Offenders with mental illness are disproportionately represented in the criminal justice system. In fact, rates of mental illness among offenders far exceed that of the general population. Serious mental illnesses among offenders include psychiatric diagnoses such as schizophrenia, bipolar disorder, depression, and anxiety disorders. Furthermore, offenders with serious mental illness have a co-occurring substance use disorder, known as a dual diagnosis or concurrent disorder, at higher rates compared to the general population. Some offenders also have psychiatric diagnoses, such as personality disorder or post-traumatic stress disorder, that are not equated with such severe functional impairment as schizophrenia, bipolar disorder, and depression but still create challenges for treatment and program management within correctional facilities (e.g., jails, prisons, detention centers).
Approximately 14–16% of offenders have a serious mental illness, although there is great variation of prevalence estimates across studies. In fact, it is believed that most rates underestimate the actual prevalence of offenders with mental illness, with some suggesting prevalence rates of 25% or higher. In addition, prevalence rates of mental illness are higher among female offenders compared to male offenders.
Offenders with serious mental illness differ widely in type of diagnosis and severity of symptoms related to their psychiatric diagnoses and can pose unique challenges within the correctional systems, which have become responsible for their supervision, treatment, and rehabilitation. Offenders with mental illness tend to have longer periods of incarceration, are less likely to be released on parole, and tend to have higher rates of reoffending compared to offenders without a mental illness. This entry focuses on the overrepresentation of offenders with mental illness within correctional facilities and discusses mental health screening, correctional treatment, and reintegration of offenders with mental illness.
Overrepresentation of Offenders With Mental Illness in Corrections
The overrepresentation of offenders with a mental illness has increased substantially over the years, with some suggesting that overrepresentation of mental illness in corrections has always been an issue. For example, many correctional facilities had high rates of offenders with a mental illness prior to the development of psychiatric hospitals.
The overrepresentation of offenders with mental illness in correctional facilities has been attributed to changes in the provision of psychiatric care and is believed to have resulted in the criminalization of persons with mental illness when combined with strained community-based mental health services. The most extreme change in provision of mental health care is known as deinstitutionalization. Deinstitutionalization refers to the movement of persons with mental illness from psychiatric hospitals into community-based mental health care. As a result of deinstitutionalization, drastic shifts in the provision of psychiatric care occurred, with many people being discharged from psychiatric hospitals into the community without homes or social supports.
The community-based mental health services that then became responsible for the care of persons with mental illness discharged from hospitals were not equipped to sustain the increase in demand for their services. A lack of available mental health services especially in terms of case management and outreach services put a strain on an already overtaxed community-based mental health system. As a result, individuals who may have been previously institutionalized were not receiving the mental health services they needed to function in the community.
The notion that persons with mental illness are funneled through the criminal justice system as a way to access psychiatric care has been provided as a rationale for the overrepresentation of offenders with mental illness within correctional facilities. Essentially, as a consequence of deinstitutionalization, people unable to access mental health services became involved in criminal activity, resulting in incarcerations, as a way to access mental health services.
Furthermore, social problems such as poverty, homelessness, substance abuse, and social marginalization; legal changes; and changes in mental health-care funding have also been contributing factors in the overrepresentation of persons with mental illness within correctional facilities. It is also believed that some criminogenic risk factors (e.g., antisocial cognition) are as common if not more common among offenders with mental illness, putting them at increased risk of involvement with the criminal justice system.
Thus, due to a growing number of individuals with mental illness living in the community, unaddressed social problems, legal changes, and a limited capacity to provide community mental health services, more individuals are being diverted from the mental health system into the criminal justice system.
Mental Health in Corrections
Correctional facilities were not designed to provide comprehensive mental health treatment and so face challenges in meeting the needs of offenders with mental illness. Furthermore, as the population of offenders with mental illness has grown, the requirements that these correctional facilities provide mental health treatment and interventions to this population have stretched their resources. To complicate matters, conditions within correctional facilities can further exacerbate mental health symptoms, and offenders with mental illness often struggle to manage the stresses and expectations correctional facilities place on them. Inmate safety is also a concern among offenders with mental illness, as these offenders have an increased risk of victimization and self-harming, so extra correctional staff resourcing may be required. Essentially, the increasing number of offenders with mental illness has substantially changed the landscape of mental health services within correctional facilities. Even so, with the right screening, resources, and provision of mental health services, offenders with mental illness can experience significant treatment gains during incarceration.
Screening and Assessment of Mental Illness Among Offenders in Correctional Facilities
Screening of mental illness among offenders provides a brief overview of psychiatric symptoms, behavioral concerns, and other information that is utilized to establish the presence of psychiatric and/or behavioral problems requiring treatment and intervention. Screening can inform the need for acute care treatment interventions to help stabilize an offender’s mental health symptoms.
Mental health screening within correctional facilities is intended to identify psychiatric elements of an offender’s current level of risk, symptoms, and overall functioning. Specifically, the intake screening process examines acute care needs such as risk of harm to self or others, current mental health and substance use symptoms, and an offender’s level of functional impairment. The screening process may involve interviews with offenders at intake into correctional facilities, use of self-report instruments, and/or review of clinical and correctional offender files. The results of mental health screening are used to determine the need for further psychiatric assessment.
Mental health assessments provide a more detailed and intensive overview of the psychiatric and behavioral problems, informing psychiatric diagnoses, treatment interventions, and intensity of treatment required. Specifically, assessments review the severity of mental health and substance use disorders, barriers to treatment, offender motivation toward treatment, and inform types and intensity levels of treatment interventions.
Along with assessment of mental health needs, correctional facilities also complete risk assessments on offenders with mental illness to establish which criminal justice risk factors to target in treatment interventions to reduce the risk of reoffending. Risk assessments also inform the level of security required for correctional supervision for offenders with mental illness.
Mental health screening and assessment are necessary to determine the appropriate type and intensity level of treatment interventions to best meet the needs of offenders with mental illness. The combination of screening and assessment of psychological and criminal risk is essential in correctional treatment among offenders with mental illness. Offenders with mental illness have been found to have improved outcomes as a result of intake screening and assessment of mental health and criminogenic needs. Criminogenic needs (e.g., substance abuse, antisocial attitudes, employment, family relationships) are factors that change over time (dynamic factors) and are considered part of a person’s risk level that when changed through targeted treatment can reduce a person’s likelihood of reoffending.
Correctional Treatment Interventions
Over the years, there have been many shifts in the way treatment of offenders with mental illness has been provided within correctional facilities. Traditionally, the focus of treatment of offenders with mental illness was on providing access to care through psychiatric medications and treatment. Based on the influence of changes in psychiatric care, the focus shifted to incorporate the recovery model within psychiatric treatment interventions provided to offenders with mental illness. The recovery model emphasizes psychological treatment and rehabilitation that support the offender’s return to pre-mental illness functioning. More recently, there has been a shift to address both mental health and criminal justice risk factors (criminogenic needs) within treatment to support overall recovery and reduce risk of reoffending among offenders with mental illness. Overall, mental health services in correctional facilities identify mental health needs, crisis management (e.g., risk of self-harm or suicide), and establish treatment interventions based on offenders’ individual needs.
Initially, most treatment interventions for offenders with a mental illness within correctional facilities focused on providing access to mental health services through pharmacotherapy (i.e., the provision of psychiatric medications). Medication adherence among offenders with mental illness was associated with decreased psychiatric symptoms and decreased rates of psychiatric relapse. Pharmacotherapy was considered to be a primary mental health treatment for offenders’ mental health symptoms and supported the premise that addressing offenders’ mental health needs would in turn reduce their contact with the criminal justice system.
Although psychiatric medication is still a component of mental health treatment within corrections, treatment interventions have expanded to incorporate psychological interventions to support offenders’ mental health recovery. The perception was that by targeting offenders’ mental health needs within treatment interventions, criminal justice involvement among offenders with a mental illness would be reduced or eliminated.
Research has indicated that targeting only mental health needs in treatment interventions among offenders with mental illness improves clinical symptoms but does not reduce rates of reoffending among offenders with a mental illness. Evidence suggests that to reduce rates of reoffending among offenders with mental illness, treatment interventions need to target criminogenic needs as well as mental health needs. Thus, a more holistic approach to treatment for offenders with mental illness targeting both mental health and criminal justice risk factors within treatment interventions has been suggested for addressing clinical symptoms and reducing the risk of rehospitalization and/or reincarceration among this offender population.
Essentially, the aim of correctional treatment and rehabilitation methods for offenders with mental illness is to reduce psychiatric symptoms, support psychosocial functioning, and improve subjective well-being, as well as reduce the risk of reoffending among offenders with a mental illness. This combined treatment approach, targeting both mental health and criminogenic needs, can reduce an offender’s likelihood of psychiatric hospital readmission and return to the criminal justice system on new charges or revocation of parole upon release into the community.
Community Reintegration of Offenders With Mental Illness
To ensure that treatment effects and skills learned by offenders with mental illness can be applied in the community, correctional mental health treatment should connect with community reintegration efforts. Based on the high risk of rehospitalization and/or reincarceration among offenders with mental illness, research supports the notion of addressing the criminal justice risk factors along with mental health treatment needs within correctional treatment and ensuring that targeted treatment efforts are continued once the offender is released into the community.
Discharge plans, which are developed during an offender’s incarceration, provide a detailed outline of the individual treatment and service needs of an offender. Discharge plans can inform the community treatment needs and prior to release can inform community-based mental health services to support continuity of care. The extent of discharge planning varies and is dependent on the offender’s unique needs and the resources available within the community into which the offender is being released. Essentially, the combined mental health and criminal justice treatment interventions support the offender’s mental health recovery, reduce the risk of reoffending, support reintegration, and comprise a continued focus of treatment intervention once the offender is within the community.
References:
- Brandt, A. L. S. (2012). Treatment of persons with mental illness in the criminal justice system: A literature review. Journal of Offender Rehabilitation, 51(8), 541–558. Retrieved from https://doi.org/10.1080/10509674.2012.693902
- Morgan, R. D., Flora, B. F., Kroner, D. G., Mills, J. F., Varghese, F., & Steffan, J. S. (2012). Treating offenders with mental illness: A research synthesis. Law and Human Behaviour, 36(1), 37–50.
- Osher, F., D’Amora, D. A., Plotkin, M., Jarrett, N., & Eggleston, A. (2012). Adults with behavioral health needs under correctional supervision: A shared framework for reducing recidivism and promoting recovery. New York, NY: Council of State Governments Justice Centre.
- Substance Abuse and Mental Health Services Administration. (2015). Screening and assessment of co-occurring disorders in the justice system (HHS Publication No. SMA-15-4930). Rockville, MD: Author.