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.

We present a general theory about how campaigns can have effects and suggest that the evaluation of communication campaigns must be driven by a theory of effects. The National Youth Anti-Drug Media Campaign illustrates both the theory of campaign effects and implications that theory has for the evaluation design. Often models of effect assume that individual exposure affects cognitions that continue to affect behavior over a short term. Contrarily, effects may operate through social or institutional paths as well as through individual learning, require substantial levels of exposure achieved through multiple channels over time, take time to accumulate detectable change, and affect some members of the audience but not others. Responsive evaluations will choose appropriate units of analysis and comparison groups, data collection schedules sensitive to lagged effects, samples able to detect subgroup effects, and analytic strategies consistent with the theory of effects that guides the campaign

BACKGROUND: Abuse and neglect have been shown to influence the mental and physical health of children; however, few studies have examined whether childhood victimization leads to an increased risk of early death. PURPOSE: This paper compares mortality data and examines cause of death for a sample of 908 abused and/or neglected individuals and 667 matched controls who were followed up into young adulthood. METHODS: Using data from a prospective cohort design study, a large group of children with substantiated cases of abuse (physical and sexual) and/or neglect approximately 25 years ago were matched with a control group of children and both groups were followed up into adulthood. The National Death Index was searched twice and official death certificates were collected for most individuals who had died. RESULTS: Surprisingly, there were no significant differences in rates of mortality for the two groups (abuse and neglect = 3.5%, controls = 3.0%). Furthermore, victims of child abuse and neglect were not more likely to experience a violent death. CONCLUSIONS: Our results do not provide support for a heightened rate of early death in abused and neglected children followed up into young adulthood. Limitations of the study are discussed as well as potential reasons for these unexpected findings.

This study investigates whether male and female abused and neglected children report higher levels of intimate partner violence (IPV) perpetration in young adulthood than a matched control group. In addition, it seeks to determine whether this association is mediated by early aggressive behavior, adult antisocial personality disorder, hostility, and problem drinking. The sample comprised individuals with official records of child abuse and/or neglect prior to age 12, and matched controls who were followed up and interviewed at approximately age 29. Those who had ever been married or cohabited (N = 961) reported on lifetime perpetration of IPV. For the total sample, abused and neglected children reported significantly higher rates of ever hitting or throwing things at a partner, ever hitting or throwing first, and ever doing so more than once. Both male and female abused and neglected children reported significantly higher rates of ever hitting or throwing things at a partner than controls. Antisocial personality disorder mediated the effects of abuse/neglect on IPV for both genders; hostility and alcohol problems, for abused and neglected females.

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 of 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.

Persons with mental illness in the criminal justice system are a vexing problem in many countries. The chapters presented in this volume explore issues central to this problem, including the role of mental illness in criminal justice involvement, the effectiveness of psychopharmacologic and traditional community mental health treatment modalities, and the conceptualization and potential efficacy and effectiveness of new community based approaches for serving offenders with mental illness. Included in this multi-disciplinary work are chapters by Jeffrey Draine; William Fisher; Stephanie Hartwell; John Pandiani, Steven Banks, and Shiela Pomeroy; Rani Desai and Dena Plemmons; Phyllis Solomon; and Nancy Wolff.

The mental health court is the newest venue for rerouting persons with mental illness from the criminal justice system to the treatment system. Mental health courts share with drug courts the mission of offering therapeutic alternatives to jail. But their success, however, depends on the nature of the illnesses to which they attempt to treat, the strength of the connection between those illnesses and criminal behavior, and the effectiveness of treatment as a deterrent. To explore these connections, mental health courts are found to have substantial limitations in terms of their potential impact on criminal behavior and incarceration of people with mental illness. Serious concerns about fairness are also raised. An alternative strategy for judicial intervention on behalf of offenders with mental illness is suggested.

In response to concerns raised by the NIH on human subject protection, the Center for Mental Health Services & Criminal Justice Research commissioned the development of this manual on prisoners as human subjects. The manual explains federal regulations on prisoners as human subjects and provides guidance on the design of consent forms and the need for certificates of confidentiality.