The study found that the extra efforts, procedures, coordination, and costs involved in implementing the mandatory referral to mental health services did not improve batterer program outcomes overall. Only a small proportion of men received treatment, and there was a lack of significant statistical improvement for the referred men as a whole. Therefore, it is difficult to justify the costs of the mandatory referral system of the relatively small portion of men involved and the small net improvement in outcomes, at least under the conditions of the study. One question left unanswered by this study was whether stricter court oversight and sanctions for noncompliance would significantly increase the portion of men in mental health treatment and improve outcomes. More research is needed on how to improve the implementation of coordinated or more comprehensive intervention, as well as on the link between mental health problems and domestic violence. A sample of 479 batterer program participants was used to test the effect of referral to mental health treatment. This sample was the total number of men who screened positive on the Brief symptom Inventory at batterer program intake. This represented 46 percent of the male batterers court-ordered to 16 weeks of counseling in Pittsburgh during the period 2004 to 2006 (1,043). A subsample of the men mandated by the court to seek mental health treatment (148) was compared to a subsample under a partially implemented mandate (149) and a voluntary referred subsample (182) who represented a quasi-control group. 6 tables and 44 references