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.

The problems posed by persons with mental illness involved with the criminal justice system are vexing ones that have received attention at the local, state and national levels. The conceptual model currently guiding research and social action around these problems is shaped by the "criminalization" perspective and the associated belief that reconnecting individuals with mental health services will by itself reduce risk for arrest. This paper argues that such efforts are necessary but possibly not sufficient to achieve that reduction. Arguing for the need to develop a services research framework that identifies a broader range of risk factors for arrest, we describe three potentially useful criminological frameworks-the "life course," "local life circumstances" and "routine activities" perspectives. Their utility as platforms for research in a population of persons with mental illness is discussed and suggestions are provided with regard to how services research guided by these perspectives might inform the development of community-based services aimed at reducing risk of arrest.

This study compared the costs and outcomes associated with three treatment programs that served 149 individuals with dual disorders (i.e., individuals with co-occurring severe mental illness and substance use disorders) who were homeless at baseline. The three treatment programs were: Integrated Assertive Community Treatment (IACT), Assertive Community Treatment only (ACTO), and standard care (Control). Participants were randomly assigned to treatment and followed for a period of 24 months. Clients in the IACT and ACTO programs were more satisfied with their treatment program and reported more days in stable housing than clients in the Control condition. There were no significant differences between treatment groups on psychiatric symptoms and substance use. The average total costs associated with the IACT and Control conditions were significantly less than the average total costs for the ACTO condition.

People in prison are exposed to and experience sexual violence inside prisons, further exposing them to communicable diseases and trauma. The consequences of sexual violence follow the individual into the community upon release. This paper estimates the prevalence of sexual victimization within a state prison system. A total of 6,964 men and 564 women participated in a survey administered using audio-CASI. Weighted estimates of prevalence were constructed by gender and facility size. Rates of sexual victimization varied significantly by gender, age, perpetrator, question wording, and facility. Rates of inmate-on-inmate sexual victimization in the previous 6 months were highest for female inmates (212 per 1,000), more than four times higher than male rates (43 per 1,000). Abusive sexual conduct was more likely between inmates and between staff and inmates than nonconsensual sexual acts. Sexual violence inside prison is an urgent public health issue needing targeted interventions to prevent and ameliorate its health and social consequences, which spatially concentrate in poor inner-city areas where these individuals ultimately return.

This study estimates prevalence rates of inmate-on-inmate and staff-on-inmate physical victimization. Inmate subjects were drawn from 13 adult male prisons and 1 female prison operated by a single mid-Atlantic state. A total of 7,221 men and 564 women participated. Rates of physical victimization varied significantly by gender, perpetrator, question wording, and facility. Prevalence rates of inmate-on-inmate physical violence in the previous 6 months were equal for males (205 per 1,000) and females (206 incidents per 1,000). Males had higher rates of physical violence perpetrated by staff (246 per 1,000 vs. 83 per 1,000). By facility, inmate-on-inmate prevalence rates ranged from 129 to 346 per 1,000, while the range for staff-on-inmate was 83 to 321 per 1,000.

OBJECTIVES: This study examined whether women with behavioral health needs are more likely to receive treatment for these problems in prison or in the community and to what extent prison disrupts or establishes involvement in treatment for these women. METHODS: Data were collected in August 2004 as part of a population survey of female inmates in the only state correctional facility for women in New Jersey. RESULTS: A total of 908 women were surveyed. Fifty-six percent of the women surveyed reported needing behavioral health treatment before incarceration, but only 62 percent of this group reported receiving such treatment in the community. The rate at which treatment matched need within this population before incarceration varied by type of treatment needed: it was the highest (58 percent) for women who needed treatment for mental health problems, lower (52 percent) for those who needed substance abuse treatment, and lowest (44 percent) for those who needed treatment for comorbid mental health and substance abuse problems. In comparison, the rate of match between need for and receipt of treatment in prison was higher for all three types of behavioral health treatment (78 percent, 57 percent, and 65 percent, respectively). Additionally, the findings suggest that prison did not disrupt the type of behavioral health treatment that inmates had previously received in the community. CONCLUSIONS: At least in New Jersey, prison appears to improve access to behavioral health treatment among female inmates. Although this conclusion is consistent with the rehabilitation goals of incarceration, it also suggests that some women may have been able to avoid prison if treatment had been provided in the community, especially for substance-related problems.

OBJECTIVES: We describe behavioral health diagnoses and community release patterns among adult male and female inmates in New Jersey prisons and assess their implications for correctional health care and community reentry. METHODS: We used clinical and classification data on a census of "special needs" inmates (those with behavioral health disorders) in New Jersey (n=3189) and a census of all special needs inmates released to New Jersey communities over a 12-month period (n=974). RESULTS: Virtually all adult inmates with special needs had at least 1 Axis I mental disorder, and 68% of these had at least 1 additional Axis I mental disorder, a personality disorder, or addiction problem (67% of all male and 75% of all female special needs inmates). Of those special needs inmates released, 25% returned to the most disadvantaged counties in New Jersey (27% of all male and 18% of all female special needs inmates). CONCLUSIONS: Two types of clustering were found: gender-specific clustering of disorders among inmates and spatial clustering of ex-offenders in impoverished communities. These findings suggest a need for gendered treatment strategies within correctional settings and need for successful reentry strategies.

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.

The federal "Second Chance Act of 2005" calls for expanding reentry services for people leaving prison, yet existing policies restrict access to needed services for those with criminal records. We examined the interaction between individual-level characteristics and policy-level restrictions related to criminal conviction, and the likely effects on access to resources upon reentry, using a sample of prisoners with Axis I mental disorders (n=3073). We identified multiple challenges related to convictions, including restricted access to housing, public assistance, and other resources. Invisible punishments embedded within existing policies were inconsistent with the call for second chances. Without modification of federal and state policies, the ability of reentry services to foster behavioral health and community reintegration is limited.

Responding effectively and efficiently to the needs of persons with mental illness returning to the community from prison requires identifying their differences in need and placement difficulties upon return and targeting reintegration investments to reflect these differences. This paper has three parts. The first part profiles the male special needs population in New Jersey prisons. These profiles describe behavioral health and criminal justice characteristics of 2715 male inmates with mental health problems, and are used to identify the scope and nature of the public's investment opportunity. The next part describes the costs associated with possible "investments." The special needs population is classified by need and placement difficulty, and then matched to reentry and community-based treatment programs. Costs are estimated for reentry planning and community-based treatment for the first year post-release. The third part recommends an investment strategy and a set of operational changes that might minimize the loss and maximize the return on the public's investment dollar in mental health.

Correctional facilities are under increasing pressure to respond to the treatment needs of mentally disordered offenders during their incarceration and to arrange for treatment post release through reentry planning. This paper constructs cost estimates for three different reentry investments using data on the population (n = 2715) of male mentally disordered inmates in New Jersey prisons. Different assumptions are used on the distribution of treatment needs and criminal characteristics within the population, ranging from equal treatment needs and placement difficulties to different treatment needs and difficulties accessing community-based resources as a consequence of their past criminal behaviors. The costs of these investments range from approximately $700,000 to $934,000 per year for roughly 500 released inmates. Reentry planning, as a social investment, protects the outcomes produced by correctional health care during incarceration and protects the public from future crime associated with untreated mental illness.

How will we know if mental health courts are effective? The answers provided by future evaluation research will reflect the extent to which the social and procedural complexity of mental health courts drives the research design and plan. This article identifies the research challenges associated with studying the effectiveness of an intervention that is nonstandardized by nature and highly dependent on macro and local influences within the environment as well as personal preferences and relationship dynamics within the intervention itself. Explored are the research challenges related to isolating the independent effects associated with mental health courts. The article concludes with recommendations for how best to evaluate mental health courts to inform best practice and policy.

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.

This paper profiles the behavioral health and criminal justice characteristics of the universe of male special inmates (N = 2,715) in New Jersey prisons. Mentally disordered inmates were found to vary significantly and systematically in their treatment needs and their risks to the community. The lack of homogeneity within the mentally disordered inmate population suggests the need to classify need-risk clusters within the offender group, develop programs that respond to particular need-risk clusters, and match types of mentally disordered offenders to these specialized programs. Recommended is a cafeteria-style approach to treatment planning that recognize the complexity of problem behaviors and the variation in the presentation of these problems.

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.

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.

In the spirit of evidence-based decision making, research findings are increasingly being used to inform practice guidelines and policy making. Whether research informs the process accurately and appropriately depends on due quality of the design. This article examines the assumptions underpinning the randomized trial in relation to its application to evaluating socially complex interventions. Because the properties of the randomized trial are not independent of the characteristics of the interventions being studied, researchers need to be more attentive to selection bias, unmeasured contextual variables and uncontrolled interaction effects that arise because the environment interacts with the intervention. It is recommended that evaluations of socially complex interventions be modified by adding a complex contextual evaluation and using multiple sites.

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.

Issues related to correctional health care are receiving increasing attention across the country. Researchers at Rutgers University conducted a study that explored the state of inmate health in New Jersey jails, and the health care response within the jails and at the time of release. Of the 21 jails in New Jersey, 17 participated in the study. There are three principal findings. First, many inmates have complicated health problems, which often are not being addressed in the community. Second, there is wide variation among jails in their response to inmates' health and behavioral problems. Third, there is remarkably little coordination between correctional health care staff and "outside" providers. Detailed evidence and recommendations appear in the report.