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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.

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.

Traditionally evaluators of offending behaviour programmes have examined group-level mean change in treatment targets without acknowledging the potential variability of change at an individual level. Clinically significant change, although used widely in the therapy literature generally, has only recently been examined within forensic therapeutic contexts. This chapter provides an overview of key concepts, and the published literature in which clinically significant change has been examined within forensic samples is reviewed. It is concluded that although this technique has the potential to validate programme theory, it is yet to be used to its full potential within a forensic context.

With the objective of encouraging the use of standard processes for exploring offenders' narratives two complementary procedures are discussed. One is a development of McAdams explorations with highly effective individuals, describing their life as if it were a book. This is a structured interview protocol that has been specifically produced for use with offenders, in which they describe their life as a film (LAAF). A number of studies with male and female incarcerated individuals as well as those without convictions have revealed important differences between people in how they give a free account of their past and future lives. This allows the differentiation of LAAF narratives and reveals the existence of dominant narrative forms in offenders' responses. These relate to those initially elaborated by Frye (1957) for fiction, namely tragedy, comedy, adventure and romance. The second method is the Narrative Role Questionnaire (NRQ) which elicits the inherent role that offenders saw themselves as playing during specific crimes. Completion of the NRQ by various samples reveals important differences between offences in the narratives that provide the agency for their criminal actions. The roles central to these narratives have also been found to embody distinct emotional components that maintain offending. Taken together the NRQ and the LAAF provide a framework for examining offence narratives which enables the main narratives of relevance to criminality to be identified and their implications for theory and practice to be elaborated.

We compare the deinstitutionalization of psychiatric patients and the developmentally disabled in the United States and demonstrate that there were two path-dependent processes with significant qualitative and quantitative differences, ultimately leading to better outcomes for developmentally disabled individuals.

Using secondary literature, we construct a sustained comparison of the two processes in terms of outcomes, timing, tempo, extent, funding, demographic composition, and investment in community services. We then reconstruct the strategies of de-stigmatization and framings of moral worth deployed in the two cases, analyzing their effects on deinstitutionalization in terms of conceptions of risk, rights, and care.

Deinstitutionalization began later for developmentally disabled individuals than for psychiatric patients, and was a more gradual, protracted process. It was not driven by fiscal conservatism, discharges, and the trans-institutionalization of the senile aged, as was deinstitutionalization for psychiatric patients, but primarily by the prevention of institutionalization of young children, and increased investment in infrastructure. Consequently, the deinstitutionalization of the developmentally disabled was far more thorough and successful. The process was shaped by the framing of the developmentally disabled as “forever children” by parents’ organizations that demanded a balance between autonomy, protection, and the provision of care. In contrast, the deinstitutionalization of psychiatric patients was shaped by their framing as autonomous citizens temporarily suffering from “mental health problems” that could be prevented, treated, and cured. This frame foregrounded the right to choose (and also refuse) treatment, while undervaluing the provision of care.

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.

Purpose – This chapter explores claims of social problem workers in criminal justice and mental health with regard to how to manage males who are identified as or self-identify as both victims and perpetrators (V/Ps) of sexual abuse. We also examine the claims of V/Ps with regard to how they manage their dual status.

Methodology – This chapter is based on an action research project on intervention services for V/Ps in Ontario, Canada. Our data include literature reviews, interviews with intervention professionals, V/P narratives, and a transcription of a stake-holder's workshop.

Findings – Intervention workers whose mandate is offender risk management state they give little attention to victimization-related issues of V/Ps, whereas workers in victims’ services often state that adult V/Ps are not covered under their mandate. This suggests that the status of offender is the master status for adult V/Ps. Our V/P narratives recount efforts at self-management and some V/Ps and intervention professionals have expressed interest in the possibility of developing programs specially designed for V/Ps.

Practical Implications – An examination of issues related to the dual status of sexual abuse V/Ps suggests that V/Ps may require special services that cannot be provided by existing programs for perpetrators and victims.

Originality/Value of Paper – Studies of social problem work might benefit from considering not only professionals’ viewpoints but also those of their clients. This chapter explores new intervention models (GLM and RJ) that incorporate ethical concerns based on a rights perspective (“moral repair”) and the experiential concerns of V/Ps.

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.

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.

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.