Expanding contexts of medicalization: The role of policy legacies, race, and class in the prevalence of treatment courts

The current study seeks to examine the association between political and sociodemographic contexts and medicalization by analyzing the prevalence of treatment courts. Using a compiled dataset of 3,132 U.S. counties across all 50 states in 2020, I examine the effect of policy legacies and racial and socioeconomic makeup on the prevalence of treatment courts, which are medicalized alternatives to traditional criminal justice involvement (e.g., incarceration). Regardless of rates of mental distress, substance use, crime rates, population size, and other relevant measures, I find that counties with higher proportions of Black and college educated residents are more likely to have mental health treatment courts. I also find that counties in conservative states and in the South have fewer treatment courts, and that counties with punitive state criminal justice policies (e.g., the death penalty) report fewer treatment courts. I discuss the implications of these findings for our understanding of the social and political contexts that facilitate medicalization, as well as for the spread of treatment courts.