PURPOSE: Prisoner re-entry is an evolving area of mental health services development. We conducted a national assessment of the structure and practice of reentry programs for people with mental illness. The goal was to inductively develop a classification of service strategies derived from current and evolving practices. METHODS: A national survey was conducted to identify service strategies being used by programs to bridge the transition from incarceration to the community for prisoners with mental illness. Fifty-eight reentry programs were identified. Program descriptions were developed for fifty. Data were used to develop a typology of reentry programs or mentally ill offenders. RESULTS: Reentry programs vary based on their location relative to criminal just and mental health systems, types of professionals staffing the treatment programs, and degree of collaboration between the two service systems. The findings of this survey supported the use of a 2X2 typology of initiatives, with one factor being which system initiated the program (criminal justice or mental health) and the other factor being whether or not there is significant collaboration between the mental health an criminal justice systems. IMPLICATIONS: If the funding trend indicated by this survey continues, the criminal justice system will become a primary funder of treatment services for mentally ill offenders returning to the community. No one knows how this shift in funding and program locations will affect the provision of mental health services.

Baseline data from a study of jail diversion services and in-jail behavioral health services were used to examine the differences in clients served by these two models of responding to people with co-occurring mental health and substance abuse problems in the criminal justice system. Clients of the diversion service had more acute psychiatric symptoms and were more likely to have a diagnosis of psychosis NOS. Clients of the in-jail service were more likely to have been on probation or parole in the past and to have received substance abuse treatment. Different service models may attract and serve different populations of clients. Diversion services may cast a wider net that includes clients who may not have otherwise been involved in forensic services.

Criminal justice, mental health, and social service professionals face a myriad of role expectations in working with prisoners with mental illness to facilitate community re-entry. These expectations include those related to law enforcement, social welfare, and administrative efficiency. The challenge for front line workers and the multiple systems that employ them is to integrate all these expectations effectively on behalf of the individual as well as the community. Current models of re-entry for individuals leaving prison with mental illness focus on the management and interaction of service systems. This paper presents a model of prisoner re-entry that incorporates a larger social context, illustrating dynamics related to both individuals with mental illness leaving prison and their interaction with the community setting. This model was generated through an interdisciplinary team effort. It was refined through a focus group process that included advocates, community members and other informants from mental health and criminal justice systems in five states. The model is designed to generate new questions for research that address both individual and community level issues.

This paper focuses on the social capital of prisoners and the impact of criminal behavior and incarceration on its formation and mobilization. Emphasis is on the time-varying nature of four attributes of social capital: the strength of connections, the ability to mobilize them, the endowment of resources within these relationships, and their social context. The incarceration experience has the potential to alter the attributes of social capital in ways that reduce its ability to improve health and justice outcomes. To offset this effect, an investment strategy is recommended that could have a positive impact on the prisoner's social capital and prospects for successful reentry.

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 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.

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.