The impact of mental illness on criminal involvement, unemployment, and homelessness appears much smaller than that implied by much of the psychiatric services research literature when a more complex social policy perspective is considered. Poverty moderates the relationship between serious mental illness and social problems. This relationship is often complicated, and not given to simple explanations. Research and policy that accounts for this complexity may lead to greater effectiveness in interventions for persons with serious mental illness.

This paper examines the effects of Medicaid managed mental health care in Massachusetts on the likelihood of admission to the inpatient forensic mental health service maintained by the state's Department of Mental Health (DMH). A cohort of individuals receiving services from DMH before and the after the introduction of managed care was used to assess the effect of Medicaid beneficiary status on the likelihood of forensic hospitalization before and after managed care. The overall rate of forensic hospitalization declined in this cohort across the two time periods. However, for Medicaid beneficiaries, whose care had become managed, this decline occurred at a slower rate. This statistical finding warrants further exploration, but should be considered by policy makers in the design of future mental health system interventions.

Lack of access to hospitalization is often cited as risk factor for incarceration among persons with severe mental illness. This proposition is examined by comparing self reports of lifetime psychiatric hospitalization histories of mentally ill jail inmates with data from a national sample of non-incarcerated mentally ill. New admissions to two jails in Massachusetts (N=996) were screened for serious mental illness using the Diagnostic Interview Schedule. Self-report data were obtained regarding hospitalization history. Rates of hospitalization in this group were compared with those of a comparable subset of respondents in the National Comorbidity Survey (NCS). Roughly 52% of mentally ill jail detainees reported at least one psychiatric hospitalization, a rate nearly three times that of the NCS group. Lifetime psychiatric use among the NCS subsample experiencing recent "trouble with the law" had an elevated lifetime hospitalization rate similar to the Massachusetts jail sample. These findings draw into question the notion that persons with mental illness in the criminal justice system have had reduced access to psychiatric inpatient treatment.

This study assessed whether persons with mental illness who were on probation and/or parole were sent to jail more to enforce adherence to treatment stipulations than for new criminal activities. Thirty-four percent (n=250) of the sample was incarcerated during the follow up period, 18 percent were incarcerated on new charges, and 16 percent were incarcerated on technical violations. Client participation in mental health treatment was protective against incarceration on technical violations. Intensive monitoring by mental health providers was a significant risk factor for incarceration on technical violations. The role of mental health services in reducing risk for arrest and incarceration remains mixed. Providing services that emphasize monitoring tend to increase risk for arrest for technical violations of criminal justice sanctions.

Service and system integration has been proposed as a solution to the problem associated with the management of persons with mental illness who have encounters with the criminal justice system. Britain's Labour government implemented a set of policies that encourage cross-system cooperation. This is the first of a two-part series examining alternative approaches to integrating services for mentally disordered offenders. Part I takes a critical look at the issue of "if it work" in the context of Britain's Labour government's "modernising" effort to better manage public systems' responses to persons with mental illness who have co-occurring offending behaviors.

Service and system integration has been proposed as a solution to the problem associated with the management of persons with mental illness who have encounters with the criminal justice system. Britain's Labour government implemented a set of policies that encourage cross-system cooperation. This is the first of a two-part series examining alternative approaches to integrating services for mentally disordered offenders. Part II provides a new holistic approach to integrating services for mentally disordered offenders. This new approach draws on economic and organizational theory to structure a whole system of care that is responsive to the whole person and accountable to society.

Persons who have mental illness are over-represented among jail and prison inmates. Efforts have been advancing to stem the flow of offenders who have mental illness into the criminal justice system. The mental health court is the newest of these approaches. There is scant empirical evidence on the performance of mental health courts. Available evidence suggests that recruitment is feasible and engagement in treatment is possible. This paper examines the mental health court model in the context of its likely therapeutic and antitherapeutic consequences and considers whether there are other ways to engage the court as a therapeutic agent that yield a better portfolio of consequence. An alternative approach to the mental health court is outlined.

This study argues that mental health policy fails because policy makers focus on the wrong risks and design policies that manage these risks in ways that increase the possibility of adverse clinical and economic outcomes. The argument made here uses the case of persons with severe mental illness in the United Kingdom as an example of the complex relationship between risk and policy making in democratic governance. Emphasis is on the nature of risk in mental health policy and how government responds to policy and political risks. Mental health policy in Britain is then analyzed in terms of its response to and management of risks. Mental health policy has historically mismanaged the risk issue in the United Kingdom and as such has set in motion the growing community-care backlash. The path to a better outcome lies in the responsible management of the right risks. Lessons from the United Kingdom experience can be usefully applied to mental health issues in many industrial democracies.

The authors evaluated the effort of New Jersey jails to plan for the postrelease treatment needs of inmates with mental illness compared with inmates with heart disease and HIV infection or AIDS. Seventy percent of interviewees expressed a belief that release planning for persons with serious mental illness is very or extremely important. However, virtually all the jails reported providing "no real release planning". A majority of the jails provide aftercare plans for fewer than 10 percent of inmates with serious mental illness. A lack of release planning was noted for the other chronic conditions. Release planning for particular chronic problems is most common and complete in facilities with special treatment programs, such as a mental health unit.

This article examines the hostile public reactions of a community that, through a state policy to consolidate all long-term behavioral health services, was to become the site of the state's only mental hospital. A telephone survey conducted in the host community (n = 800) and a matched community (n = 800) was used to test whether the origins of hostility toward consolidation were related to the public's negative attitudes toward mental illness and homelessness or to the beliefs about the discharge and supervisory behavior of the hospital. The host community was not found to have more negative views of mental illness, although it did have significantly more negative views about the homeless. Disapproval of consolidation was unrelated to negative views of mental illness or homelessness but was strongly related to the expected “bad” behavior of the hospital. These results suggest that the best way to improve relations between hospitals and their host communities is for hospitals to behave like “good” neighbors.