Community-Based Interventions for Criminal Offenders with Severe Mental Illness: Volume 12

Conceptualizing mental illness too generally as a cause of criminal involvement is not useful for policy or service implications. Such a strategy decontextualizes the experience of people with mental illness from broader incarceration patterns in the U.S. When the reasons people go to jail or return to jail are examined, it becomes clear that the key issues are social difficulties complicated by mental illness — but not caused by mental illness. To inform community mental health practice, future research should account for the broader social context of criminal behavior and interventions should be more carefully integrated into the broader policy context of criminal justice systems.

The original ‘plan’ for deinstitutionalization of America's population of persons with severe and persistent mental illness saw community mental health services as providing many of the functions of large mental hospitals in community settings. While substantial effort and resources have been committed to this enterprise, many persons with mental illness encounter significant problems in adjusting to life in the community. Prominent among these problems is the disproportionate involvement in the criminal justice system of persons with psychiatric disorders. This problem, popularly described as the ‘criminalization’ of mental illness, often threatens the clinical stability and safety of persons with mental disorders, and at the same taxes heavily the resources of the criminal justice system. This paper reviews data exploring the relationship between levels and availability of community-based services and the likelihood that persons with mental illness will become involved with the criminal justice system. Finding no relationship, we conjecture that community mental health services are effective with only certain individuals, and move toward a taxonomy of offenders with mental illness. This classification scheme takes into account the relationship between psychiatric disorder, lifestyle and pre-morbid criminal involvement, and is designed to inform system actors with regard to the targeting of these resources.

This chapter reviews the literature on case management for those with severe mental illness and then reviews the specific research on case management for forensic clients. It concludes with implications for case management programs for forensic clients and directions for future research in this area.

This chapter reports the results of a study that used anonymous administrative databases and statistical techniques to determine the number of people in two databases. Results indicate that fewer adults with severe and persistent mental illness got into trouble with the law after beginning new-generation anti-psychotic medication than before. This impact was not uniformly felt, however. Men experienced decreased criminal justice involvement, while criminal justice involvement for women increased. Access to new-generation anti-psychotic medication was substantially greater for people who had previously been in trouble with the law and this difference was greater among younger clients.

An accumulating body of research data points to the disproportionate presence of persons with mental illness in America's jails. Preventing the jail detention of people with mental illness has become an agreed-upon goal for actors in both the mental health and criminal justice systems. Toward that end, a variety of ‘jail diversion’ mechanisms have been developed to move people with mental illness who commit low-level misdemeanors away from the criminal justice system and into the mental health treatment system. Despite the increasingly widespread adoption of these programs, there is a lack of empirical data on their effectiveness, although ‘myths’ regarding these programs abound. This paper describes these programs, offers empirical data on their effectiveness, provides an overview of the challenges they face, and suggests future directions for research.

This anthropological research concerns the relationships between and among mental illness, criminality, medicine and the law, when each become, both separately and as one manifestation in the practice of forensic psychiatry, radically transformed by differing needs to assess responsibility and construct comprehensibility. The work of forensic psychiatry deals with these needs, and encompasses the professional, moral, and social concerns that inform these needs. This is an ethnographic look at the practice of criminal responsibility assessment.

The mental health court is the newest venue for rerouting persons with mental illness from the criminal justice system to the treatment system. Mental health courts share with drug courts the mission of offering therapeutic alternatives to jail. But their success, however, depends on the nature of the illnesses to which they attempt to treat, the strength of the connection between those illnesses and criminal behavior, and the effectiveness of treatment as a deterrent. To explore these connections, mental health courts are assessed through the lens of therapeutic jurisprudence. From theoretical and practical perspectives, mental health courts are found to have substantial limitations in terms of their potential impact on criminal behavior and incarceration of people with mental illness. Serious concerns about fairness are also raised. An alternative strategy for judicial intervention on behalf of offenders with mental illness is suggested.

There remains a gap in the research on the characteristics, service needs, and experiences of persons with mental illness post incarceration. This analysis uses data collected by the Massachusetts Forensic Transition Team program to describe the characteristics of the offenders with mental illness and to examine the relationship of particular characteristics towards community reintegration and adaptation post release from correctional custody. Length of incarceration (misdemeanor or felony sentence structure) and service needs at release are expected to be associated with the ability to adapt, stigma, and, in turn, short-term dispositions in the community or more structured settings.I first met Andrew in a medium security prison in the fall of 2001. He had spent the majority of his adult life in prison. During the first of three incarcerations, he served five years and was released to live in the community, which he did for almost a year, until he was re-arrested and sentenced for 2 more years. This time, when he was released, he was in the community for only 2 weeks before being arrested and re-incarcerated. Andrew grew up in South Boston. His family has a history of mental illness and alcoholism. Andrew is bipolar, suffering bouts of manic depression, and has a substance abuse problem. His drug of choice is cocaine, which he uses intravenously. He is HIV positive. He is in his early 30s. Andrew's current sentence is 5 years for 26 counts of malicious destruction of property and motor vehicle theft. While he is attempting to get his sentence revised based on his health status, he acknowledges he has difficulty living in the community. Of prison life he says, “I excel in here!” He works a half an hour a day sweeping his unit, “and then I have the rest of the day to myself”. Andrew is presentable and articulate. He participates in release planning. When he is in the community he seeks out appropriate services. Nonetheless, he has difficulty staying out of prison.