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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.

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.

A system of care is a function-specific, rather than agency-specific approach defined as a “comprehensive spectrum of mental health and other necessary services which are organized into a coordinated network to meet the multiple and changing needs of children and adolescents with severe emotional disturbances and their families” (Stroul & Friedman, 1986). A system of care provides a mental health delivery system for children with SED with a wide array of accessible, community-based services that focus on children's individual needs, include the family in treatment planning, and provide culturally competent services. System of care services are provided by multiple child serving agencies and are collaborative and coordinated (Stroul & Friedman, 1986).

Purpose – This chapter describes the problem of and approaches to ex-inmates with psychiatric disabilities exiting correctional custody. Although all ex-inmates must find housing and employment, persons with psychiatric disabilities require linkages to various health-related services and supports. These linkages are necessary, but it is unknown whether they are sufficient because discharge planning services and transition programs for ex-inmates with psychiatric disabilities historically lack an evidence base.

Approach – After a decade, the first-generation re-entry programs for ex-inmates with psychiatric disabilities have yielded little in the way of empirical data, but they have provided models for program expansion and imperatives for second-generation program assessment. Related research findings for first- and second-generation programs are highlighted with an emphasis on a unique statewide program in Massachusetts.

Findings – A review of the first- and second-generation programs suggests that progress has been slow in identifying empirically supported best practices for this population. There is a growing evidence base that community reintegration outcomes for ex-inmates with psychiatric disabilities are the result of demographic and criminal history variations, yet implications of these variations needs further exploration in the realms of service access and receptivity as well as variations in postrelease adaptation.

Implications – More knowledge and innovative research is needed on the experience of ex-inmates with psychiatric disabilities and social integration. Resources for cost effectiveness studies as well as long-term follow-up qualitative studies are necessary.

Since the demise of Delivering Race Equality strategy in 2010 under the last Labour government and with the Coalition (2010–2015), and now the Conservative government at times have adopted a “color blind” approach to race and health. This raises the fundamental question why is race equality off the political agenda and how black mental health issues can be part of a future strategy. The 2015 Care Quality Commission (CQC) annual monitoring report of the Mental Health Act (MHA; which has also incorporated the learning since the inception of the Act in 1985) further highlighted the overrepresentation of African and Caribbean men and women who are sectioned in secure wards or on Community Treatment Order (CTO) in the psychiatric system over the last 30 years. The CQC have revised the code of practice which recognizes issues around race equality as part of wider perspectives and principles of human rights.

In October 2017, the government established an independent review of the 2007 MHA as a way of providing more safeguards for patients and service users. The review, under the leadership of Sir Simon Wessely which is reported in 2018, provided an opportunity for an informed public debate on the historical and contemporary roles of psychiatry and the experiences of mental health in Britain’s African and Caribbean communities. The review did examine community anxieties about the proportionally larger numbers of black ethnic minorities receiving inpatient care and CTOs, or in the criminal justice system. However, after 30 years of Black History Month in the UK, we still need to ask the question: Are those of African descent overrepresented in these systems? If so, is serious mental illness over diagnosed among these groups due to the persistence of stereotypes rooted in the experiences of slavery, or do they in fact experience distinctive patterns of mental health and illness, perhaps due to the wider fallout of historical enslavem

Employment has been identified as a significant goal for many homeless persons with mental illness. However, treatment plans for this population typically focus on housing and mental health needs, and neglect to assess individuals’ desires and abilities to achieve and maintain paid employment. This chapter describes the work experiences of the Chicago cohort of the Access to Community Care and Effective Services and Supports (ACCESS) project.

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.

This chapter briefly summaries research over the past four decades (and prior) associated with black men and mental health in the UK. The chapter also examines some responses to the research. This is because we unfortunately remain in a situation where black men in Britain are 17 times more likely than white counterparts to be diagnosed with a psychotic illness. Research into the mental health needs of black men has been conducted repeatedly in the UK, with each new generation hopeful for change. By briefly exploring some policies that have emerged to address this inequality, this chapter highlights the barriers to change.