mental illness in the criminal justice system essay

Mental Illness in the Criminal Justice System

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The second main theme that is in the research focuses on mental illness and mass shootings. Extensive studies have been done on individuals who were bullied and how it impacted their mental capability (Kyle, 2017; Schafer, 2017; Burruss, 2017; Giblin, 2017 and Schildkraut, 2014). Most researchers realized that children that were bullied at some point in their life had a higher chance of developing a mental disorder that later required immediate attention as a grown-up, in comparison to a child that was not intimidated (Kyle, 2017; Schafer, 2017; Burruss, 2017; Giblin, 2017 and Schildkraut, 2014; Hernandez, 2014 and Wike, 2009; Fraser, 2009).

The researcher’s Kyle, Schafer, Burruss, and Giblin (2017) said in multiple studies that individuals who had experienced bullying not only suffered from emotional distress during their childhood but have shown low performance in school, lacking self-confidence, unhappiness, peer rejection, antisocial behavior, and an enormous risk towards suicide. From this research, it is evident that these problems, such as emotional distress, lack of self-esteem, and unhappiness, are major factors that contribute to the perpetrator’s oppression, which results in mental illness.

Mental illness is a disorder that is described as disturbances in an individual’s emotions, thoughts, or behavior. For example, there were studies conducted by scholars Leary, Kowalski, Smith, and Phillips (2003) based on fifteen school shootings that took place between 1995 and 2001 (Leary, Kowalski, Smith, and Phillips, 2003). The reason behind the study was to examine and rule out any possibilities regarding school shootings and students’ mental status. The studies conclude that twelve (12) out of the fifteen (15) shootings that occurred, the perpetrators had shown previous mental problems such as suffering from psychiatric behavior or immense depression (As cited in Wiki and Fraser, 2009). In agreement with these findings, Leary, Kowalski, Smith, and Phillips (2003) said that 46% of the perpetrators suffered from depression as a result of peer rejections, which automatically caused the individual to retaliate in a state of rampage (As cited in Wiki and Frazer, 2009). In their studies, the scholars say, “Peer rejection and failed romances are common in the shooters […] for high-risk adolescents, experiencing acute rejections may exacerbate an existing problem or contribute to a threshold effect after which normative functioning is compromised” (As cited in Wiki, and Fraser (2009) p. 165). We can see from this research that an individual who has suffered immensely from depression, anxiety disorders, and being socially rejected, their mental health plays an enormous factor in the violence that is carried out. Moreover, it also suggests that their peers may be worse when it comes to the psychological effects of degrading words or harassment because of the peer pressure that the perpetrators get from society. Agreeing with these findings, researchers (Leary et al., 2003) say, “the victims of shootings were those who rejected the perpetrator” (As cited in Wiki and Fraser 2009, p. 165).

Mass shootings on college campuses are similar to high school cases in many ways, with just a slight difference. Scholars in another study focused on and analyzed various school shooting cases from 1974 to 2002 regarding mental health and the shooter’s pattern (Newman, Fox, Harding, Mehta, & Roth, 2004). The researchers found out that college shootings are larger because the perpetrators are much older and, as a consequence, further along in the development of serious mental illness. The scholars also say that the perpetrators are more disconnected from their familiar landmarks of adolescent peer group formation, such as the Virginia Shooter Seung-Hui Cho (As cited in Newman and Fox, 2009). These researchers have concluded their study by saying that mental illness has been a major factor in perpetrators carrying out mass shootings at various school campuses for years.

In further research, scholars Schildkraut and Hernandez (2014) found out that Cho moved from Korea with his family to the United States in 1992; where he remained antisocial while attending middle school and was diagnosed at an early age as having “selective mutism and an immense depression” (Schildkraut and Hernandez, 2014, p. 369-370). However, researchers have looked at gun regulation legislation ever since Columbine, Sandy Hook, Northern University, and Virginia Tech to find out if there were any loopholes in laws that were not passed properly (Schildkraut and Hernandez, (2014).

Although there are stricter gun control laws, legislation is still not properly regulated. According to (Hardy, 1986; Singh, 1999; Zimring, 2001), “The Gun Control Act of 1968 support for which was fueled by the subsequent assassinations of Martin Luther King, Jr. and Robert F. Kennedy, was quickly passed and enacted into law on October 22, 1968. The key element of this act was the outlawing of sales of rifles and shotguns by mail order” (As cited in Schildkraut and Hernandez, 2014, p. 360). From this research, there is evidence to prove that even though the law had been in place, Seung-Hui Cho, the Virginia Tech Mass perpetrator who killed 32 people, was able to violate laws and purchase firearms. In fact, further in the research, scholars Schildkraut and Hernandez (2014) found out that Cho breached the 1968 Fiream Act, as well as the Brady Law, by acquiring guns after several members of the medical community had confirmed Cho as psychopathic. This research tells us that even though Cho passed his background check, he was not mentally stable and was not flagged because the system did not report him as mentally ill (Schildkraut and Hernandez, 2014). Hence, these findings are clearly stating that there are mental health loopholes that need to be addressed.

Mental health continues to be a major factor in perpetrators carrying out mass shootings because of the loopholes that are constantly ignored by the justice system. (Check) Researchers have taken a different approach to evaluating a person’s mental health in regard to mass shootings (Allely and Faccini, 2017). In a study conducted by (Allely and Faccini, 2017), the scholars found a different way to evaluate a person’s mental stability. Unlike the previous research, these scholars concluded that by using another method, such as the application ‘Path to Intended Violence model,’ they were able to present a reasonable means of classifying key contributing factors that led to perpetrators and their attacks. (Allely and Faccini, 2017). For instance, one of the perpetrators that this model was used on was a 22-year-old college student Elliot Rodger, who carried out a premeditated mass shooting on May 23, 2014, in Isla Vista, Santa Barbara, California (Allely and Faccini). As reported in the research, “The Path to Intended Violence model “presents with substantial face validity when applied to mass shootings” (Alley and Faccini, 2017, p. 206). In addition, Elliot Rodger’s clinical presentation included information on his being diagnosed of Asperger’s Syndrome (Duke, 2014), psychosis, and psychopathy (Langman, 2014, as cited in Allely and Faccini, 2017). Rodger’s mother had also informed his life coach about his numerous YouTube ranting video postings. The life coach contacted the Santa Barbara County Health Department, but nothing was done (Brown, 2015, as cited in Allely and Faccini, 2017). After the mass shootings, “Investigations revealed that Elliot Rodger had been receiving treatment for many years for mental health issues” (Alley and Faccini, 2017, p. 203). This research underlines the fact that there are continuous loopholes in the system, which need to be addressed immediately. Unlike researchers Kyle et al. and Schafer et al., scholars Ferguson and Olson (2014) opposed the belief that societal violence debate regarding youths that are diagnosed with prior mental illnesses also play aggressive video games. Researchers Ferguson and Olson (2014) studied 377 children, 62 % female, mixed ethnicity, from 13yr up, using the method known as the Pediatric Symptom Checklist to evaluate their mental stability, such as attention deficit or depressive symptoms (Ferguson and Olson 2014). From the data collected, Ferguson and Olson (2014) conclude their findings and suggest that there is “no evidence that suggests increased bullying or delinquent behaviors among youths with such illness contributed to real-life violence” (p. 127). This indicates that violent media is not a major factor in mental health. In addition to Ferguson and Olson’s (2014) findings, they also mention that “Our results did not support the hypothesis that children with elevated mental health symptoms constitute a ‘vulnerable’ population for video game violence effects” (Ferguson and Olson, 2014, p. 127). Ferguson and Olson (2014) finished their study and suggested that more extensive research is needed because of “the explosion in popularity and availability of video games” (p. 128). This study is basically saying that society’s perception of video games is not accurate towards mentally challenged individuals, and continued investigation is needed.

Researchers Giancola and Zeichner 1995; Ritter and Eslea (2005) conducted studies on a lot of college students to find out college students’ mental capability in regard to violent video games. For instance, the scholars Giancola and Zeichner 1995; Ritter and Eslea (2005) used laboratory methods to monitor video game violence’s effect on college students. The researchers’ findings contradicted the previous researchers (Ferguson and Olson 2014). Giancola and Zeichner 1995; Ritter and Eslea (2005) has determined that by using laboratory methods to measure behavior pattern, they found that college students reacted differently and showed relatively aggressive behavior towards words such as “kill” rather than “kiss” (Giancola and Zeichner 1995; Ritter and Eslea 2005, as cited in Ferguson and Olson, 2014).

• 1 Conclusion:
• 2 References

Conclusion:

Researchers have agreed that an individual who has been the victim of bullying at some point in their life can become traumatized, which can later lead to a catastrophic event: mass school shootings (Agnich, 2015; Fallahi, 2009; Austad, Fallon, Leishman, 2009; Elsass, Schildkraut, Stafford, 2016; Kaminski, Koons-Witt, Thompson, Weiss, 2010). However, other scholars have conducted research and concluded what they perceived of a mass shooting perpetrator. Scholars such (as Agnich, 2015; and Elsass et al. 2016) have conducted a study of 282 identified cases across 38 nations and found that mass shooters who have had poor parental monitoring are disconnected from a responsible, caring adult and rejected can lead to mass rampage. Fallahi et al. (2009) have conducted numerous surveys and have concluded factors towards individuals that have been perceived as being bullied. The scholars surveyed Faculty on how they perceived a mass shooter after the incident: Virginia Tech. The Faculty and staff all had different perceptions, but the majority agreed perceived factor of an individual being bullied.

On the other hand, researchers have concluded that mental illness has been immensely contributor to mass school shootings (Kyle, 2017; Schafer, 2017; Burruss, 2017; Giblin, 2017 and Schildkraut, 2014; Hernandez, 2014 and Wike, 2009; Fraser, 2009). Researchers have conducted studies on school shootings between 1995 and 2001 to find out the exact motive of the perpetrators (Leary, Kowalski, Smith, and Phillips, 2003). Researchers Leary, Kowalski, Smith, and Phillips (2003) found that in twelve out of fifteen shootings, the perpetrators had previously suffered from an aforementioned psychological abuse prior to the incident. The research also found that gun control has been a continuing hot topic in the United States for years. In the research the Pew Research Center for the People and the Press conducted a 2011 survey that reported that 26 % of Americans supported the banning of handguns, and 43 % supported the banning of semiautomatic firearms (Schildkraut and Hernandez, 2014). The researchers, Schildkraut and Hernandez (2014) stated that “support for handgun bans has continually declined since 1959 then 60 %, and support for restrictions on semiautomatic guns has continued to decline since the expiration of the AWB, both experienced slight increases in support around the time of the Columbine shooting” (Schildkraut, and Hernandez 2014 p. 368). This research says that Americans have continued to support the banning of weapons for decades now.

A minority of the research also found the most interesting findings that were reported by the polls. Researchers Newport and Jones (2011) say 60 percent of Americans are in favor of current gun laws rather than passing new ones, as opposed to the findings were 38 percent. As reported in another poll done by Gallup, the researchers finished by saying, “Stricter gun control laws 24 % and better mental health screening 15 % were the two most important measures that could prevent mass shootings” (Newport and Jones, 2011, as cited in Schildkraut, 2014 p. 368).

Furthermore, the government continues to advocate for stricter gun laws as a way to reduce access to mass shootings. However, as we can see, these attempts to reduce violence are unsuccessful; hence, the attention that is needed to strengthen the nation’s mental health has drastically diminished. Limitations placed on mental health programs have failed to protect our nation and intrude on society’s ability to live in peace. (Wolf and Rosen, 2015). As a method of solution, we must put the proper resources in place and become readily available to society. Additionally, we must allocate a bill so Congress can pass a bipartisan measure where mentally challenged individuals can go and get the treatment they need. With that, I believe we will have fewer mass shootings. The research talked about in this literature review indicates that education and future research is definitely needed in regard to bullying and mental illness. Researchers will need to focus on numbers to give us better and more accurate data. Nevertheless, we must patch the loopholes and begin to educate society while focusing on preventive strategies that will diminish the possibility of an attack significantly. Therefore, as an alternative to promoting stricter gun policies toward the mentally ill, we must supplement the need for increased mental health prevention funding and available resources; we are pointing at the wrong target (Wolf and Rosen, 2015).

• Agnich, L. E. (2015). A comparative analysis of attempted and completed school-based mass murder attacks. American Journal of Criminal Justice: AJCJ, 40(1), 1-22. doi://dx.doi.org/10.1007/s12103-014-9239-5
• Allely, & Faccini. (2017). ‘Path to intended violence’ model for understanding mass violence in the case of Elliot Rodger. Aggression and Violent Behavior, 37, 201-209. Fallahi, C. R., Austad, C. S., Fallon, M., & Leishman, L. (2009). A survey of perceptions of the Virginia Tech tragedy. Journal of School Violence, 8(2), 120. Retrieved from http://mimas.calstatela.edu/login?url=https://search.proquest.com/docview/229909646?accountid=10352
• Ferguson, C., & Olson, C. (2014). Video game violence use among “Vulnerable” Populations: The impact of violent games on delinquency and bullying among children with clinically elevated depression or attention deficit symptoms. Journal of Youth & Adolescence, 43(1), 127–136. https://doi.org/10.1007/s10964-013-9986-5
• Jaymi Elsass, H., Schildkraut, J., & Stafford, M. C. (2016). Studying school shootings: Challenges and considerations for research. American Journal of Criminal Justice: AJCJ, 41(3), 444-464. doi://dx.doi.org/10.1007/s12103-015-9311-9
• Kaminski, R. J., Koons-Witt, B. A., Thompson, N. S., & Weiss, D. (2010). The impacts of the Virginia Tech and Northern Illinois University shootings on fear of crime on campus. Journal of Criminal Justice, 38(1), 88. Retrieved from http://mimas.calstatela.edu/login?url=https://search.proquest.com/docview/237273436?accountid=10352
• Kyle, M. J., Schafer, J. A., Burruss, G. W., & Giblin, M. J. (2017). Perceptions of campus safety policies: Contrasting the views of students with faculty and staff. American Journal of Criminal Justice: AJCJ, 42(3), 644-667. doi://dx.doi.org/10.1007/s12103-016-9379-x
• Newman, Katherine; Fox, Cybelle. (2009). Repeat Tragedy: Rampage Shootings in American High School and College Settings, 2002-2008. American Behavioral Scientist, 52(9), 1286–1308. https://doi.org/10.1177/0002764209332546.
• Schildkraut, J., & Hernandez, T. C. (2014). Laws that bit the bullet: A review of legislative responses to school shootings. American Journal of Criminal Justice: AJCJ, 39(2), 358-374. doi://dx.doi.org/10.1007/s12103-013-9214-6
• Shukla, Kathan Dushyant,MEd, MS, & Wiesner, M., PhD. (2015). Direct and indirect violence exposure: Relations to depression for economically disadvantaged ethnic minority mid-adolescents. Violence and Victims, 30(1), 120-135. Retrieved from http://mimas.calstatela.edu/login?url=https://search.proquest.com/docview/1650530546?accountid=10352
• Wolf, C. R., & Rosen, J. A. (2015). Missing the mark: Gun control is not the cure for what ails the U.S. mental health system. Journal of Criminal Law & Criminology, 104(4), 851-878. Retrieved from http://mimas.calstatela.edu/login?url=https://search.proquest.com/docview/1749277033?accountid=10352.
• Wike, Traci L. Fraser, Mark M. (2009). School shootings: Making sense of the senseless. Aggression and violent behavior., 14(3), 162-169.

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The Prevalence of Mental Illnesses in U.S. State Prisons: A Systematic Review

Seth j. prins.

Columbia University Department of Epidemiology Mailman School of Public Health 722 W. 168th Street, 720-C Department of Epidemiology New York, New York 10032 ude.aibmuloc@4512pjs

Associated Data

People with mental illnesses are understood to be overrepresented in the U.S. criminal justice system, and estimates of the prevalence of mental illnesses in corrections settings are crucial for planning and implementing preventive and diversionary policies and programs. Despite consistent scholarly attention, two federal self-report surveys are typically cited, and these may not represent the extent of relevant data. This systematic review identifies studies that assess the prevalence of mental illnesses in U.S. state prisons, in order to develop a broader picture of prison prevalence and identify methodological challenges to obtaining accurate and consistent estimates.

Medline, PsycInfo, the National Criminal Justice Reference Service, Social Services Abstracts, Social Work Abstracts, and Sociological Abstracts were searched. Studies were included if they were published between 1989 and 2013; focused on U.S. state prisons; reported prevalence of diagnoses/symptoms of DSM Axis I disorders; and identified screening/assessment strategies.

Twenty-eight articles met inclusion criteria. Estimates of current and lifetime prevalence of mental illnesses varied widely; however, the range of prevalence estimates for particular disorders was much greater—and tended to be higher—in prisons than community samples.

Conclusions

Operationalizations of mental illnesses, sampling strategies, and case ascertainment strategies likely contributed to inconsistency in findings. Other reasons for study heterogeneity are discussed, and implications for public health are explored.

Introduction

People with mental illnesses are overrepresented in criminal justice settings in the United States, including jails, prisons, probation, and parole. 1 – 7 These settings are rarely appropriate for treatment. 8 For people with mental illnesses, who face inordinate poverty, unemployment, crime, victimization, family breakdown, homelessness, substance use, physical health problems, and stigma, 9 – 11 contact with the criminal justice system can exacerbate prevailing social marginalization, disrupt treatment and linkage to service systems, or represent the first occasion for treatment. For the corrections system, which was not designed or equipped to provide mental health services, the high prevalence of people with mental illnesses has capacity, budgetary, and staffing ramifications; high numbers of people with mental illnesses affect the provision of constitutionally mandated treatment “inside the walls,” transition planning and reentry services, and community corrections caseload scope and scale. More generally, mental illness (and co-occurring substance use disorders) represents a substantial component of the public health burden of mass incarceration—a policy where structural inequalities in race, class, crime, health, and social services intersect.

The overrepresentation of people with mental illnesses in the corrections system has received consistent scholarly and political attention, as lawmakers, administrators, practitioners, and advocates all depend on valid and reliable estimates of the prevalence of mental illnesses in corrections settings to plan and implement policy and programmatic responses. Such estimates are frequently presented as preambles to policy monographs, white papers, and grant programs (e.g., Bureau of Justice Assistance 12 ) that propose or fund efforts to reduce the number of people with mental illnesses in contact with the criminal justice system. Yet, only a handful of studies and federal reports are typically cited, and these may not represent the extent of relevant data.

Among this handful, two reports by the Bureau of Justice Statistics 2 , 3 have been cited at least 1,100 times, according to a recent query of Google Scholar. These reports used self-report surveys and defined mental illnesses as a current mental or emotional condition, a prior overnight stay in a “mental hospital,” or endorsement of symptoms of mental disorders in the Diagnostic and Statistical Manual of Mental Disorders (DSM). 13 Prevalence estimates were 3 to 12 times higher than community samples, reaching as high as 64%.

Given the role that such prevalence estimates play in framing programs and policies, past research has sought to inventory and integrate findings from a broader sampling of studies that use more robust case ascertainment strategies. At least seven prior systematic 14 – 18 and non-systematic 19 , 20 literature reviews or meta-analyses have been published in the past two decades. These reviews, however, tend to include studies that predate the policies that would contribute to the present program of mass incarceration (e.g., the “War on Drugs” and “three strikes laws 21 ), include international findings, combine jail and prison estimates, or focus on single or few disorders. The most recent is an important meta-analysis, based on pooled jail and prison data, that provides summary estimates for the prevalence of psychotic disorders and major depression in 33,588 incarcerated individuals worldwide. 14 This analysis puts mental illness and incarceration in a global context and addressed high levels of heterogeneity between studies with sophisticated techniques.

In the United States, however, the criminal justice system and mass incarceration are institutions with unique racialized, economic, and political contexts that make cross-country comparisons difficult. Furthermore, prisons and jails are functionally discrete (see online supplemental Table 5 ), and the two should not be conflated by researchers, as they entail different mitigation strategies from a public health perspective. The purpose of this report is therefore to summarize and synthesize research on the prevalence of mental illnesses in U.S. state prisons. This systematic review is intended to add to the existing body of literature by being both more inclusive and restrictive than prior reviews—allowing for studies whose primary focus is not mental illness and limiting review to state prisons in the United States. The present review will also explore methodological issues that continue to make obtaining accurate prevalence estimates a challenge for researchers and policymakers alike.

A systematic review of the scholarly literature was conducted to identify studies that presented prevalence estimates of mental illnesses in prisons. Articles were included if they were published in peer-reviewed, English-language journals between 1989 and August 2013; focused on US state prisons; reported prevalence estimates of diagnoses or symptoms of DSM Axis I disorders; and clearly identified the denominator for prevalence proportions. Articles were excluded if they did not present original data; focused solely on Axis II disorders, youth, jails, or foreign prisons; selected samples only of people with mental illnesses or substance use disorders; presented only combined jail and prison prevalence estimates, did not present prevalence estimates (e.g., presented only mean scale scores or odds ratios for disorders), or if the denominator for prevalence estimates was not apparent. Samples selected on substance use were excluded given the high rates at which substance use disorders co-occur with mental illnesses among incarcerated individuals, 1 , 22 and would therefore not provide good estimates of mental illnesses per se. A review of the prevalence of substance use disorders in prisons is beyond the scope of this report.

Medline, PsycInfo, the National Criminal Justice Reference Service, Social Services Abstracts, Social Work Abstracts, and Sociological Abstracts were searched. For Medline and PsycInfo, combinations of the following Medical Subject Headings (MeSH) were used: Mental Disorders, Mental Health, Prevalence, Incidence, Epidemiology, Psychotropic Drugs, Drug Therapy, Prisons, and Prisoners. For the remaining databases, similar keyword combinations, including Axis I disorder terms, were searched.

All articles were uploaded into EndNote X4 software. Duplicate entries were identified using the software’s de-duplication function and then sorted alphabetically by title to visually identify any missed duplicates. The initial search yielded 3,670 non-duplicate articles. Based on titles and abstracts, 3,388 articles did not meet inclusion criteria and were excluded. All articles published between 1989 and August 2013 contained in previous reviews/meta-analyses were captured in the present search. Full texts of the 282 remaining articles were reviewed, and an additional 254 studies were rejected based on exclusion criteria outlined above. One study 23 was excluded that re-reported findings from a earlier study included below. Twenty-eight articles were thus included in the present review. In rare cases, the author recalculated prevalence proportions when a more appropriate denominator was reported (e.g., the general facility population rather than a subpopulation). Approximations for summary prevalence estimates were calculated by taking weighted means of all reported diagnoses (“any mental illnesses”) and of major depression, bipolar disorder, schizophrenia, schizoaffective disorder, and psychotic disorder (“serious mental illnesses”). Figures were created in R version 3.0.1 with package “ggplot2.” 24

Researchers characterized the prevalence of mental illnesses in prisons in three main ways: as a broad category of unspecified psychiatric disability or “mental health problems” ( Table 1 , 4 studies 25 – 28 ) as a diagnosis of a DSM psychiatric disorder ( Table 2 and Table 3 , 19 studies 29 – 47 ) and as cut points on scales of symptoms or psychiatric distress ( Table 4 , 5 studies 48 – 52 ).

Prevalence estimates of psychiatric disability/mental health problems and key study characteristics from 5 reviewed studies

ASI: Addiction Severity Index. NR: Not reported.

Prevalence estimates of psychiatric disorder diagnoses and key study characteristics from 19 reviewed studies.

Abbreviations: ADHD: Attention Deficit Hyperactive Disorder. ASI: Addiction Severity Index. BDI: Beck Depression Inventory. CES-D: Center for Epidemiologic Studies Depression Scale. CIDI: Composite International Diagnostic Interview. DIS: Diagnostic Interview Schedule. DSM: Diagnostic and Statistical Manual of Mental Disorders. HRS: Hamilton Psychiatric Rating Scale. ICD-10: International Classification of Disease. MCMI-III: Millon Clinical Multiaxial Inventory-III. MINI-Plus: Mini Neuropsychiatric Interview-Plus. MMPI: Minnesota Multiphasic Personality Inventory. NR: Not reported. NA: Not applicable. OCD: Obsessive compulsive disorder. PTSD: Posttraumatic Stress Disorder. RDS: Referral Decision Scale. SCID: Structured Clinical Interview for DSM Disorders. STAI-S: Speilberger State Anxiety Inventory.

Prevalence estimates of psychiatric disorder groupings and key study characteristics from 5 reviewed studies.

All diagnoses are current, except for Caverley 2006 [ 34 ], which was not reported.

Abbreviations: DSM: Diagnostic and Statistical Manual of Mental Disorders. NR: Not reported. NA: Not applicable. OCD: Obsessive compulsive disorder. PTSD: Posttraumatic Stress Disorder.

Prevalence estimates of psychiatric symptoms and key study characteristics from 5 reviewed studies.

All symptoms are current, except for Conklin, 2000 [ 49 ], which is not reported. Abbreviations: BDI: Beck Depression Inventory. CES-D: Center for Epidemiologic Studies Depression Scale. DSM: Diagnostic and Statistical Manual of Mental Disorders. MCMI-III: Millon Clinical Multiaxial Inventory-III.. NR: Not reported. NA: Not applicable. PTSD: Posttraumatic Stress Disorder. STAI-S: Speilberger State Anxiety Inventory

Tables 1 - ​ -4 4 (see online supplement for expanded tables ) also present key information on each of the 28 studies in addition to prevalence estimates: facility type (e.g., single prison versus all prisons in a given state), target sample (e.g., men, women, general prison population, or some special prison population), method of case ascertainment (e.g., from case files or a particular screening or diagnostic instrument), diagnostic classification system, and current versus lifetime prevalence. Of the 19 studies that presented prevalence estimates of DSM diagnoses, 5 presented estimates of diagnosis groupings that could not be disaggregated (see Table 3 ).

Estimates of the current and lifetime prevalence of mental illnesses in state prisons varied widely. For example, in the present review, estimates for current major depression ranged from 9% to 29%, for bipolar disorder from 5.5% to 16.1%, for panic disorder from 1% (women) to 5.5% (men and women) to 6.8% (men), and for schizophrenia from 2 to 6.5%. Figure 1 summarizes current prevalence estimates for all studies that presented findings for psychiatric diagnoses (i.e., from Tables 2 - ​ -3). 3 ). Figure 2 separates the results from Tables 2 - ​ -3 3 according to studies that presented findings on men, men and women, and women, respectively. As a point of comparison, Figures 1 and ​ and2 2 also display the range of prevalence estimates for select disorders from major community surveys of mental illnesses: the Epidemiological Catchment Area survey, 53 – 55 the National Comorbidity Survey, 56 , 57 the National Comorbidity Survey Replication, 58 – 60 the National Epidemiologic Survey on Alcohol and Related Conditions, 61 – 64 and the National Survey on Drug Use and Health. 65 The figures are dot plots, in which each diamond (prison) and circle (community) represents a prevalence estimate from a single study and the lines are a visual aid for the range of estimates. For example, in Figure 1 , seven studies provided prevalence estimates for current attention deficit hyperactivity disorder in prison, ranging from approximately 10% to 25%. It is clear from Figures 1 and ​ and2 2 that community prevalence estimates tend to fall near or below the low end of the range of prison prevalence estimates, and that there is a generally a greater range in prison prevalence estimates than community estimates.

Also as a point of comparison, Figure 1 contains prevalence estimates for “any mental illness” and serious mental illness (SMI). 57 , 65 – 67 These are compared to estimates from community surveys. “Any mental illness” estimates were calculated by taking weighted means from Tables 2 - ​ -3 3 of all disorder diagnoses. It must be noted that, while reviewed studies do not include diagnoses of substance use disorders, it was not possible to exclude these disorders from most community comparisons of “any mental illnesses.” SMI estimates were calculated by taking weighted means from Tables 2 - ​ -3 3 of major depression, bipolar disorder, schizophrenia, schizoaffective disorder, and psychotic disorder. Because one study 29 was much larger (N=170,215) than the others, it exerted appreciable influence on the weighted means; thus, weighted means for “any mental illness” and SMI were also calculated excluding this study, providing the high end of the range for these categories in Figures 1 - ​ -2. 2 . Since no measure of functional impairment was available in most studies, and definitions of SMI vary across surveys, caution is warranted in making inferences from these comparisons.

Several of the studies reviewed are notable for strong methodology. In one study, 41 researchers used the Structured Clinical Interview for DSM-IV Diagnoses (SCID), 68 and found prevalence estimates of PTSD (15%), major depression (10%), and dysthymia (8%) among incarcerated women that were mostly higher than the general population. Another study, 47 however, used the SCID and clinician-administered assessment interviews and found the prevalence of PTSD among incarcerated women to be 48.2%. Another study 42 used the Composite International Diagnostic Interview 69 and clinician re-interviews and found prevalence estimates of major depression (10.8), generalized anxiety disorder (1.4) and panic disorder (4.7) among incarcerated women that were similar to or higher than the general population. Using the Minnesota Multiphasic Personality Inventory 70 followed by clinical interviews, another study 30 found prevalence estimates of major depression among incarcerated women to be 29%.

This systematic review summarizes 28 studies, published between 1989 and August 2013, of the prevalence of mental illnesses in prisons in 16 U.S. states. As a result of inclusive search criteria, this review contains data on the prevalence of mental illnesses among incarcerated subpopulations such as HIV-positive women, individuals aged 55 years and older, suicide attempters, and those under administrative segregation. This review presents a detailed summary of key study characteristics that may be of interest to researchers, policymakers, and practitioners. These details are likely implicated in the overall inconsistency in findings. Nonetheless, reviewed studies generally confirm what researchers, policymakers, practitioners, and advocates have long understood: the current and lifetime prevalence of numerous mental illnesses is higher among incarcerated populations than in non-incarcerated populations, sometimes by large margins. Yet, the wide variation in prevalence found among even the more robust studies reviewed here warrants caution against generalizations from any single study. Furthermore, given the heterogeneity in samples, states, facilities, study designs, and diagnostic instruments represented in this review, it would not be appropriate to draw more than broad conclusions about the veracity of particular prevalence estimates relative to others (e.g., studies that used validated instruments followed by clinical interviews are likely more robust than those that used only correctional health records).

Explaining the lack of consistency among prevalence estimates is no easy task; however, two likely contributing factors warrant discussion here. These can be characterized as issues of measurement and selection . Measurement issues are artifacts of the research process, and can be inferred from the characteristics of the studies summarized in this review, whereas selection issues represent “real” phenomenon about which one can only speculate based on the data presented here.

Regarding measurement, methodological differences in the operationalization of mental illness, sampling strategies, and case ascertainment strategies may explain a significant amount of the variation across studies. Measurement differences may arise from a divergence in the disciplinary orientations of researchers and the constraints on access and other resources inherent in conducting research in institutions organized around segregation, security, and control. Researchers with a forensic orientation, for example, may be less interested than community mental health researchers with strict adherence to DSM diagnostic criteria because their primary concern may be in identifying administrative needs and population management risks. Researchers may be granted limited access to a single correctional institution or to records for an entire statewide system containing only rough proxies for mental disorders. During primary data collection, intake procedures may limit the time that can be spent on screening and assessment, which may limit the type of personnel (lay versus clinician) and instruments or scales (screens versus structured diagnostic interviews) that can be used. Indeed, in the present review, over a dozen different case ascertainment strategies are represented, each with its own strengths and weaknesses around diagnostic reliability and validity. 71 Furthermore, these instruments were based on at least 5 different variations of psychiatric nosology, from DSM-III through IV-TR and the ICD-10.

Another source of variation in prevalence estimates may stem from differential “selection into prison,” which can be conceptualized as the real forces that influence the “base” or “source” populations that contribute to the composition of prison populations in different jurisdictions. These selection forces are likely determined by myriad macro- and meso-level factors beyond individuals’ propensity for arrest or crime. These include, but are not limited to, the demographic composition of state populations more broadly, political-economic arrangements and trends, criminal codes (e.g., drug policies), corrections policies, mental health and substance use treatment policies and availability of services, housing policies, policing strategies, etc.

Of particular interest for criminal justice and mental health policymakers and practitioners is the question of whether increased access to treatment services would reduce the number of people with mental illnesses (and co-occurring substance use disorders) in corrections settings. 72 If one accepts the logic that lack of treatment is a cause of people with mental illnesses’ contact with prisons, then states that (on average) provide more and better treatment for co-occurring disorders should have a lower prevalence of mental illnesses in prisons. This is an empirical question that is beyond the scope of the present review. Nonetheless, two aspects of this selection issue deserve consideration. First, state prison populations are less “local” than county or municipal jail populations, because state prisons typically receive individuals from across a state. If mental health and substance use treatment access and utilization affect the prevalence of mental illnesses in prisons, prison composition is likely to reflect the average impact of these services across numerous jurisdictions within a state. Second, most people in the United States with serious mental illnesses, including substance disorders, do not receive treatment. 73 – 75 For these individuals, contact with the criminal justice system may represent the first occasion for any treatment services. 8 Considering within- and between-state differences in service quality and access (e.g., across urban/rural areas, etc.), the impact of these services—or lack thereof—on the variation in prison prevalence may not be straightforward.

One limitation of the current review is that it does not include studies that use proxy operationalizations of mental illnesses, such as corrections department expenditures on medication or clinical staffing. Although treatment is an imperfect proxy for mental illnesses, as prevalence estimates based on treatment reflect well-documented disparities in access and utilization, 74 – 76 a systematic review of this literature would nonetheless be worthwhile, as it would draw special attention to budgetary issues. Another limitation is that this review does not include gray literature, as it was designed to focus on peer-reviewed publications. With 50 states, at least 50 departments of corrections with varying degrees of data unification and reporting standards, and varying numbers of prisons per state, systematically obtaining unpublished or low-circulation reports from these agencies and facilities was beyond the scope of the present review. Such a project is clearly a crucial component of future research.

Reasons for the high prevalence of mental illnesses in prisons have been explored in depth elsewhere. 8 , 10 , 77 – 81 In response, specialized programs designed to divert people with mental illnesses from contact with law enforcement, courts, and corrections to the community; improve reentry after incarceration; and reduce recidivism have been in effect for over a decade. 82 – 86 Despite these efforts, the prevalence of mental illnesses in prisons remains high. Our ability to accurately measure the impact of such programs, in addition to changes in more fundamental causes of the prevalence of mental illnesses in prisons (e.g., drug policy), depends largely on the sorts of estimates summarized in this review. Also of interest to policymakers and practitioners is the fact that most of the roughly 2,300,000 incarcerated individuals in the United States 87 will be released, contributing to the approximately 4.8 million individuals—the majority of the U.S. corrections population—that resides in the community, on probation and parole. 88 Around 43% of these individuals will recidivate within 3 years. 89 As such, accurately measuring the prevalence of mental illnesses “inside the walls” is essential for community corrections planning. Given the existence of brief, well-validated instruments that screen for mental illnesses, such as the Brief Jail Mental Health Screen, 90 K6, 67 and Correctional Mental Health Screen, 91 reporting standards for routine assessments upon intake are clearly feasible. Even in the absence of such standards, prison administrators, working in collaboration with mental health policymakers and practitioners, can (at relatively low cost) calibrate such screening instruments to their populations and begin collecting valid and reliable prevalence estimates.

Incarceration creates or exacerbates chronic incapacitation among the exposed and their families and communities well beyond the effects of mental illness. 92 Incarcerated individuals are at increased risk for HIV/AIDS and other sexually transmitted infections, hepatitis, tuberculosis, sexual violence, drug use, and suicide. 92 Incarcerated populations are now aging populations, with sentences increasingly exceeding life expectancies. 92 Material and psychosocial consequences are also grim, as many formerly incarcerated individuals are denied public housing, employment in numerous fields, income support, education subsidies, supplemental nutrition assistance, and participation in civic institutions such as jury duty and political franchise. 92 These concerns have public health ramifications in their own right, but have additional implications for individuals with mental illnesses, who already face numerous barriers to community integration. 8 , 93 The United States incarcerates a higher rate and number of individuals than any other country. 87 As such, no discussion of community mental health in the United States is complete without consideration of prison prevalence and the policies that produce it.

Supplementary Material

Data supplement.

Handbook on Crime and Deviance pp 419–436 Cite as

Mental Illness and the Criminal Justice System: Issues and Considerations

• Erin M. Falconer 6  
• First Online: 29 August 2019

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Part of the book series: Handbooks of Sociology and Social Research ((HSSR))

Mass incarceration and lack of appropriate mental health care have created a public health crisis in the United States (U.S.). The U.S. is now treating individuals who most require mental health care as criminals; the approach to the criminalization of mental illness is not that different from the approach taken in the 1800s, when the mentally ill were imprisoned rather than treated. Also, the seriously mentally ill impose a substantial financial and resource burden on the system. People with serious mental illness require medical treatment and access to stable, supportive housing. Instead of meeting these necessities, the U.S. system makes it more likely that the most severely impaired individuals will be incarcerated. Incarceration further worsens mental health symptoms and functioning. The goals of any justice system include deterrence, rehabilitation, reparation, and protection of the public. However, the U.S. emphasis on increasingly harsh and punitive measures for individuals with mental illness does little to address these goals. Instead, it is more likely to worsen psychological symptoms, resulting in mental decompensation and crisis, and less protection of the public when the individual is released from prison. There have been some recent efforts to address these issues, including enhancing pre-arrest and pre-trial diversion strategies facilitated by technology and analytics, improving coordination between social and health services, mental health courts, and in-jail alternatives to harsh punishment for those with mental illness.

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Mental Health Issues in the Criminal Justice System Essay

In the recent past, the number of mentally ill people taking part in the criminal justice system has been increasing. People with mental illness are convoluted in the criminal justice system for several reasons since they cannot control their situations. Providing services to this community enhance fairness and equity in society.

Most of the providers have been serving the affected individuals for quite some time and have gained immense experience in the field. Consequently, many people with criminal records enter mental health services system through referral ways such as crisis services, social services departments, human services agencies, educational programs, families, and individual-referrals (Cole & Smith, 2010).

Majority of mentally ill persons referred from courts, probation departments, and jails are not necessarily dangerous or violent. This implies that their participation in the criminal justice system may signal a higher serious illness or immediate attention for comprehensives services.

Also, such individuals have similar needs as other individuals with mental illness on the current case records (Sales, 2007). For this reason, providing services to this group does not interfere with serving other criminals, and may curb future arrest or incarceration.

The integration of mental health service providers in the criminal justice system addresses the needs of people with mental illness. Such a relationship of the groups enhances communication and coordination of the issues affecting the mentally ill individuals.

Furthermore, providers need clarifications towards the types of information that can or should be made available within the criminal justice system. At the same time, the manner of conquering the challenges and obstacles interwoven in mental health and criminal justice services are addressed.

Criminal justice system involvement in the issue is attributed to the stigma of mental illness and the degree of transparency in service delivery systems. For instance, the chances of arresting mentally ill persons are higher due to their deeds and conditions.

On the other hand, many individuals with mental illness have no sources of funds, which may make them be detained because they cannot afford even minimal bails (Sales, 2007). Additionally, such people are not allowed to be released on personal recognizance.

Repeatedly, individuals with mental illness are usually charged with more serious crimes than their counterparts convicted with similar behavior. Moreover, people with mental illness are charged, convicted and sentenced severely in comparison to other individuals accused of the same crimes. Apart from that issue, persons with mental illness spend two to five times longer periods in jail than people implicated with no mental disorder (Cole & Smith, 2010).

At the time, innovative approaches have been constructed aimed at disrupting the cycle of arrest and re-arrest of persons with mental illness popularly referred to as criminalization of persons with mental illness. Police officers have been receiving training in the applicable treatment of persons with mental illness.

For instance, correctional services have developed programs for improved identifications, treatment and freeing of persons with mental illness. The courts have incorporated programs to channel persons with mental illness from the criminal justice systems into treatments. As such, community rehabilitation programs have been working with mental health providers to address the needs of people with mental disorders.

Despite the initiatives adopted, challenges have emanated in court-ordered treatment for persons with mental disability since they may have an opportunity to change incarceration through programs such as diversions and probations. When an individual is implicated with a criminal offense, the individual becomes a subject to the authority of the criminal justice system.

Measures such as probation and diversion are likely to be included as some form of treatment mandated or ordered, by a criminal court at various point in a criminal proceeding. Often, treatments mandated are usually diverse to factor in many options available. Therefore, the considerations made by a court will depend on the circumstances surrounding the individual.

Effective programs have also been designed to work actively in touching the treatment plans developed by health providers. The programs involve means of offering a treatment plan and designing a written crisis plan to the affected individuals. On the other hand, the plans of health care directives should reflect the individual treatment choice (Cole & Smith, 2010).

Victims’ rights movement has been formed for the legal protection of complainants and defendants in courts. Currently, almost every state has either passed laws or adopted constitutional amendments to assist victims in a criminal hearing. Initially, Wisconsin established a bill of rights for victims and provided funding for victim assistance programs.

This was followed by California, which borrowed the concepts developed in Wisconsin. Crime victims and victims’ rights organizations pushed for all states to work on protecting victims’ rights. Their main concern was that several victims were disregarded and to some extent mistreated by criminal justice systems since they only focused on the protection of the legal rights of defendants (Sales, 2007).

While it is true that victims’ bill of right differs from one state to the other, they all require that victims be treated with respect and fairness by police officers, prosecutors, and other officials. Also, the police officers should notify victims about the progress of their cases from the investigation stages to the time when the criminal will be released from prison. This will ensure that mentally ill individuals are treated fairly and reasonably.

Cole, G. F., & Smith, C. E. (2010). The American system of criminal justice (12th ed.). Belmont, CA: Wadsworth Cengage Learning.

Sales, B. D. (2007). The Criminal justice system . New York: Plenum Press.

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People With Mental Illness in the Criminal Justice System: Answering a Cry for Help

• Darren L. Lish , M.D., D.F.A.P.A.

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According to the U.S. Bureau of Justice Statistics, more than 2.2 million adults were incarcerated in U.S. federal and state prisons and in county jails in 2013 ( 1 ). The number of incarcerated Americans has risen dramatically since 1980, largely due to “tough on crime” laws. In addition to the rising number of incarcerated individuals, the percentage of inmates with mental illness has been steadily increasing, with rates more than quadrupling from 1998 to 2006 ( 2 ). Many have attributed this trend to the deinstitutionalization of mentally ill persons beginning in the 1960s, when mental hospitals across the country began closing their doors. It is estimated that more than two million arrests in the United States each year involve people with serious mental illness, and on any given day in the United States, there are approximately 550,000 people with serious mental illness in our jails and prisons.

Jails and prisons have become places where a disproportionate number of people with mental illness and co-occurring substance use disorders spend significant amounts of time—their ties to the community severed, their treatment needs unmet, and their illnesses made worse. Upon release, many individuals have limited to no access to the types of services and supports necessary to facilitate community reentry and reintegration. In my role as chief of psychiatry in the Colorado Department of Corrections, I am all too familiar with the growing number of mentally ill offenders in our state and the complicated processes that put them there and that act as barriers to effective treatment and transitioning back into the community.

Written by a committee of the Group for the Advancement of Psychiatry, People With Mental Illness in the Criminal Justice System: Answering a Cry for Help represents the collective wisdom of leaders in community psychiatry to help psychiatrists identify successful strategies to aid individuals and families with behavioral health needs in the criminal justice system with the overall goal of reducing the overrepresentation of mentally ill persons behind bars. The book uses a collection of Dear Abby letters from individuals and family members who have personal experience with the intersection of mental illness and the criminal justice system. These poignant letters provide real stories of the challenges faced not only by mentally ill individuals and their family members but also by professionals involved in all aspects of this system, and the letters are used to highlight the failings of the intersection of our mental health and criminal justice systems.

The chapters are organized mostly according to the sequential intercept model, showing how important intervention can be along any of the multiple stops an individual makes within the criminal justice system. The authors encourage development of collaborative partnerships throughout the criminal justice system: partnerships between families, law enforcement, community and correctional mental health providers, judges, and the court system.

One of the major themes of the book is that many, if not most, of the people with mental illness in our nation’s jails and prisons are there as a result of inadequate access to treatment services in the community. These individuals highlight the need for trauma-informed care for this population and for awareness of co-occurring substance use disorders, learning disorders, and health conditions that must be recognized and treated. While delivering a message of optimism and encouragement, the authors point out important gaps in service, particularly during the transition from incarceration to the community and the importance of working toward integrated community-based care for these individuals. In addition to improved treatment services in the community, the book makes recommendations for jail diversion programs at the time of arrest through judicially supervised community-based treatment plans. There are also important discussions about improving training for police and parole officers who work with mentally ill individuals and about improved treatment and conditions within the correctional environment.

At the end of each of the short, accessible chapters are simple, bullet-point recommendations for change to encourage more outreach and collaboration among those who work with mentally ill individuals in the criminal justice system. Helpful examples of dialogue are provided to promote this collaboration in a practical and real-world fashion. An extensive set of appendices presents information for professionals on a variety of important topics, including principles for criminal justice and community psychiatry, sequential intercept mapping, stages of engagement with the criminal justice system, regulations concerning the Health Insurance Portability and Accountability Act of 1996, screening and mental status or criminal justice history, essential systems of care, and the risk-need-responsivity model. There is also a section of online criminal justice and mental health resources that provide additional information and assistance for individuals, families, and clinicians.

The overall message of the book is that effective partnerships among treating psychiatrists and other mental health professionals, law enforcement, judges, and our patients and their families can have an enormous impact in reducing the overrepresentation of persons with mental illness in our jails and prisons. As stated in this book, “There is something terribly wrong with a society that is willing to spend more money to incarcerate people with mental illnesses than to treat them” (p.xii). I hope that mental health providers in the community, as well as individuals involved in our legal and correctional systems, will pick up this accessible and engaging book and begin the process of examining what each of us can do to reverse this disturbing trend.

The author reports no financial relationships with commercial interests.

1 Bureau of Justice Statistics , US Department of Justice: Prisoners in 2013 . Washington, DC, 2014 ; http://www.bjs.gov/content/pub/pdf/p13.pdf Google Scholar

2 Bureau of Justice Statistics , US Department of Justice: Mental Health Problems of Prison and Jail Inmates . Washington, DC, 2006 ; http://www.bjs.gov/content/pub/pdf/mhppji.pdf Google Scholar

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Mental Illness in The Criminal Justice System

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Addressing Mental Illness in the Criminal Justice System

Mental Health in the Criminal Justice System

Mental Health and the Criminal Justice System: Examining the Prevalence of Mental Health Issues Among Incarcerated Individuals

The intersection of mental health and the criminal justice system has become a significant concern worldwide. Incarcerated individuals often face a higher prevalence of mental health issues compared to the general population. This essay explores the extent of mental health problems among incarcerated individuals and proposes strategies to improve mental health services within the criminal justice system.

The Prevalence of Mental Health Issues in Incarcerated Individuals

Research consistently indicates that incarcerated individuals are more likely to suffer from mental health issues compared to the general population. The stressors associated with incarceration, such as confinement, isolation, and loss of autonomy, can exacerbate pre-existing mental health conditions or trigger new ones. Common mental health disorders observed among incarcerated populations include depression, anxiety, post-traumatic stress disorder (PTSD), and substance use disorders.

Factors Contributing to Mental Health Issues in Incarcerated Populations

• Pre-existing Conditions : Many individuals who enter the criminal justice system already have untreated or under-treated mental health conditions. The lack of access to mental health services in the community often leads to their overrepresentation in the criminal justice system.
• Trauma and Adverse Childhood Experiences : Incarcerated individuals are more likely to have experienced trauma and adverse childhood experiences, which can contribute to the development of mental health disorders.
• Inadequate Mental Health Services : The criminal justice system may not have sufficient resources and qualified staff to address the mental health needs of incarcerated individuals adequately.
• Stigma and Lack of Understanding : Stigma surrounding mental health within the criminal justice system can prevent individuals from seeking help or receiving appropriate treatment.

Improving Mental Health Services in the Criminal Justice System

• Screening and Assessment : Implementing comprehensive mental health screening and assessment protocols during intake can identify individuals with mental health issues and ensure appropriate treatment planning.
• Diversion Programs : Developing diversion programs that redirect individuals with mental health issues away from incarceration and into treatment and community-based support can be effective in addressing underlying mental health concerns.
• Training for Criminal Justice Personnel : Providing training for law enforcement, corrections officers, and other criminal justice personnel on recognizing and responding to mental health issues can promote a more compassionate and understanding approach.
• Mental Health Courts : Establishing specialized mental health courts that focus on treatment rather than punishment can better address the needs of individuals with mental health issues involved in the criminal justice system.
• Collaboration with Mental Health Professionals : Creating partnerships between criminal justice agencies and mental health providers can ensure a coordinated and comprehensive approach to addressing mental health needs.
• Crisis Intervention Teams : Developing crisis intervention teams that consist of mental health professionals and law enforcement officers can de-escalate situations involving individuals experiencing mental health crises.
• In-Reach and Aftercare Services : Providing in-reach services within correctional facilities and ensuring continuity of care through aftercare services after release can support individuals in managing their mental health conditions upon reentry.

The prevalence of mental health issues among incarcerated individuals is a pressing concern that demands attention and action. To improve mental health services within the criminal justice system, a multi-faceted approach is required. This includes comprehensive screening and assessment, diversion programs, training for criminal justice personnel, establishment of mental health courts, collaboration with mental health professionals, crisis intervention teams, and in-reach and aftercare services. By prioritizing mental health care and adopting a more compassionate and holistic approach, the criminal justice system can better address the mental health needs of incarcerated individuals and contribute to their successful rehabilitation and reintegration into society.

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Law, Health Policy & Disability Center

Law, health policy & disability center receives grant to examine the intersection of mental health and criminal justice.

Under a new grant from the Nellie Ball Trust Research Fund, the Law, Health Policy & Disability Center (LHPDC) will work with a local agency to illustrate the challenges facing individuals with mental health disorders.

People with serious mental illness (SMI) are disproportionately represented in the criminal justice system, often because there is nowhere else to place people who may be a danger to themselves or others, says Angie Pretz, PhD, MSW, a research scientist who received the $31,000 one-year grant from the Nellie Ball Trust Research Fund. Pretz’s grant submission is titled “Criminalizing Mental Health: The intersection of Serious Mental Illness and the Criminal Legal System.” 

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Intervention could help young women avoid criminal justice system

"We know that as women move through their 20s, there's a reduction of involvement in the legal system, and we need to better understand the positive factors that are part of that process," says Maria Schweer-Collins. (Credit: Getty Images )

You are free to share this article under the Attribution 4.0 International license.

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Adolescence is the prime time to help young women who’ve had repeated run-ins with the US juvenile justice system find a different path, a new study shows.

In one of the longest ongoing intervention studies focused on delinquency in women, researchers followed the same group of women over two decades, to their mid-30s. The women were in their mid-teens and heavily involved in Oregon’s juvenile justice system when they started participating in the research, initially through the Oregon Social Learning Center, a nonprofit research center based in Eugene.

As adults, nearly three-quarters of the women continued to be involved with the justice system and more than a third had been in jail or prison. However, the researchers discovered that on average the women last interacted with the justice system at age 22, pinpointing adolescence as the critical time to intervene.

“Adolescence is a pivotal time to provide the support and services that can lead to sustained changes into adulthood,” says Leslie Leve, one of the researchers and department head for counseling psychology and human services in the University of Oregon’s College of Education.

“Teens are undergoing tremendous changes in brain , social, and personal development. They are our future employee base and future leaders. For the health of our society, it is important to invest in their growth and well-being.”

The research comes at a time when women’s involvement with the US justice system is growing at a faster rate than men’s, and the national conversation is focused on alternatives to incarceration , especially for women.

For example, the Vera Institute of Justice in California is working at the county level to end the incarceration of young females and those whose gender expression falls outside the binary forms. Also, the states of Hawaii and Maine each have had times in recent years when no females under age 18 were incarcerated in their correctional facilities.

The length of the research, now going on 27 years, provides a unique opportunity to watch the lives of women in the study unfold.

“If we had ended the study when the participants reached their early 20s, the conclusion would have been more somber: Three out of four of these women who were involved in the juvenile justice system as teens continued to be involved with the justice system as adults,” says Maria Schweer-Collins, a research assistant professor at the College of Education and the Prevention Science Institute. “But because we continued to follow them, we see that for many, their life takes a turn.”

Future research will investigate the factors that enabled many of the women to become disentangled from the criminal justice system, Schweer-Collins says.

“When did they stop being involved with the legal system?” she asks. “For those whose involvement ended, what changed for them?”

Future research will also look at potential factors, such as entering a stable, long-term relationship with a partner or becoming a parent, as well as changes in how the justice system responded to the women as they aged.

“Stay tuned,” Schweer-Collins says. “We know that as women move through their 20s, there’s a reduction of involvement in the legal system, and we need to better understand the positive factors that are part of that process.

“Once we identify those factors, then the question is how can they help inform interventions and justice system practices in adolescence so women can reach that life-changing turning point earlier in their lives.”

The study appears in the journal Frontiers in Psychology .

Carly Dierkhising, associate professor of criminal justice at California State University Los Angeles is a coauthor of the study.

The National Institute of Justice and the National Institute on Drug Abuse supported the work.

Source: Sherri Buri McDonald for University of Oregon

Planting workshop raises spirits of women in prison

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With mental health system under strain, more patients being transferred to facility for sex offenders

In an effort to free up more mental health bed space in the state’s overwhelmed criminal justice system, the Wisconsin Department of Health Services is sending more of its mental health patients to a facility that has traditionally treated sex offenders.

In February, the Department of Health Services established an inpatient unit at Sand Ridge Secure Treatment Center, a treatment facility in Mauston traditionally meant for sexually violent persons. The unit will serve 20 male clients for competency treatment, a program typically provided at Mendota Mental Health Institute in Madison instead.

Competency treatment is for people who are deemed unable to stand trial due to mental illness, substance abuse, or developmental disabilities, and must be given treatment before their court proceedings can continue. They have not been found guilty.

On the other hand, people in the sexually violent persons program at Sand Ridge have been convicted of sex offenses and have already served their prison sentenc e. They are sent to the facility to reduce their risk of reoffending before being released.

Since February, 12 people have been sent to Sand Ridge for competency treatment under the new program.

In an email, the Department of Health Services said the decision to transfer patients to Sand Ridge is in response to “increased need.”

From 2016 to 2023, the number of people referred to the department for competency treatment has increased drastically, from 352 to 877. According to attorneys who represent clients in competency proceedings, hundreds are on the waitlist for inpatient treatment, sometimes waiting for months for a bed space.

"As staffing allows, a key piece of our overall plan to address the needs of forensic patients includes opening up more of our seven facilities to them," the statement said. "This gives patients access to the care they need as quickly as we can provide it."

Starting in 2018, the Department of Health Services also began sending another type of patient — those found not guilty by reason of mental disease or defect, or NGI — to Sand Ridge. Sand Ridge currently has 60 beds for those patients, all men.

Over the years, 107 people who were found not guilty by reason of mental disease or defect have been sent from Mendota to Sand Ridge .

The decisions have concerned some who say Sand Ridge is not historically designed for the type of patients that the state is increasingly sending there.

Criminal defense attorney Craig Mastantuono believes the transfer could be a way to alleviate the strained system, but he said he would have concerns if patients from Mendota were subject to the same program and were mixed with patients from Sand Ridge.

“I don’t think you want to mix those populations,” Mastantuono said.

According to the Department of Health Services, the three types of clients at Sand Ridge are housed in separate housing areas, each with 20 beds. Depending on individual circumstances, programming such as education can be shared.

Many attorneys and forensic psychologists say the transfer of patients to Sand Ridge is a reasonable solution to get more people into urgently-needed mental health treatment.

University of Wisconsin-Madison criminal justice professor Kenneth Streit said the new unit will allow people on the waitlist for Mendota and other state mental hospitals to get treatment at a civil facility sooner, with more access to personal space and state-trained medical professionals. Many are currently languishing in county jails.

“A person’s going to have much more contact with people who are aware of what their symptoms are and aware of how that person should be behaving,” Streit said.

Despite differences, experts believe similar skills are needed at both facilities

Historically, Mendota Mental Health Institute and Sand Ridge Secure Treatment Center have served very different types of people. While Mendota Mental Health Institute serves people in a variety of circumstances, Sand Ridge handles a much more specific population.

As a result, experts said the mental health needs of the patients at the two facilities are very different.

According to forensic psychologists and criminal defense attorneys, patients at Mendota more often live with mental health disorders such as bipolar and paranoid schizophrenia.

In comparison, people at Sand Ridge more commonly struggle with sexual disorders such as sexual sadism and pedophilia, according to Michael Caldwell, psychology professor at University of Wisconsin-Madison and former staff psychologist at Mendota Mental Health Institute.

For people found not guilty by reason of mental disease or defect, also known as NGI, “your mental disorder has to be so disabling that you lack substantial capacity to control your actions,” Caldwell said. “In the [sexually violent persons] world, there has to be some amount of inability to control in there, but it’s nowhere near the level of the NGI situations.”

That being said, Caldwell believes some of the therapy and psychiatry skills required to treat people with sexual disorders are transferable to treating competency clients or people found not guilty by reason of mental disease or defect.

Many competency clients need education on how the court system works before they can stand trial, and Caldwell believes most counselors should be able to treat competency clients once they get training on the specifics of court proceedings.

Staff at Mendota are currently conducting training for staff at Sand Ridge, according to the Department of Health Services.

Given the wider range of mental health treatments and expertise Mendota affords, Mastantuono said Sand Ridge should have similarly-trained staff in place before more patients are transferred there.

“Post-convicted, sentence-served, civilly-committed, allegedly sexually-violent persons, with a very specific need to go through sexually-violent persons treatment programming, is entirely different from that,” Mastantuono said.

Criminal defense attorney Mindy Nolan says mental health needs vary greatly even within a group of people committed under the same program.

Nolan believes that treatments always need to be individualized and that extra training and care need to be taken to treat the new clients being transferred to Sand Ridge.

“If people are trained as psychologists or psychiatrists, they can adapt and work in a lot of different areas,” Nolan said. “But I also think that it is important to just recognize that this is a very different type of treatment.”

Wisconsin’s mental health and criminal justice systems are under strain

Even before COVID-19, the number of people in need of mental health services in Wisconsin was increasing. But the pandemic put even more strain on both the mental health and criminal justice system.

Mastantuono says he is seeing more criminal cases stemming from acute mental health crises than ever before.

“The country’s having a mental health crisis, and it’s definitely bringing more people into the criminal justice system, exacerbating the cases of those already involved in the criminal justice system (with) backlogs, delays,” Mastantuono said.

Given the cost and time it would take to build a new mental health facility, some experts say that opening more space at Sand Ridge is the best short-term solution under the circumstances.

“If you can temporarily find some other physical space and find the staff to do that, that's generally a better approach than saying, 'Let’s build ourselves a new facility,'” Streit said.

Of course, bringing new people to an established facility can lead to uncertainty and the risk of violence, but experts believe the risks are likely lower than if the patients were in other settings.

“It’s not a zero risk for any kind of violence in any kind of institution,” Caldwell said. “But places like Mendota or Sand Ridge are safer than most jails and prisons by far."

Eva Wen is a data reporter for the Milwaukee Journal Sentinel. Reach her at [email protected] .