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.