Correctional outcomes of offenders with mental disorders

While there is now a considerable literature on the extent of mental disorder (MD) within correctional settings, there is much less research on the correctional outcomes of offenders with a mental disorder (OMDs). This study contributes to that knowledge base by comparing the profiles and institutional and community outcomes of federally-sentenced Canadian offenders with, and without, a MD and examines the correctional response to their management. Results showed that OMDs had higher risk and need ratings and were more likely to be serving their current sentence for a violent offense. Outcomes for OMDs were poorer as reflected by higher rates of institutional charges and transfers to segregation, and higher rates of recidivism on release. This difference holds for the recidivism analysis, even when variables related to risk are controlled. The results demonstrate the complex needs of OMDs and points to the requirement for correctional agencies to provide specialized interventions that address both their mental health and criminogenic needs. Future research is required to examine whether type of diagnosis, particularly the degree of antisocial orientation, contribute to these poorer outcomes.     

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.     

Dissecting the relationship between mental illness and return to incarceration

Purpose

We examine all releases to parole supervision in a single state over a period of four years to consider how a diagnosis of mental illness is associated with return to incarceration.

Methods

We use survival methods and Cox regression to understand patterns of and influences on return to prison. Our measure of mental illness is based on in-prison clinical diagnoses. Data include a rich set of administrative variables with demographic, criminal history and institutional controls.

Results

Our findings suggest that (1) there is a statistically significant relationship between having a DSM diagnosis and reincarceration, (2) substance-related disorders account for most of that relationship, and (3) there are some important variations among types of disorders examined.

Conclusions

Research that examines mental illness and recidivism without controlling for substance use disorders/problems is likely to be uninformative and misleading. Findings provide qualified support for the notion that programming addressing criminogenic risks and needs may be as important, or more so, than therapeutic programming focusing on mental illness when recidivism reduction is the goal.     

The parole performance of offenders released from shock incarceration (boot camp prisons): A survival time analysis

The parole performance of offenders who were released after successfully completing a shock incarceration program was examined and compared to the performance of offenders who were serving time on probation or parole after a period of incarceration. Separate survival analyses were performed for recidivism as measured by (1) arrests and (2) failures (jailed, absconded, or revoked). Prior incarceration, age, age at first arrest, and risk assessment score were related to recidivism but type of sentence was not. Intensity of supervision was significantly related to recidivism but this relationship was eliminated when risk level was controlled. There was no evidence that shock incarceration reduces recidivism. Future research should focus on methods of reducing failures during community supervision for these young, nonviolent offenders within the framework of either a shock incarceration program or some other sentence.An earlier version of this paper was presented at the American Probation and Parole Association 14th Annual Training Institute, Milwaukee, Wisconsin, August 1989.     

The impact of mental health services on arrests of offenders with a serious mental illness

This study examines the impact of mental health services on arrests of offenders with a serious mental Illness (SMI) by assessing changes in associations between receipt of outpatient and emergency room/inpatient services and arrests one, two, and three quarters later. A variety of data sets were used for identifying 3,769 offenders who were in the Pinellas County Florida jail between 7/1/2003 and 6/30/ 2004, and 7,755 offenders who were in the Harris County Texas jail between 10/1/2005 and 9/30/2006. Arrests, out-patient and emergency room/inpatient services were assigned to one of 16 ninety-day periods between 7/1/2002 and 6/10/2006 in Pinellas County and one of 12 such periods between 10/1/2004 and 9/15/2007 in Harris County. Generalized estimating equations were used. Covariates were age, gender, race, diagnosis, and homelessness. The results were also adjusted for exposure to arrests. In Pinellas County, outpatient services significantly reduced the risks of arrests 1 quarter later by 17% (odds ratio [OR] = 0.83, 95% confidence interval [CI]: 0.78-0.87, p < .001), two quarters later by 11% (OR = 0.89, 95% CI: 0.84-0.94, p < .001), and three quarters later by 9% (OR = 0.91, 95% CI: 0.86-0.96, p = .001). In Harris County, these services reduced the risk of arrest 1 quarter later by 5% (OR = 0.95, 95% CI: 0.91-0.99, p = .028), but not two and three quarters later. In Pinellas County, ER/inpatient services increased the risk of arrests by 22% (OR = 1.23, 95% CI: 1.15-1.30, p < .001), 8% (OR = 1.08, 95% CI: 1.02-1.15, p = .010) and 11% (OR = 1.11, 95% CI: 1.02-1.16, p = .001) one, two, and three quarters later. In Harris County, these services increased the risk of arrest only 1 quarter later (OR = 1.16, 95% CI: 1.11-1.22, p < .001). Results suggest that service receipt and its timing may have had some impact on the arrests of adults with a SMI and criminal justice involvement.     

Public preferences for rehabilitation versus incarceration of juvenile offenders

While juvenile justice policy in the United States has become more punitive in recent years, it remains unclear whether the public actually favors this response in lieu of more rehabilitation-oriented services. Public opinion polling generally shows that the public favors less punitive responses than policymakers often suppose, but significant questions remain about the accuracy of these perceptions generally, and in how they have been assessed in particular. Data from four states (Illinois, Louisiana, Pennsylvania, and Washington) aimed at assessing public preferences for rehabilitation and incarceration as a response to serious juvenile crime indicated that, for the most part, the public was willing to pay more in taxes for rehabilitation than incarceration.     

Sexual offenders with serious mental illness: prevention, risk, and clinical concerns

Individuals with serious and persistent mental illness who have also engaged in illegal sexual behavior present a unique challenge for our legal and clinical systems. Frequently, these individuals may engage in problematic sexual behaviors which result in hospitalization rather than incarceration, and an overburdened and resource-deficient public community mental health system is ill-equipped to address the seriousness of these sexual behaviors. We have a rather limited understanding of how prevention programs, intervention strategies, and risk assessment would work with this population. Here we evaluate data from a sample of 245 inpatient psychiatric sexual offenders in a forensic mental health setting and compare these with what information has already been presented in some of the literature. Through an examination of seriously mentally ill sexual offenders and their clinical presentation, legal history, and risk management concerns, we illustrate a variety of tertiary prevention needs. Future directions in the area of prevention and risk management for seriously mentally ill sexual offenders are also discussed.     

Effectiveness of a prolonged incarceration and rehabilitation measure for high-frequency offenders

Objectives

To estimate the incapacitation effect and the impact on post-release recidivism of a measure combining prolonged incarceration and rehabilitation, the ISD measure for high frequency offenders (HFOs) was compared to the standard practice of short-term imprisonment.

Methods

We applied a quasi-experimental design with observational data to study the effects of ISD. The intervention group consisted of all HFOs released from ISD in the period 2004–2008. Two control groups were derived from the remaining population of HFOs who were released from a standard prison term. To form groups of controls, a combination of multiple imputation (MI) and propensity score matching (PSM) was used including a large number of covariates. In order to measure the incapacitation effect of ISD, the number of convictions and recorded offences in a criminal case of the controls were counted in the same period as their ISD counterfactuals were incarcerated. The impact on recidivism was measured by the prevalence and the frequency of reconvictions corrected for time at risk. Robustness of the results were checked by performing a combined PSM and difference-in-difference (DD) design.

Results

The estimate of the incapacitation effect was on average 5.7 criminal cases and 9.2 offences per ISD measure. On average 2.5 convictions and 4 recorded offences per year per HFO are prevented. The HFOs released from ISD showed 12 to 16 % lower recidivism rates than their control HFOs released from prison (Cohen’s h?=?0.3–0.4). The recidivists of the ISD group also showed a lower reconviction frequency than the control group recidivists (Cohen’s d?=?0.2).

Conclusions

The ISD measure seems to be effective in reducing recidivism and crime. The estimated incapacitation effect showed that a large portion of criminal cases and offences was prevented. DD analysis and sensitivity analyses confirmed the robustness of the PSM results. Due to the absence of actual treatment data, the effects found cannot be attributed separately to resocialization, imprisonment, or improvement of life circumstances.     

Doing time: A qualitative study of long-term incarceration and the impact of mental illness

Once convicted, the perpetrator of serious crime embarks upon a new journey: the challenge of adjusting to long-term imprisonment. Prisoners' views of incarceration and the meaning of this experience may affect their later adjustment to life in the community. On the basis of brief narrative responses collected during an epidemiological survey of the psychological health of prisoners in France, this study examined the impact of incarceration on psychological state in a group of 59 inmates serving long sentences. Qualitative content analysis and computer-assisted linguistic analysis (using ALCESTE software) were performed on the textual data of open responses to three standard questions. Using a combination of these two approaches, seven categories of the subjective experience of prisoners in the sample were identified: the Outside World, Others, Punishment, Time, Affects and Impulses, Self-Concept, and Speech. Further qualitative analyses were then performed to compare the responses of Severely Mentally Ill (SMI) subjects and subjects with no psychiatric disorder. These analyses revealed contrasting attitudes towards incarceration. SMI subjects spoke in more hostile and persecutory terms about their experience in prison, attributing suffering to external circumstances, while subjects with no psychiatric disorder evoked similar themes, but with an introspective attitude. The themes evoked by mentally ill individuals in our sample suggest that their reactions to the prison environment arise in part from aspects of their psychiatric symptoms, and this may have relevance to future mental health policy and practices in criminal corrections.     

Community-based care for people with severe mental illness in Canada

The development of mental health services for people with severe mental illness has in many ways paralleled that in other countries, particularly the United States. As reliance on inpatient psychiatric care has been sharply reduced, a wide range of community supports have been developed. Several distinct institutional and legal features have contributed to shaping the nature of these community supports, which are described herein. At present, the result is a highly fragmented system of care. Key evidence-based practices, notably assertive community treatment, supported employment, and integrated treatment for concurrent severe mental illness and substance use disorder, achieve considerable integration at the clinical level, but remain relatively unavailable in most provinces. The policy of regionalization of services risks inhibiting the development of such practices, which require more centralized technical assistance and monitoring. An evolutionary approach of gradually introducing integrated, evidence-based programs may provide the most feasible strategy for improving the system.     

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.     

Comparison of outcomes of patients with personality disorder to patients with mental illness,following discharge from medium secure hospital: systematic review

Background: Medium secure hospitals (MSHs) are costly yet outcome studies, particularly regarding the differential effects of diagnosis, are scant. Research Question: Are there differences in outcomes after MSH discharge for patients with PD compared to patients with mental illness (MI): systematic review. Method: Systematically reviewed studies which distinguished outcomes for patients with PD from those with MI, regarding reconvictions, readmissions and/or mortality rates. Results: From eight studies, comprising 1017 patients, mean reconviction rates per 100,000 person-years for patients with PD were higher (14,369) than those with MI (7799). However, mean readmission and mortality rates were lower (8403 and 668 per 100,000 person-years) compared to those with MI (13,390 and 1083) per 100,000 person-years. Conclusions: Diagnosis appears to differentially impact on reconviction, readmission and mortality rates. Services could tailor pathways to prioritise symptom management and promoting healthy lifestyles for patients with MI, and reducing reoffending for patients with PD.     

Coping with crime: Institutional rehabilitation of offenders with mental health issues

Effectively coping with criminal behavior is one of the most serious social issues confronting contemporary policy makers. Philosophical arguments have been made to address the causes of Crime rather than simply treating its symptoms. While this makes sense logically, the feasibility of such a endeavor is questionable. This being the case, it appears that treating the symptoms of criminal behavior is not only a necessary but possibly the only course of action. In this light, the measures taken to address crime to this point in time have, for the most part, been ineffective and in may cases, the costs have far exceeded the benefits. Recidivism rates clearly illustrate that a large percentage of newly committed crimes are being perpetrated by individuals who have been convicted of offenses in the past. Accordingly, effective rehabilitation emphasizing individually tailored programs of treatment during periods of institutionalization is necessary, prior to reintegration of offenders back into society. This need is particularly evident when faced with psychologically disturbed inmates.     

A replication study of obsessional followers and offenders with mental disorders

The purpose of this study was to compare certain demographic, clinical, and criminal variables within subgroups of obsessional followers, and compare them to a group of offenders with mental disorders to attempt to replicate earlier findings. A static group archival design utilized a non-random group of convenience and a randomly selected comparison group. Sixty-five obsessional followers and 65 offenders with mental disorders were evaluated by psychiatrists and psychologists for court ordered reasons during their criminal proceedings. Both groups were evaluated during the same period, in the same court diagnostic clinic, and generally for sentencing determinations. The obsessional followers were measured on demographic, diagnostic, pursuit, victim, threat, violence, emotional, motivational, and defense variables. Inferential comparisons that used parametric and nonparametric statistics were done within and between groups on select variables. The obsessional followers had significantly greater estimated IQ than the offenders with mental disorders, but were neither older nor better educated. There were no significant differences in the high prevalence of both DSM-IV Axis I and II diagnoses. Obsessional followers who stalked prior sexual intimates were significantly more likely to have a substance abuse or dependence diagnosis. Obsessional followers who stalked strangers or acquaintances were more likely to be delusional. The majority of the obsessional followers, primarily motivated by anger, both threatened and were violent toward person or property. The modal obsessional follower is an average or above IQ, unemployed, unmarried male in his fourth decade of life. chronically pursuing a prior sexually intimate female. He is diagnosed with substance abuse or dependence and a personality disorder NOS, and has a prior psychiatric, criminal and substance abuse history. He is angry, likely to threaten her, and assault her person or property without causing serious injury.