Deinstitutionalization and other factors in the criminalization of persons with serious mental illness and how it is being addressed

One of the major concerns in present-day psychiatry is the criminalization of persons with serious mental illness (SMI). This trend began in the late 1960s when deinstitutionalization was implemented throughout the United States. The intent was to release patients in state hospitals and place them into the community where they and other persons with SMI would be treated. Although community treatment was effective for many, there was a large minority who did not adapt successfully and who presented challenges in treatment. Consequently, some of these individuals’ mental condition and behavior brought them to the attention of law enforcement personnel, whereupon they would be subsequently arrested and incarcerated. The failure of the mental health system to provide a sufficient range of treatment interventions, including an adequate number of psychiatric inpatient beds, has contributed greatly to persons with SMI entering the criminal justice system. A discussion of the many issues and factors related to the criminalization of persons with SMI as well as how the mental health and criminal justice systems are developing strategies and programs to address them is presented.

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Economics of decriminalizing mental illness: when doing the right thing costs less

CNS Spectrums ◽

10.1017/s1092852919001792 ◽

2020 ◽

Vol 25 (5) ◽

pp. 566-570

Author(s):

Darci Delgado ◽

Ashley Breth ◽

Shelley Hill ◽

Katherine Warburton ◽

Stephen M. Stahl

Keyword(s):

Mental Health ◽

Mental Illness ◽

Justice System ◽

The United States ◽

Diversion Programs ◽

State Hospitals ◽

Complicated Process ◽

The Right ◽

Number Of Individuals ◽

Sheer Number

The United States’ criminal justice system has seen exponential growth in costs related to the incarceration of persons with mental illness. Jails, prisons, and state hospitals’ resources are insufficient to adequately treat the sheer number of individuals cycling through their system. Reversing the cycle of criminalization of mental illness is a complicated process, but mental health diversion programs across the nation are uniquely positioned to do just that. Not only are these programs providing humane treatment to individuals within the community and breaking the cycle of recidivism, the potential fiscal savings are over 1 billion dollars.

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Community treatment orders and the experiences of ethnic minority individuals diagnosed with serious mental illness in the Canadian mental health system

International Journal for Equity in Health ◽

10.1186/s12939-014-0069-3 ◽

2014 ◽

Vol 13 (1) ◽

Cited By ~ 8

Author(s):

Magnus Mfoafo-M’Carthy

Keyword(s):

Mental Health ◽

Mental Illness ◽

Health System ◽

Ethnic Minority ◽

Serious Mental Illness ◽

Mental Health System ◽

Community Treatment ◽

Community Treatment Orders

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Parity and Difference: The Value of Parity Legislation for the Seriously Mentally Ill

American Journal of Law & Medicine ◽

10.1017/s009885880000280x ◽

2003 ◽

Vol 29 (2-3) ◽

pp. 185-201

Author(s):

John V. Jacobi

Keyword(s):

Mental Health ◽

United States ◽

Mental Illness ◽

Mental Health Services ◽

Health Services ◽

Serious Mental Illness ◽

The United States ◽

Persistent Mental Illness ◽

Seriously Mentally Ill ◽

People With Mental Illness

Mental illness affects the health status of about one in five Americans each year. More than five percent of adult Americans have a “serious” mental illness—an illness that interferes with social functioning. About two and one-half percent have “severe and persistent” mental illness, a categorization for the most disabling forms of mental illness, such as schizophrenia and bipolar disorder. All mental illness interferes to some degree with social activities. Left untreated, serious mental illness can be disabling—disrupting family life, employment status and the ability to maintain housing. Nevertheless, privately insured people in the United States (that is, the majority of insured people in the United States) are not covered for mental health services to the same extent that they are covered for physical health services. Second-class coverage of mental health services reduces access to care for people with mental illness because cost becomes a significant barrier to service. The resulting lack of treatment fuels the disabling potential of mental illness.

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Mental illness management in corrections

10.1093/med/9780199360574.003.0002 ◽

2015 ◽

Cited By ~ 1

Author(s):

Charles L. Scott ◽

Brian Falls

Keyword(s):

Mental Health ◽

Health Care ◽

Mental Illness ◽

Community Mental Health ◽

Mental Health Care ◽

Serious Mental Illness ◽

The United States ◽

Revolving Door ◽

Community Settings ◽

Correctional Systems

An increasing number of individuals with mental illness are now treated in correctional environments instead of community settings. In the incarcerated population, prevalence estimates of serious mental illness (SMI) range from 9 to 20% compared to 6% in the community. More astonishingly, over three times more persons with serious mental illness in the United States are located in jails and prisons than in hospitals. It was not always like this. How did U.S. correctional systems become de facto mental health institutions for so many? Scholars point to a number of reasons for the increasing prevalence of mental illness among incarcerated individuals, including deinstitutionalization and limited community resources, prominent court decisions and legislative rulings, and the ‘revolving door’ phenomenon. There are many similarities between correctional and community mental health care services. Both systems typically provide appropriate medications, emergency care, hospitalization, medication management, and follow-up care. However, key differences often exist in correctional systems, including restricted formularies due to concerns of medication abuse or cost, alternative involuntary medication procedures, restricted access by visitors, and the inability of mental health providers to control the treatment environment. This chapter summarizes the historical context of correctional versus community mental health; factors resulting in the increasing management of people with mental illness in correctional settings; and similarities and differences between the provision of mental health care in correctional versus community settings.

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The Blame Game

New Criminal Law Review An International and Interdisciplinary Journal ◽

10.1525/nclr.2018.21.2.247 ◽

2018 ◽

Vol 21 (2) ◽

pp. 247-266

Author(s):

Andrea D. Lyon

Keyword(s):

Mental Health ◽

Decision Making ◽

Mental Illness ◽

Criminal Justice ◽

Mentally Ill ◽

Public Perceptions ◽

The Public ◽

The Many ◽

Many Sources ◽

Broad Policy

Although in recent years it has become a bit easier to discuss mental health challenges in public, mental illness is still somehow viewed by many in the public as a moral failing. It is that underlying judgement, that unwillingness to look at the many sources that leads to profound misunderstandings by the public, particularly in the context of a criminal trial. In this article I examine these issues in that context in order to better identify, and come to a better understanding of where our shared biases get in the way of a reasoned view of such evidence. The article examines some broad policy questions regarding what we, as a society, do with our mentally ill, and then looks at public perceptions and their impact on criminal justice decision making.

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Court diversion for those with psychosis and its impact on re-offending rates: results from a longitudinal data-linkage study

BJPsych Open ◽

10.1192/bjo.2018.71 ◽

2019 ◽

Vol 5 (1) ◽

Cited By ~ 5

Author(s):

Olayan Albalawi ◽

Nabila Zohora Chowdhury ◽

Handan Wand ◽

Stephen Allnutt ◽

David Greenberg ◽

...

Keyword(s):

Mental Health ◽

Mental Illness ◽

Criminal Justice ◽

Serious Mental Illness ◽

Justice System ◽

New South ◽

Order Group ◽

South Wales ◽

Court Diversion ◽

Treatment Order

BackgroundWith significant numbers of individuals in the criminal justice system having mental health problems, court-based diversion programmes and liaison services have been established to address this problem.AimsTo examine the effectiveness of the New South Wales (Australia) court diversion programme in reducing re-offending among those diagnosed with psychosis by comparing the treatment order group with a comparison group who received a punitive sanction.MethodThose with psychoses were identified from New South Wales Ministry of Health records between 2001 and 2012 and linked to offending records. Cox regression models were used to identify factors associated with re-offending.ResultsA total of 7743 individuals were identified as diagnosed with a psychotic disorder prior to their court finalisation date for their first principal offence. Overall, 26% of the cohort received a treatment order and 74% received a punitive sanction. The re-offending rate in the treatment order group was 12% lower than the punitive sanction group. ‘Acts intended to cause injury’ was the most common type of the first principal offence for the treatment order group compared with the punitive sanction group (48% v. 27%). Drug-related offences were more likely to be punished with a punitive sanction than a treatment order (12% v. 2%).ConclusionsAmong those with a serious mental illness (i.e. psychosis), receiving a treatment order by the court rather than a punitive sanction was associated with reduced risk for subsequent offending. We further examined actual mental health treatment received and found that receiving no treatment following the first offence was associated with an increased risk of re-offending and, so, highlighting the importance of treatment for those with serious mental illness in the criminal justice system.

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Serious Mental Illness, Criminal Justice, and the Death Penalty

Social Work, Criminal Justice, and the Death Penalty ◽

10.1093/oso/9780190937232.003.0013 ◽

2020 ◽

pp. 159-171

Author(s):

Anna Scheyett ◽

Katherine J. Crawford

Keyword(s):

Mental Health ◽

Mental Illness ◽

Criminal Justice ◽

Criminal Justice System ◽

Death Penalty ◽

Serious Mental Illness ◽

Mental Health Professionals ◽

Health Professionals ◽

Justice System ◽

Community Members

This chapter addresses the intersection of mental health and the criminal justice system. Individuals with serious mental illness (SMI) are at higher risk of involvement with the criminal justice system and at greater risk of more severe sentencing. Mental Health America estimates that 20% of persons on death row have a serious mental illness. Someone who was actively mentally ill at the time of a crime, but who has received treatment and is now stable, will proceed to trial as death eligible. This chapter holds that, as the majority of mental health professionals, social workers have a responsibility for educating lawmakers, community members, and those in the criminal justice system, as well as other practitioners about the multiple levels of injustice and inequity surrounding individuals with SMI and the criminal justice system. These issues range from inadequate and inconsistent treatment in the community, jails, and prisons to differential sentencing practices.

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The Role of the Recovery Guide

A Practical Guide to Recovery-Oriented Practice ◽

10.1093/oso/9780195304770.003.0010 ◽

2008 ◽

Author(s):

Larry Davidson ◽

Michael Rowe ◽

Janis Tondora ◽

Maria J. O'Connell ◽

Martha Staeheli Lawless

Keyword(s):

Mental Health ◽

Mental Illness ◽

Case Management ◽

Serious Mental Illness ◽

Service Use ◽

Systems Of Care ◽

Mental Health Systems ◽

State Hospitals ◽

Provision Of Services ◽

Services And Supports

We have defined and discussed the nature of various notions of recovery, grappled with the implications of a recovery vision for mental health system transformation, and begun to draw the outlines of a transformed system. Now we can turn to the question of how such services and supports can actually be offered to people who need them. Here we propose what we call the recovery guide model. Analogous to the role currently played by case management, the recovery guide model is an organizing vehicle by which practitioners can offer a range of services and supports to people, either directly or through others. As with case management, the intensity, scope, focus, and duration of a recovery guide’s work with a person will depend on that person’s needs, preferences, life circumstances, and goals at a given point in his or her unique recovery journey. In this chapter we describe the basic aims, tenets, and tools of this approach. First, though, we offer a brief review of advances in mental health case management that preceded and led up to the concept of recovery guides, including the present recognition that, in a recovery-oriented system of care, people with serious mental illness can no longer be considered “cases” that others manage (Everett & Nelson, 1992). With the failure of a combination of Thorazine and psychotherapy to achieve the aims of deinstitutionalization (Johnson, 1992), case management became the predominant service that mental health systems offered their clients with serious mental illness (Sledge, Astrachan, Thompson, Rakfeldt, & Leaf, 1995). In addition to being inadequately funded, community-based systems of care that were developed to enable people with serious mental illness to leave state hospitals were fragmented and uncoordinated “non-systems” of care (Hoge, Davidson, Griffith, & Jacobs, 1998). As it was practically impossible for people seeking care to navigate these complex and unintegrated health and social service systems on their own, the case manager role was created to identify and coordinate the provision of services to meet their multiple needs in the community (Hoge, Davidson, Griffith, Sledge, & Howenstine, 1994; Sledge et al., 1995). Case managers’ primary responsibility was to assess people’s needs, link them to services, and monitor their service use and outcomes.

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