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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 issue we confront today is not primarily one concerning a special day for an individual. The issue is in reality whether our nation can summon the will and vision to recognize a great and historic period in its history by designating the birthdate of one who made major contributions to the period a national public holiday.”

Two major reform movements have shaped child and adolescent mental health services over the past quarter-century: the Systems of Care movement, and more recently, the movement toward evidence-based practice. Results from several studies indicate that youth served in traditional residential or inpatient care may experience difficulty re-entering their natural environments, or were released into physically and emotionally unsafe homes (Bruns & Burchard, 2000; President's Commission on Mental Health, 1978; Stortz, 2000; Stroul & Friedman, 1986; U.S. Department of Health and Human Services, 1999). The cost of hospitalizing youth also became a policy concern (Henggeler et al., 1999b; Kielser, 1993; U.S. Department of Health and Human Services, 1999). For example, it is estimated that from the late 1980s through 1990 inpatient treatment consumed nearly half of all expenditures for child and adolescent mental health care although the services were found not to be very effective (Burns, 1991; Burns & Friedman, 1990). More recent analyses indicate that at least 1/3 of all mental health expenditures for youth are associated with inpatient hospitalization (Ringel & Sturm, 2001).

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.

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 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.

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.

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.

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.

The participants in this forum were asked to respond in 500 words or less to a hypothetical question: why have a bibliographic or library instruction program? posed by an equally hypothetical administrative superior. An editorial assistant, upon receipt of all responses, sent copies of each to all participants so that they might comment further in 500 words or less. The copies that were sent for comment were made totally anonymous, in order to assure that comments would not be ad hominem, but rather based on substance. (Names have been inserted in the printed comments by the editor.) Another consideration in preserving initial anonymity was the editor's desire to not know which response had been authored by which of the participants until after his own comment was written and submitted.