Mental illness in the eyes of the law: examining perceptions of stigma among judges and attorneys

In response to the increasing numbers of mentally ill persons placed under the care of correctional institutions, community-based diversion programs have been established to address the unique needs and challenges of this vulnerable population. Given that legal personnel may serve as gatekeepers in placement decisions, and the lack of existing research examining their attitudes toward offenders with mental illness, the present study aimed to evaluate perceptions of dangerousness and treatment need among a sample of judges, prosecutors, and public defenders across the state of Mississippi. While controlling for age, results of a factorial MANCOVA revealed that public defenders, relative to both judges and prosecutors, endorsed more compassionate attitudes about defendants with mental illnesses. Furthermore, political ideology did not significantly influence attitudes toward mentally ill offenders. While judges and prosecutors endorsed more negative stereotypes about mental illness and perceived mentally ill defendants as a greater risk to the community, mean scores across groups suggested moderately positive attitudes overall. Study limitations, implications for correctional mental health providers, and directions for future research are discussed.     

Assessing the Needs of Women Recently Released From Prison

The growing number of females incarcerated in the United States suggests that greater importance needs to be placed on preparing practitioners and communities for their eventual release from prison. Female offenders present a unique set of needs, including greater mental health, substance abuse, and medical health problems than their male counterparts. Furthermore, women may possess unique needs at various points of their involvement with the criminal justice system (i.e., before, during, and following a period of incarceration). The current study examines the needs of female offenders while they are reentering the community from the perspective of community service providers who work directly with recently incarcerated women. Survey results reveal that community service providers identify needs in 7 domains. Prevalence and urgency measures provide unique profiles of the needs of female offenders, and respondent reports of the effectiveness of the existing community-based service sector lead to numerous implications and suggestions for future research.     

Effects of Pre-release Services on Access to Behavioral Health Treatment after Release from Prison

Using the Serious and Violent Offender Reentry Initiative data-set, substance use and mental health needs of released inmates are examined to explore whether there is a positive relationship between pre-release services and behavioral health treatment access at three months post-release. Two weighted hierarchical linear models were run testing the effects of three key pre-release services: pre-release needs assessment, pre-release linkage with inmates’ post-release case managers, and pre-release assistance with accessing post-release health insurance. Results demonstrate that pre-release needs assessment significantly increases the odds of receiving post-release substance abuse treatment, and case management linkage and assistance with accessing health insurance significantly increase the odds of mental health treatment after release. Policy implications for reentry service provision targeting behavioral health needs, and directions for future research, are discussed.     

The mental health service crisis of neoliberalism -- an antipodean perspective

Major transformations in forms of governance of the liberal state have been wrought over the course of the last century, including the rise of neoliberalism and 'new public management.' Mental health too has witnessed change, with pharmacological treatment displacing residential care, a shift to community-based services, mainstreaming with general health care, and greater reliance on civil society institutions such as the family or markets. This article considers whether mental health law, and its court/tribunal 'gatekeepers' have kept pace with those changes. It argues that the focus of the liberal project needs to shift to measures which will better guarantee access to mental health services, and keep a more watchful eye on both 'hidden' coercion of people on community treatment orders, and passive neglect of human need.     

When special needs categories for exceptional students overlap mental health diagnoses: The Canadian experience and its Charter implications

This paper explores Canadian 'educational' categorical systems for special needs students and their relation to mental health diagnoses. Parents wishing to access special education services for their children are generally required to consent to their children being formally assessed. Frequently, the school board committee will require a psychological or psychiatric assessment which may lead to diagnosis of a mental health disorder that overlaps with the special needs category to which the child is assigned. This paper explores whether Canadian parents of exceptional students are in fact providing fully informed and voluntary consent given: (a) frequent parental lack of understanding of the overlap between the so-called 'educational' special needs category and a mental health diagnosis; and (b) the power of the school board to proceed with a special education placement based on a particular category even without parental agreement. The argument is made that making special education service eligibility contingent on meeting the criteria for one or more government approved categories of 'disorder' or 'impairments', some of which overlap mental health diagnoses, infringes Canadian Charter s.15 equality rights as well as s.7 liberty and security of the person rights.     

Theoretical Foundations for the Design and Placement of Community-Based Treatment Facilities for Juveniles

With deinstitutionalization and community-based treatment of delinquents becoming more common, the need for facilities compatible with re-integration efforts is crucial. In line with the increasing local needs for dealing with juvenile offenders in the community, this paper advocates the use of delinquency theory as the conceptual foundation for the architectural design and placement of community-based alternatives to incarceration. In addition, we present guidelines for the site selection, community acceptance and physical design of a model community-based treatment facility for minor offenders, which are based on a theoretical integration of social control theory and the labeling approach.     

Acculturation and mental health: Response to a culturally-centered delinquency intervention

There is a dearth of research examining intervention effectiveness for ethnic minorities and few studies have investigated within-group differences in response to treatment. This study examined the prevalence of mental health problems among Anglo- and Mexican-American juveniles entering probation and their response to a comprehensive intervention designed to address drug, alcohol, and mental health in a culturally-sensitive manner. We hypothesized that all youths would demonstrate mental health improvements from pretest to posttest, and the improvements would be equal for Mexican-American youth of varying levels of acculturation and an Anglo comparison group. Participants included a total of 103 adolescents ages thirteen to eighteen years, of whom 59 percent were male and 81 percent were Mexican American. Hypotheses were supported, indicating this comprehensive, community-based intervention targeting delinquent adolescents and their families was effective in improving mental health regardless of ethnic background or level of acculturation. That is, regardless of group differences in mental health problems at intake, youth with different cultural orientations reported significantly reduced levels of internalizing and externalizing behavior problems at posttest.     

Substance use,health, and mental health: problems and service utilization among incarcerated women

This article profiles self-reported substance use, health, and mental health problems among a sample of incarcerated women in Kentucky as well as lifetime service utilization. Findings indicate that a high percentage of women reported use of alcohol, cocaine, and multiple substances during the month before incarceration. In addition, participants reported common health problems such as dental, female reproductive, physical injuries, and mental health problems including depression and anxiety. Participants reported moderate use of emergency room and mental health treatment but limited substance abuse treatment utilization. Implications for criminal justice programs and linkages with community-based aftercare services for women are recommended based on findings that health and mental health problems are associated with service utilization before incarceration.     

Factors related to recidivism for youthful offenders

Little is known about youth who were previously placed in a detention facility and what factors predict a subsequent recidivism to placement. This study of a two-county juvenile offender population (one urban and one rural) investigates what demographic, educational, mental health, substance dependence, and court-related variables predict recidivism to detention placement. Findings from logistic regression analysis indicate that seven variables significantly predict juvenile offenders’ recidivism placement, some expected and some unexpected. Predictors that made recidivism more likely include youth with a previous conduct disorder diagnosis, a self-reported previous suicide attempt, age, and number of court offenses. Conversely, predictors that made recidivism less likely include race (Caucasian), a previous attention-deficit hyperactivity disorder diagnosis, and a misdemeanor conviction. These findings indicate that the use of a community-based suicide and mental health screening and referral approach may help to identify and assist these high-risk youth in receiving needed services prior to juvenile court involvement or during delinquency adjudication.     

The cost benefits of providing community-based correctional services: An evaluation of a statewide parole program in California

This was a cost-benefit study of a statewide program involving multiple community-based services for parolees in California. Program effectiveness was assessed by comparing program costs to incarceration costs avoided due to decreases in recidivism. During the first year following parole release, program participants on average stayed out of prison longer than the comparison population. Participants who completed any of the community-based services stayed out of prison substantially longer. The reductions in re-incarceration yielded a net saving of $21 million in incarceration costs over the study period, after the costs of the program and parole supervision were subtracted, or a 47 percent net return on each program dollar invested. This study did not include potential cost savings to other parties in the justice system. These findings suggest future investments in community-based correctional services might produce substantial financial benefits. A fuller apprehension of the potential benefits would benefit from continuing evaluations, including studies employing a true experimental design.     

论BOT的核心法律问题

本文认为, ＢＯＴ与项目融资的关系、特许权协议的法律性质以及政府保证的范围构成 ＢＯＴ的三大核心法律问题,并明确指出：ＢＯＴ作为一种特殊的私人直接投资,与项目融资有着本质区别,决非项目融资的一种特殊形式;作为ＢＯＴ基础协议的特许权协议,应属行政合同;而ＢＯＴ的政府保证,不仅应包括政府就有关政策、法律问题所作的承诺和担保,而且也应包括对投资回报率等商业性条件所作的保证。     

Engagement processes in model programs for community reentry from prison for people with serious mental illness

Linking prisoners with mental illness with treatment following release is critical to preventing recidivism, but little research exists to inform efforts to engage them effectively. This presentation compares the engagement process in two model programs, each representing an evidence-based practice for mental health which has been adapted to the context of prison reentry. One model, Forensic Assertive Community Treatment (FACT), emphasizes a long-term wrap-around approach that seeks to maximize continuity of care by concentrating all services within one interdisciplinary team; the other, Critical Time Intervention (CTI), is a time-limited intervention that promotes linkages to outside services and bolsters natural support systems. To compare engagement practices, we analyze data from two qualitative studies, each conducted in a newly developed treatment program serving prisoners with mental illness being discharged from prisons to urban communities. Findings show that the working relationship in reentry services exhibits unique features and is furthered in both programs by the use of practitioner strategies of engagement, including tangible assistance, methods of interacting with consumers, and encouragement of service use via third parties such as families and parole officers. Nevertheless, each program exhibited distinct cultures and rituals of reentry that were associated with fundamental differences in philosophy and differences in resources available to each program.     

Staying Out: Reentry Protective Factors Among Rural Women Offenders

The current study examines protective factors for women who transition from county jails to rural Appalachian communities, areas with limited health and behavioral health services. The study included drug-using women recruited from three jails in rural Appalachia and followed-up at 12-months post-release. Analyses focused on differences between women who remained in the community and those who returned to custody, as well as a multivariate model to determine protective factors for reentry success. At the bivariate level, staying out of jail was associated with being older, having a job, not using drugs, stable housing, receiving health treatment, and having prosocial peers. In the multivariate model, the most robust predictors of staying out of jail were drug use abstinence, health care utilization, and prosocial peers. Most research on criminogenic needs associated with reentry success have focused on men, and most focused on reentry to urban communities where services and resources are more accessible. These findings have important implications for criminal justice systems to implement reentry programs for women offenders during the transition to the community.     

Treating offenders with mental illness: a research synthesis

The purpose of this research synthesis was to examine treatment effects across studies of the service providers to offenders with mental illness. Meta-analytic techniques were applied to 26 empirical studies obtained from a review of 12,154 research documents. Outcomes of interest in this review included measures of both psychiatric and criminal functioning. Although meta-analytic results are based on a small sample of available studies, results suggest interventions with offenders with mental illness effectively reduced symptoms of distress, improving offender's ability to cope with their problems, and resulted in improved behavioral markers including institutional adjustment and behavioral functioning. Furthermore, interventions specifically designed to meet the psychiatric and criminal justice needs of offenders with mental illness have shown to produce significant reductions in psychiatric and criminal recidivism. Finally, this review highlighted admission policies and treatment strategies (e.g., use of homework), which produced the most positive benefits. Results of this research synthesis are directly relevant for service providers in both criminal justice and mental health systems (e.g., psychiatric hospitals) as well as community settings by informing treatment strategies for the first time, which are based on empirical evidence. In addition, the implications of these results to policy makers tasked with the responsibility of designating services for this special needs population are highlighted.     

MAKING THE CONNECTION: LEGAL ADVOCACY AND MENTAL HEALTH SERVICES

Recent research documenting the magnitude of mental health needs among juveniles has intensified calls for interventions that both address clinical needs and decrease recidivism. This article first examines research supporting the movement toward community mental health treatment for juveniles and argues that effective legal advocacy requires interdisciplinary coordination to identify and address mental health needs. Next, we present one jurisdiction's model for increasing access to community‐based mental health services and discuss how attorneys can apply the model to achieve this end.     

Mental Health Among Incarcerated Women: An Examination of Factors Impacting Depression and PTSD Symptomology

Female offenders experience mental health symptoms at a higher rate than male offenders and females in the community. The current study investigated individual characteristics and experiences that may impact symptoms of depressive disorders and posttraumatic stress disorder (PTSD) among a sample of female inmates in a large Southern prison system. Results showed high rates of reported childhood and adult victimization experiences among the sample. Factors such as seeking mental health treatment prior to incarceration significantly impacted the reporting of depressive and PTSD symptoms, as did victimization histories. Findings suggest that women would benefit from screening to identify mental health needs at the onset of incarceration as well as gender responsive needs assessment and programming to address histories of victimization and current mental health symptomatology.     

People with special needs and sexual behaviour problems: balancing community and client interests while ensuring effective risk management

Abstract

Deinstitutionalisation movements of the mid-1900s led to changes in policy and practice in the management of people with special needs (defined for this article as people with severe and persistent mental illness, intellectual disabilities and high levels of personality factors that interfere with treatment participation). Although the majority of clients with special needs receive care in community settings and interact more with family, friends and others in the community, some such clients require more rigorous case management. For clients who have offended, especially sexually, community-based services are scarce, and concerns regarding reoffence potential often supersede traditional understandings of diminished capacity. Recent reports suggest that jails and prisons have replaced hospitals as the institutions-of-choice for clients with special needs who engage in inappropriate conduct. This paper examines policies and practices regarding community risk management of people with special needs who have sexually offended. Vignettes are provided to illustrate how some clients and agencies have been affected, and suggestions are made to ensure best practices in risk management and public safety.     

Demographic and abuse characteristics in adolescent male sexual offenders with “special needs”

Adolescent sexual offenders with “special needs” are thought to pose different challenges for therapists working clinically. However, this population has received little attention in the literature, with the research in this area very limited. This study looked at the demographic and abuse characteristics of 24 adolescent sexual offenders with “special needs” who were compared with a group of 155 male adolescent sexual offenders with no special needs. Significant differences were found between the two groups. Those with special needs had higher levels of all forms of abuse, and differences were also found on some sub-scales of the Child Behaviour Checklist. Implications for research and clinical practice are discussed.     

Experiences of Incarcerated Veterans in an All-Veterans Housing Unit: a Qualitative Study

Many US veterans leave military service with a variety of psychosocial risk factors stemming from readjustment to civilian life, and there is increased public concern about the incarceration of veterans given ongoing conflicts in Iraq and Afghanistan. Prisons are playing instrumental roles in developing interventions to address the problems justice-involved veterans face both psychologically and environmentally in the form of veterans’ service units (VSUs), dormitories developed to assist with community reintegration, and connecting veterans to medical and mental health services. This study uses qualitative data from 87 veterans on a VSU who participated in a program improvement survey asking about their programming and reentry needs, experiences on the unit compared to other units, and any suggestions for improvement. Qualitative analysis of responses identified several themes including veterans’ needs around physical fitness, job training, education, and mental health and substance abuse treatment; positive experiences on the VSU compared to traditional units; the positive partnership role with the State Department of Corrections and the local Veterans Affairs (VA) medical center; and concerns on the unit about VA eligibility, combat status, and “real veterans.” These results are some of the first to capture the experiences of veterans on a VSU and the findings highlight potential benefits and challenges with implementing VSUs. Greater research and evaluation are needed to develop more treatment-oriented, rehabilitative models of justice and to continue to refine the VSU model.