The Organizational Response to Persons with Mental Illness Involved with the Criminal Justice System: Volume 12

Subject:

Table of contents

(13 chapters)

Since 1963, the promise of the Community Mental Health Centers Construction Act (1963), the planned provision of community-based mental health services, and advances in psychotropic medication and treatment suggested that the mentally ill might be better managed and served in the community than in hospital (Bachrach & Lamb, 1989; Grob, 1991). While “dehospitalization” proceeds today (Geller, 2000), large numbers of individuals with mental illness also return to the community from correctional custody and bring with them complicated clinical profiles and service needs (Laberge & Morin, 1995; Rice & Harris, 1997; Lamb & Weinberger, 1998; Lamb et al., 1999). An increasing awareness of this phenomenon has resulted in estimates that prisons contain four to five times the rate of persons with mental illness found in the community (Morris & Tonry, 1990; Regier et al., 1990; Morris et al., 1997; Rice & Harris, 1997; Wolff et al., 1997). According to the 2000 Prison Census, about 150,900 or 1 in 10 state inmates were in mental health programs; 114,400 or 1 in 13 were receiving psychotropic medication; and 18,900 or 1 in 80 were in 24-hour psychiatric care (Bureau of Justice Statistics, 2000). While the recent estimates suggest that approximately 16% of all those incarcerated in state prisons (16% of all males and 24%of all females) have some sort of mental illness (Ditton, 1999), a meta-analysis examining the prevalence of mental disorder with a narrow criterion found that 10% of male and 18% of female inmates had an Axis I major mental disorder of thought or mood (Pinta, 2001).

The Lemuel Shattuck Hospital Youth Service Program adopted a public health approach to address the mental health needs of incarcerated juvenile offenders in Massachusetts. The program, which operated for 6 years, provided psychiatric care and neuropsychological assessment to delinquent youth as well as training for psychiatry residents, neuropsychology fellows and Massachusetts Department of Youth Services’ staff. The program recognized and attempted to address the health care disparity of limited access to quality mental health services for incarcerated youth, particularly those from disadvantaged and minority backgrounds. The program was a collaborative venture among the Massachusetts Departments of Public Health and Youth Services, and Tufts-New England Medical Center. The scope of the problem of mental health care for incarcerated youth will be first outlined, followed by a history and evaluation of the program from a public health and system integration perspective.

Large numbers of adults with mental illness detained by police, seen in the courts, and confined in prisons and jails has been a longstanding concern of officials in the mental health and criminal justice systems. Diversion programs represent an important strategy to counteract the criminalization of persons with mental illness. The challenge is to identify and integrate resources in such a way that an organization bridging the police, courts, mental health, substance abuse, homelessness, welfare and entitlements agencies would evolve that would effectively and appropriately serve offenders with mental health issues, keeping them stable in the community and reducing recidivism.

This chapter offers a prospective and naturalistic study of the impact of a risk-assessment and risk-management program on mentally abnormal young offenders admitted to a medium secure adolescent psychiatric inpatient unit in the United Kingdom (U.K.) because of violent, dangerous or self-harming behaviour. As a result of the risk assessment, there was a reduction in their violent, dangerous or self-harming behaviour that was significantly associated with a reduction in the number of risk factors. About 80% were discharged directly back into the community.

In the year 2001, the Risk Assessment Pilot Program was implemented in Argentina with the aims of establishing a systematic manner of assessing risk for violent recidivism in conditional release candidates and contributing to the design of intervention programs that help to reduce the criminal recidivism rate. The baseline assessment showed that conditional release candidates had a high-risk profile: 72.5% had severe or moderate substance abuse problems; 62% had failed in previous probation, conditional release or discharge from a mental institution; 85% had serious or moderate employment problems before incarceration. Individuals who were substance abusers were incorporated to the Drug Abuse Biochemical Control Program. Variations in dynamic factors were assessed with conditionally released subjects. Some encouraging results were obtained through December 2003 and their initial impact on judicial and penitentiary institutions is already seen.

Courts play a critical role in facilitating access to alcohol, drug, and mental health services for juvenile offenders. This research examines the court's decision to refer offenders to A&D services and whether offender ethnicity affects this rehabilitative response. Results suggest ethnicity has no effect on treatment recommendations independent of its relationship to other variables. Rather, ethnicity modifies the effect offense type has on the treatment referral decision. Specifically, Blacks arrested for A&D offenses are significantly less likely than their White counterparts to be referred to care. Distinctions in drug laws seem to limit access to A&D services for Blacks.

A sample of capital trials in North Carolina was analyzed to determine the impact on death sentencing of introducing mitigators related to diminished capacity on behalf of defendants. The results show that mitigators of this type were frequently submitted to the jury for consideration, and if accepted, the chances of a defendant being sentenced to death were diminished. However, when these mitigators were submitted but not accepted, the defendant's likelihood of receiving a death sentence was substantially escalated. These findings suggest a need for attorneys to carefully weigh the advantages and disadvantages of presenting diminished capacity mitigators in capital trials, and if choosing to do so, the absolute necessity of convincing the jury of their validity.

Resource constraints at all levels of the criminal justice system as well as the lack of a widely accepted, validated screening scale have made it difficult to screen adequately for serious mental illnesses (SMI) in offender populations. This study examined the use of the K6 scale, a recently developed and validated screening tool for SMI, using a sample of past-year arrestees. Among the main findings were that 18% of the sample screened positive for SMI. In contrast, commonly used screening questions misidentified a large proportion of arrestees with SMI. Based on these findings, we recommend the use of K6 scale to more accurately identify offenders with SMI.

Medical and legal records of 64 inmates receiving mental health services at a maximum-security prison located in the Northeast United States were examined to look at whether prison adjustment is impacted by housing in a mental health residential treatment unit. Inmates in the residential treatment unit, the “treatment group” had a significant decrease in hospitalizations and disciplinary reports while housed in the residential treatment unit. Inmates with a mental health history housed in the general population, the “control group,” did not show a decrease in these behaviors during a similar time period. Results find that inmates referred to the residential treatment unit seem to have high numbers of hospitalizations and segregations while housed in the general population, which level off and become similar to the control group upon entry to the residential treatment unit. Implications for future research evaluating the impact of the residential treatment unit on the behavior of the inmate after he has left the unit are discussed.

Recidivism is often used to measure the success of the criminal justice initiatives. We explore alternate measures of success that were identified for special offenders through the development of program theory. Using content analysis of 50 closed files from the Special Offenders Services program in Lancaster County, PA, we found that most offenders completed the program without re-offending, maintained their medication, participated in counseling, fulfilled their court cost obligations, and had few housing transitions. However, there were differences between parolees and probationers in terms of their outcomes. We recommend that special offender programs use uniform data-recording procedures.

Current thinking suggests that specialized services are needed for the successful community reintegration of ex-inmates with psychiatric disabilities (Hartwell & Orr (1999). Psychiatric Services, 50, 1220–1222; Healey (1999). National Institute of Justice, February; Hartwell, Friedman, & Orr (2001). New England Journal of Public Policy, 19, 73–82). Nevertheless, stable community re-entry after criminal incarceration involves the response of multiple organizations due to the complexity of community re-entry factors. This chapter presents findings from the analysis of secondary data collected since 1998 and a qualitative interview study with ex-inmates with psychiatric disabilities that identified pathways and turning points influencing community re-entry. Using Sampson and Laub's life course theory as a framework (Sampson & Laub (1993). Crime in the making: Pathways and turning points through life. Cambridge, MA: Harward University Press.), the pathways and turning points offer a point of departure for agencies and organizations in responding to ex-inmates with psychiatric disabilities in the community. Pathways related to service needs at release include race, age, education, diagnosis, and criminal history; whether an individual is on probation or parole; and whether an individual has a history of homelessness, mental health services, and/or substance abuse. Turning points post release include institutional resource availability, living arrangements, psychotropic medication compliance, outpatient therapy and substance abuse treatment, and having entitlements and benefits in place at release.

DOI
10.1016/S0196-1152(2005)12
Publication date
2005-08-08
Book series
Research in Social Problems and Public Policy
Editor
Series copyright holder
Emerald Publishing Limited
ISBN
978-0-76231-231-3
eISBN
978-1-84950-360-0
Book series ISSN
0196-1152