OBJECTIVE: While criminal justice involvement among persons with severe mental illness is a much discussed topic, there are few large scale studies that systematically describe the patterns and prevalence of arrest in this population. This study examines rates, patterns, offenses and sociodemographic correlates of arrest in a large cohort of mental health service recipients. METHOD: The arrest records of 13,816 individuals receiving services from the Massachusetts Department of Mental Health in 1991-1992 were examined over roughly a 10-year period. Bivariate relationships between sociodemographic factors and arrest were also examined. RESULTS: Roughly 28% of the cohort experienced at least one arrest. The most common charges were “crimes against public order” (trespassing, disorderly conduct, etc.) followed by serious violent offenses and minor property crime. The number of arrests per individual ranged from one to 71. Five percent of arrestees (roughly 1.5% of the cohort) accounted for roughly 17% of arrests. The proportion of males arrested was double that of females. Persons 18-25 had a 50% chance of at least one arrest. This rate declined with age, but did so unevenly across offense types. CONCLUSIONS: The likelihood of arrest appears substantial among persons with severe mental illness, but the bulk of offending appears concentrated in a small group of persons and among persons with sociodemographic features similar to those of offenders in the general population. Data such as these could provide a platform for designing jail diversion and other services seeking to reduce both initial and repeat offending among persons with serious mental illness.

In the face of the Massachusetts Governor's attempts to close one of the state's four remaining state hospitals, Massachusetts legislators overrode the Governor's veto of funding for the hospital, but required the state's Mental Health Authority to author a study of the implications of further loss of public sector inpatient beds. The Center for Mental Health Services Research of the University of Massachusetts Medical School conducted its own study concluding that maintaining a longer-term inpatient capacity in the public sector in central Massachusetts was both necessary and accrued a significant number of benefits. This article can serve as a model for the reasoned position that a state hospital in 21st century psychiatry can be looked at as a multiservice center that fulfills a key role in a public sector, integrated system of treatment, care, training and research.

The substantial number of persons with mental illness encountered in many sectors of the criminal justice system has spurred actors from various agencies within that system to take actions aimed at reducing the growth of this population. These actions have included the development of specialty police units, jail diversion programs, and other mechanisms for channeling persons with mental illness out of the criminal justice system and into mental health treatment. The courts, too, have become involved in this effort with the recent development of the "mental health court," the latest of the "specialty" or "problem solving courts." These courts have not been without their critics, however, nor are they the only feasible approach to court-based diversion. This paper identifies and explores a range of options for structuring the relationship between criminal courts and local mental health systems. Beginning with a discussion of the rationale motivating the development of mental health courts, two alternatives to this specialty court model are discussed. One involves judges dealing with defendants having mental illness and substance abuse on a case-by-case basis. The other takes advantages of linkages that may already exist between most courts and the mental health providers who conduct their forensic assessments, expanding the role of these providers to serve as boundary spanners between courts and the components of local mental health systems. Regardless of the model adopted, however, appropriate linkages must exist between the courts and relevant providers. A case study is provided that demonstrates how the status of a locale's linkages can be evaluated and how the information derived from such evaluation can be used to improve the linkages between police, courts, and health and human services agencies.

Arrest rates among the population of youth who have been served in child mental health systems are known to be high during adolescence and young adulthood, but individual longitudinal patterns have not been examined. The present study used developmental trajectory modeling, a contemporary method used widely in criminology, to examine clusters of individual criminal justice involvement patterns at ages 8 through 25, from database records of 13 individuals in public adolescent mental health services. Three groups of particular concern emerged: one with increasingly high offense rates and two with moderate to high violent offense rates that did not desist. Offense patterns in these groups indicate that early intervention should occur before age 15. Some risk factors were identified. Peak offending for most groups occurred between ages 18 and 20. Implications of these findings for mental health services during the transition to adulthood are offered. Studies that have followed youth with serious emotional disturbance (SED) from child.

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.

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.