the court and social integration. For Braithwaite, this means “social control that is warm and firm” (p. 152). The central role of praise, as well as respectful disapproval (see quote on page 14 for an exception), in the rituals of the court are also consistent with Braithwaite: “Key to the art of ensuring that shame is reintegrative rather than stigmatizing are therefore the preserve the continuum of love even in the face of conflict and to leaven shame with praise” (p. 167).
The observation data presented here are consistent with recent applications of reintegrative shaming in MHCs. Researchers argue that legal actors, most importantly the judge, emphasize respect during standard reviews, even in the case of displeasure (Dollar and Ray 2015). Moreover, researchers find that reintegrative shaming is used more in MHCs because of the organizational structure itself, especially judicial discretion and direct interactions, which provides more opportunities to have respectful dialogue in line with reintegrative shaming such as offering praise, forgiveness, and encouragement (Ray et al. 2011). In the sanctioning process of MHCs that follows a violation, the tone and language are attempting to reduce a deviant stigmatizing master status (Makkai and Braithwaite 1994). This is tied to a harm reduction approach from the bench to deal with noncompliance from a therapeutic standpoint (Trawver and Rhoades 2013).
A crucial part of reintegration is connecting a client to the larger community (Braithwaite 1989) and engagement in civil and social life (Fisler 2015). This is partly achieved through including family members, social workers, and case managers in the MHC process and hearings and the overarching teamwork model of MHCs. Ultimately, reintegration is about taking on a new or previously held positive social status. The focus on prosocial status (Miller and Johnson 2009)—law-abiding member of the community—is echoed in the observational court data and related to reintegration.
For reintegrative shaming to work, it might need to be linked to procedural justice as described in recent work (Canada and Watson 2013; Fisler 2015; Kopelovich et al. 2013; Munetz et al. 2014; Ray and Dollar 2014). Earlier research explicitly links procedural justice to a decrease in stigma. Poythress and colleagues (2002) suggest that reductions in stigma are associated with procedural adaptations that are beneficial to therapeutic outcomes. Current research highlights the importance of perceptions of procedural justice while participating in the court and post-exit and the role of the judge. Relatedly, Ray and Dollar (2014) report that recent MHC graduates’ sense of stigma after exiting the court was associated with perceptions of procedural justice while participating in MHC. Also, research finds that MHC clients’ lower levels of coercion are related to more perceived procedural justice from the judge (Munetz et al. 2014).
Court observations and client reflections in court and in interviews suggest that it is through the rituals that procedural justice takes shape. In the case of reviews, clients are given an opportunity to have a voice. Judges make great efforts—in line with procedural justice and reintegrative shaming research—to ask personal questions in a respectful and caring way, showing genuine concern for their well-being and progress. The quality of interactions between judges and clients, judicial tone, and overall engagement is cited as important to positive MHC outcomes (Fisler 2015; Wales, Hiday, and Ray 2010), and research also notes the variation on judge-defendant interaction is related to procedural justice (Kopelovich et al. 2013). The data presented here suggest that respectful and caring approaches from other MHC team members, especially probation given their frequent contact and role in how violations are reported, are also important to clients’ experiences with the court. This is consistent with Canada and Watson’s (2013) analysis identifying the role of other team members in a client’s perceptions of procedural justice. It could be that rituals in MHC, like those described here, are an important part of the process that leads to positive perceptions of fairness and subsequent reductions in stigma.
Stigma and Shame Revisited
Based on court observations, personnel within the MHC frame their exchanges with clients in full recognition of the low status and social stigma that they experience and the need to repair spoiled identities. Rituals work when the team, especially the judge, is focused on the exchange and recognize the complexities that MHC clients face as they participate in the court on the road to stability and in many cases sobriety. However, there is a certain amount of stigma inherent to the criminal justice system that MHCs cannot ameliorate. Clients are very aware that they are not free to do as they desire but are encumbered in the criminal justice system and are required to follow the courts’ orders. Some MHC personnel suggest that there will always be some stigma in MHCs. One probation officer commented that it “creeps back in” to the working of the court largely through the structure of the court itself. A MHC team member with a long tenure linked the stigma of the court to its name: “We had talked originally when the court started about not even calling it Mental Health Court, because we thought just by that name on the calendar, somebody would see that and know they were mentally ill.”
Interviews with members of the MHC team also provide insights into the role of stigma in the court process. In response to questions about stigma in the MHC process, a defense attorney reveals that the court has the potential to be de-stigmatizing but that was contingent upon a “client’s success in the court.” Court observational data suggest that the relationship might be more complex, with a possible non-recursive relationship. It could be that successful rituals—whether the client is in compliance or not—can reinforce or reorient the client toward success. There are also cases where too much focus on rituals or excessive ceremonialism can misfire with this client group and heighten stress, which reduces the potential positive effect of rituals.
Unlike Braithwaite’s (1989) account, it is often the case that shaming in general is avoided. However, to the extent that there is shame in the MHCs, it is of the nature and purpose described by Braithwaite. It might be that the distinction between shame and stigma does not seem to be as crucial in the orientation or practices of the two MHCs in this study. Braithwaite’s account was written prior to the emergence of any problem-solving courts. It might also be that the nature of MHCs themselves and their focus on mental health, given the societal stigma around mental health conditions as well as the challenges beyond issues of criminality, face difficulties in integrating people who are mentally ill in the community.
Given the lack of shaming in the rituals in MHC, they are not true reintegration ceremonies because they focus on reintegration and the repair of spoiled identities without stigmatization or shame. The rituals that surround noncompliance issues are not automatically punitive and are not driven to increase the stigma among the clients. Braithwaite and Mugford (1994:166) make a crucial clarification between types of ceremonies in terms of the ratio of stigmatizing versus reintegration meanings during the ceremony. They state, “When the ratio is high, we have a degradation ceremony; when the ratio is low, a reintegration ceremony.” In both MHCs, the majority of team members were resistant to the shaming side of this ratio, which is standard in both reintegration ceremonies and reintegrative shaming (Braithwaite 1989). Braithwaite (1989:81) declares that “a shaming ceremony followed later by a forgiveness and repentance ceremony” are more successful than a shaming ceremony alone. These rituals are not degradation rituals designed or practiced in such a way as to lower or reinforce the social standing (which is already low). Data from both MHCs show that although in most cases there is deference by MHC clients toward judges, the clients are not systematically or intentionally demeaned or degraded in the MHC interactions. Even the use of the referential category client illustrates the non-stigmatizing language that court personnel use in addressing individuals who enter into MHC.
Conclusion
This article reveals how the MHC process is shaped by rituals and adds to the growing research that finds a reduction in stigmatization in MHCs. The current analysis is consistent with recent analyses that posit specific mechanisms to explain MHC outcomes and experiences including reintegrative shaming (Dollar and Ray 2015; Ray et al. 2011) and procedural justice (Canada and Watson 2013; Kopelovich et al. 2013; Poythress et al. 2002; Ray and Dollar 2014; Wales et al. 2010). These findings coupled with recent work on MHCs highlight some of the benefits of the MHC structure and ceremonies in reducing stigma. Rituals can serve different ends or functions, many of which are beneficial to the client, the mission of the MHC, and possibly the broader community, if the clients are more successful because of the support, positive reinforcement, and an empowering, renewed sense of self. However, the consequences of these practices are not necessarily socially beneficial. Communal reintegration through rituals is a goal of MHC—but they may fail. If rituals fail, they can lead to shame and more stigma.
Rituals in MHC focus on positive emotional energy in line with the expectations of interaction ritual theory. One of the true potentials of the MHC process is how being in court and participating in interactional experiences has the capacity to resocialize individuals toward a collective morality: “It is intense interaction rituals that generate the most powerful emotional energy and the most vivid symbols, and it is these that are internalized” (Collins 2004:44). The power of these rituals to reduce stigma and repair spoiled identities lies not only in the success of the ritual performance but also in the acceptance and participation of an individual client. Collins (2004:43) declares that “Intense moments of interaction ritual are high points not only for groups but also for individual lives.” He further contends that individuals seek emotional energy and so “situations are attractive or unattractive to them to the extent that the interaction ritual is successful in providing emotional energy” (Collins 2004:44).
The observational data suggest that these rituals can have a profound effect on the lives of MHC clients consistent with prior research. Poythress and colleagues (2002) report that participants in a MHC compared with a comparison group from a traditional misdemeanor court rated their hearing as having a more positive emotional impact. This was especially the case in terms of graduation ceremonies that elicited emotionality among clients and audience members. Some argue that heightened positive emotional reactions to court hearings are related to perceptions of coercion and procedural justice (Poythress et al. 2002) specifically from judicial interactions (Munetz et al. 2014), which others also link to recidivism (Ray et al. 2010) and attitudes toward recovery (Kopelovich et al. 2013). Future research needs to further examine how MHC clients themselves view the process and its emotional content—and their perceptions of fairness—and if in fact it has led to the experience of reduced stigma and reintegration. It could be that these rituals—if positive—may be associated with a sense of procedural justice, which has been linked to less stigma after graduating from the court (Ray and Dollar 2014).
While the emphasis on a non-stigmatizing approach is seen in these two MHCs, not all MHCs may operate in this way. However, recent work comparing MHCs to traditional courts suggests that MHCs are more likely to use reintegrative shaming and show respect and forgiveness toward clients (Ray et al. 2011). Future works needs to better compare and assess different settings with MHCs and identify what aspects of the setting make MHCs more or less conducive to non- stigmatizing practices. Observational data from these two MHCs indicate that judicial leadership and buy-in are important as well as stable MHC teams. Other factors such as educational training, judicial consistency, and tenure of MHC might also be important factors to consider in future research.
Most of the ritual processes in the MHCs described in this article were intended. However, there were clearly unintended outcomes from the actions of legal actors. This illustrates Merton’s (1957) seminal distinction between manifest and latent functions. Judges and attorneys are intending to positively impact the client by performing rituals within the MHC, but there were additional benefits to their actions that added to the impact of the rituals. Clients have a significant social burden to overcome, and while MHCs cannot undo or overpower all of these stigmas they endure, most of the court actors try to reduce them, and in some cases, they succeed. While the manifest purpose of the courts is to provide treatment for clients, enhance public safety and reduce criminal recidivism, the powerful but less obvious purpose is to rebuild clients into functioning citizens with rights and responsibilities as opposed to criminals with mental illness. Although MHCs are not always successful in this endeavor, the power of rituals shows potential to influence clients’ treatment and societal reintegration.
Studying MHCs contributes to our general understanding of the intersection of criminal justice and mental health and assists in evaluating community-based mental health practices. The data from two MHCs highlight the positive role that rituals can play in reducing social stigma and repairing the spoiled identities of MHC clients. These results are promising in that MHCs may be able to help repair clients’ spoiled identities through positive ritual performances.
Footnotes
Acknowledgements
I am grateful for the comments provided by the participants at the conference. The author would like to thank Steve Pfaff, Jennifer McKinney, Sara Koenig, David Diekema, four anonymous reviewers, and the editor for helpful comments on earlier drafts of this article.
Author’s Note
Karen Snedker is also a Clinical Assistant Professor at the University of Washington, School of Nursing, Department of Psychosocial and Community Health. An earlier version of this article was presented at the American Sociological Association Annual Conference in San Francisco.
Funding
The author(s) disclosed receipt of the following financial support for the research, authorship, and/or publication of this article: Seattle Pacific University Faculty Research Grant.