One of the greatest problems of deinstitutionalipation has
been the very large number ofpersons with severe mental
illness who have entered the criminal justice system
instead of the mental health system.
Persons with Severe Mental Illness
in Jails and Prisons: A Review
H. Richard Lamb, Linda E. Weinberger
Mental health professionals have become increasingly concerned about the
number of persons with mental illness in jails and prisons. This issue is a
relatively recent one. Reports of large numbers of mentally ill persons in
American jails and prisons began appearing in the 1970s (Swank and Winer,
1976; Stelovich, 1979; Whitmer, 1980). This phenomenon had not been
reported since the nineteenth century (Torrey, 1997).
To understand this problem better, a literature review was conducted. Two
of the primary questions addressed were whether large numbers of persons
with severe mental illness who commit legal transgressions are being taken to
jails and sent to prisons instead of to hospitals or other psychiatric treatment
facilities and whether the number has increased since deinstitutionalization.
The review also examined other aspects of this issue, including the char-
acteristics of mentally ill offenders, factors cited as causes of mentally ill per-
sons' being placed in the criminal justice system, the relationship between
mental illness and violence, access to treatment for this population, the role of
the police, and society's attitudes toward mentally ill offenders. Finally, rec-
ommendations are made about how inappropriate placement of this popula-
tion in the criminal justice system can be prevented and how to treat mentally
ill offenders both in the system and after they are released into the community.
MEDLINE, Psychological Abstracts, and the Index to Legal Periodicals and
Books were searched from 1970, and all relevant references were obtained.
Source Lamb, H R , and Weinberger, L. E. "Persons with Sever Mental Illness in Jails and Pnsons: A Review." Psych,-
alnc Setvices, 199$, 49 (4). 483-492. Reprinted by permission.
Results and Discussion
lncarceration Versus Hospitalization. Many factors come into play
in determining why a person with mental illness is arrested rather than
taken to a hospital. Generally, persons who are thought to have committed
a felony are arrested and brought to jail regardless of their mental condition.
The criminal justice system, charged by society with the responsibility for
removing from the community persons accused of committing serious
crimes, sees no alternative but to place the person in custody in a secure set-
ting first and then arrange for psychiatric treatment if necessary (Lamb and
Grant, 1982). If the person is thought to have committed a serious crime,
the police and the criminal justice system generally do not want to leave this
person in a psychiatric hospital where security may be lax, the offense may
be seen by staff as secondary to the patient’s illness, and the person may be
released to the community in a relatively short time.
For persons charged with misdemeanors, the situation becomes more
complex. Abramson (1972) was the first to coin the term criminalisation of
the mentally ill; he observed that persons with mental disorders who
engaged in minor crimes were increasingly subject to arrest and prosecu-
tion in a county jail system. Subsequently, many authors applied the con-
cept of criminalization to persons with mental disorders who were arrested
€or serious crimes.
The distinction between arrest and incarceration of mentally ill per-
sons who have committed minor offenses and those who have committed
serious offenses is an important one. As Steury (1991) notes, no consen-
sus exists on the definition of criminalization of persons with mental dis-
orders. Some researchers define criminalization at the point of arrest
(Cocozza, Steadman, and Melick, 1978; Steadman, Cocozza, and Melick,
1978; Schuerman and Kobrin, 1984; Teplin, 1984) and others require pros-
ecution (Dickey, 1980; Hochstedler, 1986, 1987; Arvanites, 1988), while
others use incarceration in jails and prisons (Steadman, Vanderwyst, and
Ribner, 1978; Teplin, 1983).
In our opinion, the term crirninalization should be used primarily in
connection with mentally ill persons who are arrested with or without jail
detention and prosecuted for minor offenses instead of being placed in the
mental health system. As noted, it is clear that persons who have commit-
ted serious offenses, no matter how mentally ill, would normally be
processed in the criminal justice system (Hochstedler, 1986; American Bar
Association, 1986; Ogloff and others, 1990). However, it should be acknowl-
edged that many mentally ill persons who commit serious crimes and enter
the criminal justice system might not have engaged in such behavior if they
had been receiving adequate and appropriate mental health treatment
(Dvoskin and Steadman, 1994).
Penrose (1939) advanced the thesis that a relatively stable number of
persons are confined in any industrial society. Using prison and mental hos-
PERSONS W1TH SEVERE MENTAL ILLNESS IN JAILS AND PRISONS
pita1 census data from eighteen European countries, Penrose found an
inverse relationship between prison and mental hospital populations. He
theorized that if one of these forms of confinement is reduced, the other will
increase. According to this theory, where prison populations are extensive,
mental hospital populations will be small, and vice versa. Thus, if there is
room in prisons and a shortage of hospital beds, many mentally ill persons
who come to the attention of law enforcement might well be directed to the
criminal justice system. Another corollary of this theory is that if civil com-
mitment is reduced, involvement with the criminal courts will increase
Proportion of Incarcerated Persons with Mental Illness. The Bolton
study (Arthur Bolton Associates, 1976) was one of the first extensive and
methodologically sound attempts to determine the percentage of county jail
inmates with mental illness. In a five-county combined sample of 1,084
adults in California county jails, 6.7 percent were psychotic, and 9.3 percent
were judged to have nonpsychotic mental disorders, not including person-
ality disorders. For Los Angeles County, the figures were 7.8 percent psy-
chotic and 5.7 percent nonpsychotic.
In a more recent systematic study, Teplin (1990) interviewed 728 ran-
domly selected male admissions to the Cook County jail in Chicago. Using
a structured psychiatric interview, they found that 6.4 percent met diag-
nostic criteria for schizophrenia, mania, or major depression. In a second
study of women entering a county jail in Chicago, Teplin, Abram, and
McClelland (1996) found that 15 percent had severe psychiatric disorders
within the previous six months, 1.8 percent had schizophrenia or a schizo-
phreniform disorder, 2.2 percent were manic, and 13.7 percent had major
depression. Guy and others (1985) interviewed ninety-six randomly
selected admissions to the Philadelphia city jail and found that 14.6 percent
had schizophrenia or manic-depressive illness.
With regard to state prisons, in a 1987 Michigan study of 1,070 state
prison inmates carefully selected through a stratified random sampling pro-
cedure, 2.8 percent were found to have schizophrenia, 5.1 percent to have
major depression, and 3.8 percent to have bipolar disorder or mania (Neigh-
bors, 1987). Jemelka and others (1992) used the Diagnostic Interview
Schedule with 109 inmates in the state of Washington and found prevalence
rates of 4.4 percent for schizophrenia, 10.0 percent for major depression,
and 3.7 percent for mania. Similar rates were found in California and Ohio
prisons Uemelka, Rahman, and Trupin, 1993). Steadman and others (1987)
studied a random sample of 3,332 inmates representing 9.4 percent of New
Yorks general prison population, as well as 352 of the 360 inmates in the
prisons’ mental health units. They found that 8 percent of the sample had
severe psychiatric functional disabilities that clearly warranted some type
of mental health intervention, and another 16 percent had significant men-
tal disabilities that required periodic services (specific diagnoses were not
DEINSTITUTIONALIZATION: PROMISE AND PROBLEMS
Generally, clinical studies suggest that 10 to 15 percent of persons in state
prisons have severe mental illness (Jemelka, Rahman, and Trupin, 1993). It
may be that in recent years, correctional staff have become better able to rec-
ognize signs of mental disturbance and, as a result, refer more of these indi-
viduals to mental health professionals. Thus, better recognition may also
contribute to the prevalence rate of inmates identified as mentally ill.
The magnitude of the problem can be seen when we multiply the per-
centages of mentally ill persons in jails and prisons by the number of
inmates. For instance, in 1995, there were more than 483,000 persons in
jails and more than 1,587,000 persons in state and federal prisons (U.S.
Department of Justice, 1995). Thus, even a small percentage of such large
populations represents a very significant number of mentally ill persons in
jails and prisons.
The large number of mentally ill individuals in jails and prisons has
presented serious problems for correctional staff. Gibbs (1983) noted that
second to overcrowding, the presence of inmates with psychological prob-
lems was the most serious concern for correctional personnel.
Description of the Population. In a study of 102 male inmates of a
county jail randomly selected from those referred by jail staff for psychiatric
evaluation, 99 percent had previous psychiatric hospitalizations, and 92 per-
cent had arrest records (75 percent for felonies) (Lamb and Grant, 1982). Four-
fifths exhibited severe and overt psychopathology, and more than three-fourths
met criteria for civil commitment. When arrested, more than a third were tran-
sients, and only 12 percent were employed. More than half were currently
charged with felonies and 39 percent with crimes of violence. Thus, this pop-
ulation is characterized by extensive experience with both the criminal justice
system and the mental health system; severe, acute, and chronic mental illness;
and poor functioning.
The same study also found that of those charged with misdemeanors,
more than half had been living on the streets, on the beach, in missions, or
in cheap hotels, compared with less than a fourth of those charged with
felonies (Lamb and Grant, 1982). Persons living in such places obviously
have a minimum of community supports. The authors speculated that the
less serious misdemeanor offense is frequently a way of asking for help. Still
another factor may be that many uncared-for mentally ill persons may be
arrested for minor criminal acts that are really manifestations of their ill-
ness, their lack of treatment, and the lack of structure in their lives. It was
also observed that some inmates, even though overtly psychotic, had under-
lying antisocial personality problems that appeared to play a major role as
causative factors in their alleged criminal behavior. Findings were compa-
rable in a similarly selected sample of 101 inmates of a county jail for
women (Lamb and Grant, 1983).
Other studies have shown that a large proportion of mentally ill per-
sons in a jail population were homeless before arrest and incarceration
(Michaels and others, 1992; Martell, Rosner, and Harmon, 1995). For
PERSONS WITH SEVERE MENTAL ILLNESS IN JAILS AND PRISONS
instance, one study in New York City found that homeless mentally ill per-
sons were grossly overrepresented among defendants with mental disorders
entering the criminal justice and forensic mental health systems for both
violent and nonviolent offenses (Martell, Rosner, and Harmon, 1995). Forty-
three percent of the defendants with mental disorders were homeless at the
time of the crime for which they were arrested. The rate of homelessness
was twenty-one times higher in the overall sample of defendants with men-
tal disorders than in the overall population of mentally ill persons in the city.
Moreover, homeless defendants were significantly more likely to have been
charged with victimizing strangers.
Current Trends. It is often asserted that the number of mentally ill
persons currently in our criminal justice system is larger than before dein-
stitutionalization (Torrey, 1997; Palermo, Smith, and Liska, 1991; Davis,
1992). This assertion is consistent with Penrose’s theory described above. It
can be argued that society’s tolerance in the community of the deviant
behavior of people with mental disorders appears to be limited. This lim-
ited tolerance is especially true for those who have direct contact with men-
tally ill persons: the courts, families, and other citizens. Many believe that
if social control through the mental health system is impeded because of
constraints such as fewer long-term state hospital beds, community pres-
sure will result in placement of some of these persons in the criminal jus-
In the 1970s, studies began to appear showing that the arrest rate for
former psychiatric hospital patients was higher than that for the general
population (Zitrin and others, 1976; Sosowsky, 1978). Various attempts
were made to account for the higher rate. Steadman, Cocozza, and Melick
(1978) concluded from their data that the increase was due almost
entirely to the increased number of persons with arrest records being
admitted to mental hospitals. They speculated that “persons who for-
merly would have been caught in the ‘revolving cell door’ are now bounc-
ing back and forth between state hospitals and jails as solutions are
sought in mental health treatment for what are usually nuisance behav-
iors or property offenses” (p. 820).
A related explanation in the late 1970s was the theory of the “psychiatri-
cization” of criminals (Cocozza, Steadman, and Melick, 1978; Davis, 1992).
This theory hypothesized that the increased rate of violent crime after hospi-
tal discharge was due to jail and prison overcrowding and that mental hospitals
were increasingly admitting individuals formerly dealt with by the criminal
justice system. On the other hand, a 1978 study in a California county showed
that former hospital patients with no history of arrests when they entered the
hospital were arrested roughly three times more often after discharge than the
general county population and five times more often for serious violent crimes
Another explanation for the increased arrest rate of former hospital patients
is that a more criminal group of mentally ill individuals is now hospitalized
PROMISE AND PROBLEMS
as a result of the stricter criteria lor civil commitment, which rely heavily on
dangerousness (Steadman and others, 1984). Finally the relationship between
mental illness and violence, as discussed below, may be another factor. Despite
the arguments offered, sufficient evidence does not exist to settle these issues
An important question is whether the number of mentally ill persons
in jails and prisons has increased since deinstitutionalization. A number of
studies over the past several decades have purported to demonstrate an
increase, but Teplin (1983) perhaps said it best when she wrote, “It is con-
cluded that the research literature, albeit methodologically flawed, offers at
least modest support for the contention that the mentally ill are being
[increasingly] processed through the criminal justice system” (p. 54). This
evidence is largely clinical and inferential, and it is certainly highly sugges-
tive. However, because of the lack of good studies of mentally ill persons in
jails and prisons before deinstitutionalization, findings of research con-
ducted since that time cannot be considered conclusive evidence that the
number of mentally ill persons has increased.
Nevertheless, it appears that a greater proportion of mentally ill per-
sons are arrested compared with the general population. One of the better
studies suggesting this disproportionate rate was conducted by Teplin
(1984). Chicago policemen were observed over a 2,200-hour, fourteen-
month period, and 1,382 police-citizen encounters were documented. The
presence of psychiatric illness in a suspect was determined at the scene by
a system that took into account behavioral symptoms and the environmen-
tal context. It was found that 27.9 percent of the suspects without mental
disorders and 46.7 percent of the psychiatrically ill suspects were arrested.
Perhaps two of the more persuasive arguments that a higher proportion
of persons with severe mental illness can be found in the criminal justice
system since deinstitutionalization are the presence of large numbers of such
persons now residing in our jails and prisons and the clinical observations
of clinicians and researchers. It is the impression of clinicians and
researchers that a large proportion of the severely mentally ill persons they
see in jails and prisons are similar in almost every way to long-term patients
in state hospitals before deinstitutionalization (Lamb, 1982). Obviously, life-
time residents of state hospitals had little opportunity to commit crimes and
to be arrested.
In a similar vein, it was observed even in the 1970s that more liberty
for the traditional psychiatric hospital patient placed in the community,
including the ability to refuse treatment, is likely an important factor in
explaining the observed increased arrest rate and violence (Sosowsky, 1978;
Grunberg, Klinger, and Grument, 1977). As discussed below, it is generally
the untreated mentally ill person who is more violent, particularly if sub-
stance abuse is involved.
Mental Illness and Violence. Until recently it was generally believed
that persons with major mental illness such as schizophrenia and bipolar
PERSONS WITH SEVERE MENTAL ILLNESS IN JAILS AND PRISONS
illness were not more likely to commit violent crimes than the general pop-
ulation (Stone, 1997). However, a growing body of evidence has shown a
relationship between mental illness and violence, especially among persons
who are psychotic and do not take their medications (Monahan, 1992; Tor-
rey, 1994; Mulvey, 1994; Link and Stueve, 1995; Mednick, Brennan, and
Katila, 1996; Junginger, 1996; Hodgins and others, 1996; Marzuk, 1996;
Swanson and others, 199713). This relationship is most striking in relatively
nonviolent societies, such as in Scandinavia. For instance, Mednick, Bren-
nan, and Katila (1996) found that males in Denmark with a severe mental
disorder who were admitted to a psychiatric hospital by age forty-four rep-
resented only 5 percent of the total population of males but were responsi-
ble for about 30 percent of all the violent offenses committed by males.
Similarly, female mental patients in Denmark constituted about 5 percent of
the female population but were responsible for 50 percent of all the violent
offenses committed by females. Similar findings were noted in Sweden
Substance abuse also increases the risk of violent behavior, particularly
in combination with severe mental illness (Stone, 1997; Mulvey, 1994; Hod-
gins and others, 1996; Swanson and others, 1997b; Hodgins, 1992; Stead-
man, 1997; Fulwiler and others, 1997). Although it would appear that the
vast majority of persons with serious mental illness are not more dangerous
than the general population, the recent literature cited above suggests the
existence of a subgroup that is more dangerous. It has been asserted that
violent behavior by this subgroup stigmatizes mentally ill persons generally
and that it will be difficult to reduce the stigma until the violence of this
subgroup is addressed (Torrey, 1997).
Causative Factors. The factors most commonly cited as causes of
mentally ill persons’ being placed in the criminal justice system are deinsti-
tutionalization and the unavailability of long-term hospitalization in state
hospitals for persons with chronic and severe mental illness, more formal
and rigid criteria for civil commitment, the lack of adequate support sys-
tems for mentally ill persons in the community, the difficulty mentally ill
persons coming from the criminal justice system have gaining access to
mental health treatment in the community, and a belief by law enforcement
personnel that they can deal with deviant behavior more quickly and effi-
ciently within the criminal justice system than in the mental health system
(Laberge and Morin, 1995; Jemelka, Ti-upin, and Chiles, 1989). A factor less
commonly discussed is the public’s attitudes toward persons with mental
disorders who commit crimes.
In an article about the homeless mentally ill population, Belcher (1988)
wrote that “a combination of severe mental illness, a tendency to decom-
pensate in a nonstructured environment, and an inability or unwillingness
to follow through with voluntary aftercare arrangements and take prescribed
medication contributed to involvement with the criminal justice system.
Wandering aimlessly in the community, psychotic much of the time, and
DEINSTITUTIONALIZATION: PROMISE AND PROBLEMS
unable to manage their internal control systems, these people found the
criminal justice system was an asylum of last resort” (p. 193).
Deinstitutionali4ation. As noted, the belief that deinstitutionalization is
a cause of mentally ill persons’ being placed in the criminal justice system
is a widely held theory for which some evidence exists (Lamb and Grant,
1982; Teplin, 1983). It can certainly be demonstrated that less room cur-
rently exists in state mental hospitals for chronically and severely mentally
ill persons. In 1955, when the number of patients in state hospitals in the
United States reached its highest point, 559,000 persons were institutional-
ized in state mental hospitals out of a total national population of 165 mil-
lion. Now the figure is 57,151 for a population of more than 275 million. In
about forty years, the United States has reduced its number of occupied state
hospital beds from 339 per 100,000 population to 21 per 100,000 on any
given day (Survey and Analysis Branch, Center for Mental Health Services,
2000). However, these figures may not accurately reflect the numbers of per-
sons who receive highly structured twenty-four-hour care because of the
development and growth of a variety of community psychiatric facilities
(many of them locked) in the various states that attempt to provide this
kind of care (Lamb, 1997).
In our opinion, deinstitutionalization set the stage for increasing num-
bers of mentally ill persons to enter the criminal justice system. Moreover,
serious problems in implementing deinstitutionalization have often been
encountered, such as inadequate or inappropriate outpatient treatment,
insufficient community resources, and insufficient twenty-four-hour highly
structured psychiatric care facilities for those who need them. To the extent
that deinstitutionalization has resulted in these problems, we believe that it
is a significant factor accounting for the placement in jails and prisons of
many mentally ill persons who would otherwise be treated in the commu-
nity or in a hospital.
More Restrictive Civil Commitment Criteria. Many people believe that
more stringent civil commitment criteria have contributed not only to dein-
stitutionalization but to an increased number of mentally ill persons in jails
and prisons (Laberge and Morin, 1995; Belcher, 1988; Borzecki and
Wormith, 1985; Husted and Nehemkis, 1995). In 1969, California’s then-
novel civil commitment law, the Lanterman-Petris-Short Act, went into
effect. Within a decade, every state and Puerto Rico made similar modifica-
tions in their commitment codes. Such a rapid and complete consensus
among legislatures is virtually unprecedented. More important, it reflected
a nearly universal view that past inattention to the rights of mentally ill per-
sons needed to be corrected.
In effect, the new civil commitment laws accomplished three things.
First, the laws changed the substantive criteria for commitment from more
general criteria that simply embodied concepts of mental illness and need for
treatment to more specific criteria that embodied either dangerousness result-
ing from mental illness or the incapacity to care for oneself. Second, the laws
PERSONS WITH SEVERE MENTAL ILLNESS IN JAILS AND PRISONS
changed the duration of commitment from indeterminate and extensive peri-
ods to determinate and brief periods. Third, the new laws explicitly provided
that persons civilly committed have rapid access to the courts, attorneys, and,
in some cases, jury trials; this access ensured the kinds of due process guar-
antees to civilly committed persons that criminal defendants had obtained
over the previous decade (Lamb and Mills, 1986).
These procedural safeguards and clear commitment standards resulted
in fewer as well as shorter commitments. Thus, many mentally ill individ-
uals who would otherwise have been civilly committed by family or others
were now left to reside in the community. Moreover, the civil commitment
standard for dangerousness in some states, such as Alaska (Alaska, sec.
47.30.7401, California (California Welfare and Institutions Code, sec. 5300),
and Washington (Revised Code of Washington Annotated [West], sec.
71.05.280), becomes more restrictive when extended commitments are
sought. Therefore, only the most dangerous mentally ill persons remain hos-
pitalized, and the less dangerous are discharged. The result is greatly
increased numbers of mentally ill persons in the community who may com-
mit criminal acts and enter the criminal justice system.
On the other hand, it has been observed that changes in civil commit-
ment law have often not had in practice the impact intended by those who
wrote them (Appelbaum, 1997). These reforms have been resisted by
judges, mental health professionals, families, and even attorneys when they
were seen as shifting the focus away from patients’ treatment needs. Thus,
in some instances, more restrictive commitment laws may not have been an
important cause of an increased number of mentally ill persons in jail.
Access to Treatment. The availability, or lack of availability, of treatment
resources in the community has three important aspects. First, it is clear that
in most, though by no means all, jurisdictions in this country, mental health
treatment, housing, and rehabilitation resources are insufficient to serve the
very large numbers of mentally ill persons in the community (Lamb, 1999).
For instance, case management has come to be viewed as one of the essen-
tial components of an adequate mental health program (Dvoskin and Stead-
man, 1994; Steadman and others, 1984; Kanter, 1995). However, the criminal
justice system is ill prepared to provide case management services to men-
tally ill persons who are leaving jails and prisons. In many jurisdictions, local
mental health agencies have also been slow to provide these services to this
population (Jemelka, Trupin, and Chiles, 1989).
Second, community mental health resources may be inappropriate for
the population to be served (Teplin, Abram, and McClelland, 1996). For
instance, mentally ill persons may be expected to come to outpatient clin-
ics when the real need for a large proportion of this population is outreach
services. Some service providers may lack the ability to provide the degree
of structure required by many mentally ill offenders.
Third, mentally ill persons who have been in jail may not be able to
gain access to community treatment even when it is available. These persons
PROMISE AND PROBLEMS
have been described as resistant to treatment, dangerous, seriously sub-
stance abusing, and “sociopathic” Oemelka, Trupin, and Chiles, 1989;
Borzecki and Wormith, 1985; Draine, Solomon, and Meyerson, 19941, char-
acteristics generally not considered desirable by most community mental
health agencies. Furthermore, because many of these agencies may not have
the capability to provide the needed structure, limit setting, and safety for
staff necessary to treat these persons successfully, their reluctance to treat
them may be appropriate.
A large proportion of mentally ill persons who commit criminal
offenses tends to be highly resistant to psychiatric treatment (Laberge and
Morin, 1995; Borzecki and Wormith, 1985; Lamb, 1987). They may refuse
referral, may not keep appointments, may not be compliant with psychoac-
tive medications, may not abstain from substance abuse, and may refuse
appropriate housing placements. As Whitmer (1980) has observed, attempts
at outpatient treatment with such persons “take on the aspect of a contest
that a woefully unprepared therapist must sooner or later forfeit” (p. 67).
Hence, he used the term JoYfeited patients to emphasize that these persons
are not just passively lost to treatment, but that mental health professionals
have actively struggled to treat them and have had to acknowledge defeat.
Thus, the mental health system finds these mentally ill offenders
extremely difficult to treat and resists serving them (Laberge and Morin,
1995; Draine, Solomon, and Meyerson, 1994). This reluctance extends to
virtually all areas of community-based care, including therapeutic housing,
social and vocational rehabilitation, and general social services Uemelka,
Trupin, and Chiles, 1989). Moreover, many mentally ill offenders are intim-
idating because of previous violent and fear-inspiring behavior. Treating this
group is very different from helping passive, formerly institutionalized
patients adapt quietly to life in the community (Bachrach, Talbott, and Mey-
erson, 1987). Community mental health professionals are not only reluc-
tant but may also be afraid to treat them, especially when measures are not
adopted to ensure staff safety Then these mentally ill persons are left for the
criminal justice system to manage (Draine, Solomon, and Meyerson, 1994).
We should add that we have also seen outpatient facilities in which struc-
ture is provided, staff are protected, and mental health and criminal justice
staff closely collaborate; under such circumstances, many of these persons
are successfully treated.
The Role of the Police. A large proportion of acutely mentally ill persons
come first to the attention of the police (McNiel and others, 1991; Zealberg
and others, 1992; Way, Evans, and Banks, 1993; Lamb and others, 1995).
Even if the police consider the problem to be mental illness, the mental
health option can involve a number of problems and irritants. There may
be long waiting periods in emergency rooms during which police officers
cannot attend to other duties. Mental health professionals may question the
judgment of police and refuse admission, or they may admit for only a brief
hospital stay a person who just a short time before constituted a clear men-
PERSONS WITH SEVERE MENTAL ILLNESS 1N JAILS AND PRISONS
ace to the community (Laberge and Morin, 1995; Lamb and others, 1984;
On the other hand, the police know very well that if they refer a psy-
chiatric case to the criminal justice system, the offender will be dealt with in
a more systematic way. He or she will be taken into custody, will probably be
seen by a mental health professional attached to the court or in the jail, and
will probably receive psychiatric evaluation and treatment. Thus, arrest is a
response with which police are familiar, one over which they have more con-
trol, and one that they believe will lead to an appropriate disposition
(Laberge and Morin, 1995; Holley and Arboleda-Florez, 1988). Moreover,
when persons who are socially disruptive are excluded from psychiatric facil-
ities, the criminal justice system becomes the system “that can’t say no”
(Borzecki and Wormith, 1985, p. 243).
With regard to minor offenses, a number of factors have been pro-
posed to explain why a mentally ill person is arrested rather than taken to
a hospital. A person who appears mentally ill to a mental health profes-
sional may not appear so to police officers, who, despite their practical
experience, have not had sufficient training in dealing with this population
and are still laypersons in these matters (Husted and Nehemkis, 1995;
Husted, Charter, and Perrou, 1995). Also, mental illness may appear to the
police as simply alcohol or drug intoxication, especially if the mentally ill
person has been using drugs or alcohol at the time of arrest. Still another
factor is that in the heat and confusion of an encounter with the police and
other citizens, which may include forcibly subduing the offender, signs of
mental illness may go unnoticed (Lamb and Grant, 1982).
In addition, law enforcement officers may be more inclined to take
mentally ill persons to jail if they believe no appropriate community alter-
natives are available (Ogloff and Otto, 1989), a practice that has been
referred to as mercy booking. Although this practice may be viewed as
unconstitutional, the vast majority of states have not enacted legislation
against detaining noncriminal mentally ill people in jail (Ogloff and others,
The demands of citizens also come into play. Many retail stores have a
policy that anyone caught shoplifting should go to jail, and store managers
are instructed to make a citizen’s arrest and call the police without excep-
tion. In another kind of situation, people who have just been assaulted by
a psychotic person are frequently not inclined to be sympathetic to their
assailant even when mental disturbance is evident. Thus, an angry citizen
may insist on signing a citizen’s arrest and having the person taken to jail.
Society’s Attitudes. The public has traditionally believed that any sen-
tence other than prison is too lenient for serious offenders, even if they are
mentally ill (Petersilia, 1987). Moreover, some view mental illness as voli-
tional and perhaps a deliberate attempt to avoid punishment (Perr, 1985;
Johnson, 1985). Still another important factor is the public’s fear of men-
tally ill persons who commit criminal offenses.
PROMISE AND PROBLEMS
The public’s growing intolerance of perpetrators, whether mentally ill
or not, is demonstrated by its acceptance of and desire for more restrictive
detention laws for offenders. With respect to offenders with mental disor-
ders, some states have repealed sexual psychopathology laws that permitted
mental health treatment for sex offenders rather than criminal processing
and imprisonment. Diminished capacity, which can be a factor in granting a
more lenient sentence, has also been repealed in a number of states. More-
over, legislation has been passed whereby offenders with mental disorders in
prison can have their periods of social control extended if they are identified
as dangerous before their parole date or the expiration of their sentence. For
example, in California, mentally ill offenders considered to be dangerous
(California Penal Code, sec. 2962) and sexually violent predators (Califor-
nia Welfare and Institutions Code, sec. 6600) are usually transferred on their
parole date or on expiration of their sentence to state mental hospitals, where
they are confined for treatment for renewable periods of one or two years. In
our opinion, these laws reflect the attitudes of society toward mentally ill
Although psychiatric interventions exist in the criminal justice system,
mentally ill persons are more strictly controlled in that system than are
patients in psychiatric hospitals (Laberge and Morin, 1995). Moreover, the
criminal justice system, despite protestations to the contrary, appears to
have little interest in decriminalizing persons with psychiatric disorders
even though they represent a considerable burden and use scarce resources.
In a thoughtful article, Laberge and Morin (1995) observed that a general
decriminalization of psychiatric cases would threaten the criminal justice
system to its foundations because such an approach might be perceived as
undermining the principle of equality of all before the law. This perception
would exist even where criminal law recognizes mental disorders as con-
ferring a special status.
Specific treatment of mentally ill persons in the criminal justice system
is often seen as special treatment both by the general public and within the
criminal justice system. For instance, the insanity defense is perceived by
most Americans as a frequently raised defense, as well as a way to evade jus-
tice. However, studies have shown that this defense is seldom used and
rarely successful (Pasewark and Pantle, 1981; Sales and Hafemeister, 1984).
In addition, it has been demonstrated that persons who successfully use this
defense may be detained for considerably longer periods than others con-
victed for the same offenses (Pasewark, 1986; Golding, Eaves, and Kowaz,
Moreover, it appears the criminal justice system is more inclined to
interpret and deal with criminal behavior in terms of illness when the
deviant person acknowledges the illness and is willing to undergo treatment
for it (Conrad and Schneider, 1980). Clearly, the appropriateness of treat-
ing mentally ill offenders safely in the community should be assessed. How-
ever, undertaking successful treatment for this population can be daunting.
PERSONS WITH SEVERE MENTAL ILLNESS IN JAILS AND PRISONS
For instance, Brelje (1985) wrote that effective psychotherapy for mentally
ill offenders involves the patient’s insight, an awareness of vulnerability to
or presence of a mental disorder, a realistic understanding of the nature of
the mental illness, a motivation to change or prevent recurrence of symp-
toms, an acceptance of treatment goals and strategies, realistic personal
goals, and the patient’s awareness of his or her legal status and its meaning.
However, Laberge and Morin (1957) have observed that many mentally
ill offenders do not take responsibility for their illness or their offenses and
do not acknowledge their need for treatment. They refuse a therapeutic rela-
tionship and refuse to take medication and keep appointments. Therefore,
they are often not seen by society as persons who should be excused for their
legal transgressions. It appears that despite the concern of mental health pro-
fessionals and many family members about mentally ill persons in jail, the
general public would show little support for not placing social controls on
individuals who commit offenses and refuse to submit to treatment that sets
limits on their behavior.
Thus, criminalization of mentally ill persons who have committed
minor offenses cannot be seen as resulting simply from the usual explana-
tions of lack of long-term hospitalization, lack of adequate support systems
in the community, difficulty in gaining entry into the mental health system,
and more restrictive criteria for civil commitment. Another crucial factor is
society’s concern that criminal offenses be dealt with and that persons com-
mitting them be controlled and punished, especially if they are not clearly
willing to accept the patient role.
Conclusion and Recommendations
Much has been learned about what needs to be done to prevent mentally ill
persons from being inappropriately placed in the criminal justice system
and about how to treat them once they are there and after they are released
into the community What has been lacking is widespread and comprehen-
sive implementation of interventions shown to be effective (Jamelka, Rah-
man, and Trupin, 1993). Several of these strategies are summarized below.
Steps should be taken to prevent inappropriate arrest of mentally ill
persons (Husted, 1994). The police are often the first to respond to emer-
gencies involving people with severe psychiatric disturbances (Zealberg and
others, 1992). However, the police may not always recognize a need for, or
have access to, emergency psychiatric resources. Clearly, mental health
expertise is needed at this point to prevent criminalization. There is a press-
ing need for formal training of police officers to help them better understand
mental illness and improve their attitudes toward individuals with mental
disorders (Husted, Charter, and Perrou, 1995; Murphy, 1989).
Mental health consultation provided to the police in the field can result
in a response that combines the specialized knowledge and expertise of law
enforcement and mental health professionals. Such an approach can greatly
DEINSTLTUTlONALIZATION: PROMISE AND PROBLEMS
increase the number of mentally ill persons given appropriate access to the
mental health system rather than inappropriately diverted to the criminal
justice system. For example, an evaluation of psychiatric emergency teams
consisting of police officers and mental health professionals found that the
teams were able to deal with psychiatric emergencies in the field, even with
a population characterized by acute and chronic severe mental illness, a
high potential for violence, a high prevalence of serious substance abuse,
and long histories with both the criminal justice and the mental health sys-
tems (Lamb and others, 1995). These teams took or sent almost all of the
persons in crisis to the mental health system and not to jail.
For individuals who are arrested and placed in jail, it is generally rec-
ommended that the facility routinely screen all incoming detainees for
severe mental disorder and that jail administrators negotiate programmatic
relationships with mental health agencies to provide multidisciplinary psy-
chiatric teams (Teplin, 1990; Lamb and others, 1984). These teams should
be established inside jails to provide short-term crisis evaluation, treatment,
and referral to a psychiatric hospital if necessary The teams should include
psychiatrists so that psychoactive medications can be prescribed.
Mentally ill detainees who have committed minor crimes, such as tres-
passing and disorderly conduct, should be diverted to the mental health sys-
tem entirely, or at minimum for treatment. For instance, mental health
teams should be readily available for consultation to the arraignment courts
and especially to the municipal courts, where many acutely psychotic
patients appear with very minimal criminal charges. Steadman, Barbera, and
Dennis (1994) found that only a small number of U.S. jails have diversion
programs for mentally ill detainees. They also observed that objective data
on the effectiveness of these programs are lacking. On the other hand, it has
been found that court-mandated and -monitored treatment in lieu of jail was
effective in obtaining a good outcome for chronically and severely mentally
ill persons who committed misdemeanors (Lamb, Weinberger, and Reston-
Belcher (1988) wrote that a system that relies solely on voluntary com-
pliance may not provide adequate structure for mentally ill offenders. He and
others (Torrey, 1997; Husted, 1994; Swanson and others, 1997a; Hoffman,
1990; Miller, 1992; Clear, Byrne, and Dvoskin, 1993) recommended such
mechanisms as outpatient commitment, court-monitored treatment, treatment
as a condition of probation or parole, and psychiatric conservatorship or
supervision by agencies such as Oregon’s Psychiatric Security Review Board
(Rogers, Bloom, and Manson, 1982). Freeman and Roesch (1989) acknowl-
edged that the court or parole board has a right to set conditions for release
to the community that include mandatory treatment. Nevertheless, mental
health professionals have an ethical and legal obligation to inform patients
fully about the nature of the treatment and obtain their consent for it.
It is important to recognize that persons with mental disorders who are
discharged from psychiatric or correctional institutions experience multi-
PERSONS WITH SEVERE MENTAL
ILLNESS IN JAILS AND PRISONS
ple problems that cannot be adequately treated in traditional community-
based facilities (Stein and Test, 1980; Witheridge and Dincin, 1985). Thus,
placement in the community often results in rehospitalization or reincar-
ceration (Lamb and Weinberger, 1993). To reduce this cycle, assertive case
management programs are recommended.
The great majority of mentally ill offenders need the basic elements of
case management, which starts with the premise that each person has a des-
ignated professional with overall responsibility for his or her care (Dvoskin
and Steadman, 1994; Lamb and Weinberger, 1993). The case manager for-
mulates an individualized treatment and rehabilitation plan with the par-
ticipation of the mentally ill person and often the supervision of the court.
As care progresses, the case manager monitors the mentally ill person to
determine if he or she is receiving and complying with treatment, has an
appropriate living situation, has adequate funds, and has access to voca-
The case manager not only provides outreach services, but also serves
as an advocate for the individual and makes sure that the mentally ill per-
son is not drifting away from the supportive elements of such a network.
An assertive case management program deals with clients on a frequent and
long-term basis, using a hands-on approach that may necessitate meeting
with clients on their own turf or even seeing clients daily (Wilson, Tien, and
Eaves, 1995). This form of contact and familiarity with clients helps the case
manager and client anticipate and prevent significant decompensation.
Important advances have been made in recent years in the management
of the violent behavior of severely mentally ill persons (Harris and Rice,
1997; Buckley and others, 1997). Behavior therapy and pharmacotherapy-
in particular, the use of the new atypical antipsychotic medications-are
a few examples. It is crucial that these modalities be widely implemented.
Mental health agencies in the community must be able to provide the
degree of structure and limit setting needed by mentally ill offenders, as well
as ensure the safety of staff. When highly structured twenty-four-hour care
is required, it should be provided.
The role of family members is an important aspect in the care of men-
tally ill offenders. Often overlooked are family members’ needs for guidance
and support. Families should be instructed in ways to help stabilize their
relative (Lamb and Weinberger, 1993). They should also be involved in sup-
port programs to help them during crises and in self-help programs so they
can benefit from the experience of other families in similar situations (Hyl-
We believe that a significant increase in mental health services for
severely mentally ill persons, from outpatient treatment and case man-
agement to highly structured twenty-four-hour care, would result in far fewer
mentally ill persons’ committing criminal offenses. Thus, one of our most
important recommendations is for increased mental health services. The
criminal justice system should not be viewed as an appropriate substitute
for the mental health system. Moreover, it has been our experience that an
enormous stigma is attached to people who have been categorized as both
mentally ill and an offender, and it is thus extremely difficult to place them
in community treatment and housing. The difficulty is even greater when
they have been in a forensic hospital.
Clearly, many mentally ill persons who commit criminal offenses
present formidable challenges to treatment because of their treatment
resistance, poor compliance with antipsychotic medications, potential
dangerousness, high rate of substance abuse, and need for structure. To
a large extent, the public mental health system has given up on them and
allowed them to become the responsibility of the criminal justice system.
We believe these recommendations would contribute to successful treat-
ment of this population.
Implementing these recommendations would mean tailoring mental
health services to meet the needs of mentally ill offenders and not treating
them as if they were compliant, cooperative, and in need of a minimum of
controls. The lives of a large proportion are characterized by chaos, dys-
phoria, and deprivation as they try to survive in a world for which they are
ill prepared. They cry out for treatment and for structure, and we believe it
is the obligation of the mental health system to provide it. If effective and
appropriate interventions are provided, these individuals may not only
improve psychiatrically but may also engage in considerably less criminal
Abramson, M. F. “The Criminalization of Mentally Disordered Behavior: Possible Side-
Effects of a New Mental Health Law.” Hospital and Community Psychiatry, 1972, 23,
Alaska. Alaska Statutes 47.30.740.
American Bar Association, Criminal Justice Standards Committee. ABA Criminal justice
Mental Health Standards. Washington, D. C.: American Bar Association, Criminal Jus-
tice Standards Committee, 1986.
Appelbaum, P. S. “Almost a Revolution: An International Perspective on the Law of
Involuntary Commitment.”Journal of the American Academy of Psychiatry and the Law,
Arthur Bolton Associates. Report to the California State Legislature. Sacramento, Calif.:
Arthur Bolton Associates, Oct. 1976.
Arvanites, K. “The Impact of State Mental Hospital Deinstitutionalization on Commit-
ments for Incompetency to Stand Trial.” Criminology, 1988,26, 307-320.
Bachrach, L. L., Talbott, J. A,, and Meyerson, A. 7. “The Chronic Psychiatric Patient as
a ‘Difficult’ Patient: A Conceptual Analysis.” In A. T. Meyerson (ed.), Barriers to Treat-
ing the Chronic Mentally Ill. New Directions for Mental Health Services, no 33. San
Francisco: Jossey-Bass, 1987.
Belcher, J. R. “Are Jails Replacing the Mental Health System for the Homeless Mentally
Ill?” Community Mental HealthJournal, 1988, 24, 185-195.
Borzecki, M., and Wormith, J. S. “The Criminalization of Psychiatrically 111 People: A
Review with a Canadian Perspective.” Psychiatric Journal of the University of Ottawa,
PERSONS WITH SEVERE MENTAL ILLNESS IN JAILS AND PRISONS
Brelje, T. B. “Problems of Treatment of NGRIs in an Inpatient Mental Health System.”
Paper presented at a meeting of the Illinois Association of Community Mental Health
Agencies, Chicago, 1985.
Buckley, P. F., and others. “Aggression and Schizophrenia: Efficacy of Risperidone.” Jour-
nal ofthe American Academy o f Psychiatry and the Law, 1997,25, 173-181.
California. California Penal Code, sec. 2962.
California. California Welfare and Institutions Code, sec. 5300.
California, California Welfare and Institutions Code, sec. 6600.
Clear, T. R., Byme, J. M., and Dvoslun, J. A. “The Transition from Being an Inmate: Discharge
Planning, Parole, and Community-Based Services for Offenders with Mental Illness.” In
H. J. Steadman and J. J. Cocozza (eds.), Mental Illness in America’s Prisons. Seattle, Wash.:
National Coalition for the Mentally I11 in the Criminal Justice System, 1993.
Cocozza, J. J., Steadman, H. J., and Melick, M. E. “Trends in Violent Crime Among
Ex-Mental Patients.” Criminology, 1978, 16, 317-334.
Conrad, P., and Schneider, J. W. Deviance and Medicalization: From Badness to Sickness.
St. Louis, Mo.: Mosby-Year Book, 1980.
Davis, S. “Assessing the ‘Criminalization’ of the Mentally I11 in Canada.” Canadianlour-
nal ofpsychiatry, 1992,37, 532-538.
Dickey, W. “Incompetency and the Nondangerous Mentally I11 Client.” Criminal Law
Bulletin, 1980, 16, 22-40.
Draine, J., Solomon, P., and Meyerson, A. T. “Predictors of Reincarceration Among
Patients Who Received Psychiatric Services in Jail.” Hospital and Community Psychia-
try, 1994,45, 163-167.
Dvoskin, J. A., and Steadman, H. J. “Using Intensive Case Management to Reduce Vio-
lence by Mentally 111 Persons in the Community.” Hospital and Community Psychiatry,
Freeman, R. J., and Roesch, R. “Mental Disorder and the Criminal Justice System: A
Review.” InternationalJournal ofLaw and Psychiatry, 1989, 12, 105-115.
Fulwiler, C., and others. “Early-Onset Substance Abuse and Community Violence
by Outpatients with Chronic Mental Illness.” Psychiatric Services, 1997, 48,
Gibbs, J. J. “Problems and Priorities: Perceptions of Jail Custodians and Social Service
Providers.”Journal o f Criminal Justice, 1983, 11, 327-349.
Golding, S., Eaves, D., and Kowaz, A. “The Assessment, Treatment, and Community
Outcome of Insanity Acquitees: Forensic History and Response to Treatment.” Inter-
nationalJournal of Law and Psychiatry, 1989, 12, 149-179.
Grunberg, F., Klinger, B. I., and Grument, B. R. “Homicide and the Deinstitutionaliza-
tion of the Mentally 111.” AmericanJournal ofpsychiatry, 1977, 134, 685-687.
Guy, E., and others. “Mental Health Status of Prisoners in an Urban Jail.” CriminafJus-
tice and Behavior, 1985, 12, 29-53.
Harris, G. T,, and Rice, M. E. “Risk Appraisal and Management of Violent Behavior.”
Psychiatric Services, 1997,48, 1168-1176.
Hochstedler, E. “Criminal Prosecution of the Mentally Disordered.” Law and Society
Review, 1986,20, 279-292.
Hochstedler, E. “Twice-Cursed? The Mentally Disordered Defendant.” Criminal Justice
and Behavior, 1987,14,251-267.
Hodgins, 5. “Mental Disorder, Intellectual Deficiency, and Crime: Evidence from a Birth
Cohort.” Archives of General Psychiatry, 1992,49,476-483.
Hodgins, S., and others. “Mental Disorder and Crime: Evidence from a Danish Birth
Cohort.” Archives o f General Psychiatry, 1996,53, 489-496.
Hoffman, B. F. “The Criminalization of the Mentally Ill.” CanadianJournal of Psychiatry,
Holley, H. L., and Arboleda-Florez, J. “Criminalization of the Mentally 1 1 1 : I. Police Per-
ceptions.” CanadianJournal o f Psychiatry, 1988,33, 81-86.
Husted, J. R. “The Last Asylum: The Mentally Ill Offender in the Criminal Justice Sys-
tem.” In D. T. Marsh (ed.), New Directions in the Psychological Treatment of Serious
Mental Illness. New York Praeger, 1994.
Husted, J. R., Charter, R. A,, and Perrou, M. A. “California Law Enforcement Agencies
and the Mentally I11 Offender.” Bulletin of the American Academy of Psychiatry and the
Husted, J., and Nehemkis, A. “Civil Commitment Viewed from Three Perspectives: Pro-
fessional, Family, and Police.” Bulletin of the American Academy of Psychiatry and the
Hylton, J. H. “Care or Control: Health or Criminal Justice Options for the Long-Term
Seriously Mentally Ill in a Canadian Province.” InternationalJournaI of Law and Psy-
Jemelka, R. P., Rahman, S., and Trupin, E. W. “Prison Mental Health: An Overview.” In
H. J. Steadman and J. J. Cocozza (eds.), Mental Illness in America’s Prisons. Seattle,
Wash.: National Coalition for the Mentally 111 in the Criminal Justice System, 1993.
Jemelka, R. P., Trupin, E. W., and Chiles, J. A. “The Mentally I11 in Prisons: A Review.”
Hospital and Community Psychiatry, 1989,40,481-491.
Jemelka, R. P., and others. “Computerized Offender Assessment: Validation Study.” Psy-
chological Assessment, 1992,4, 138-144.
Johnson, P. E. “The Turnabout in the Insanity Defense” In M. Tonry and N. Morris
(eds.), Crime andjustice: An Annual Review o f Research. Chicago: University of Chicago
Junginger, J. “Psychosis and Violence: The Case for a Content Analysis of Psychotic
Experience.” Schizophrenia Bulletin, 1996,22, 91-103.
Kanter, J. (ed.). Clinical Studies in Case Management. New Directions for Mental Health
Services, no. 65. San Francisco: Jossey-Bass, 1995.
Laberge, D., and Morin, D. “The Overuse of Criminal Justice Dispositions: Failure of
Diversionary Policies in the Management of Mental Health Problems.” International
Journal ofLaw and Psychiatry, 1995, 18, 389-414.
Lamb, H. R. Treating the Long-Term Mentally Ill. San Francisco: Jossey-Bass, 1982.
Lamb, H. R. “Incompetency to Stand Trial: Appropriateness and Outcome.” Archives of
General Psychiatry, 1987, 44, 754-758.
Lamb, H. R. “The New State Mental Hospitals in the Community.” Psychiatric Services,
Lamb, H. R. “Public Psychiatry and Prevention.” In R. E. Hales, S. C. Yudofsky, and J.
A. (eds.), Textbook of Psychiatry. (3rd ed.) Washington, D.C.: American Psychiatric
Lamb, H. R., and Grant, R. W. “The Mentally 1 1 1 in an Urban County Jail.” Archives of
General Psychiatry, 1982,39, 17-22.
Lamb, H. R., and Grant, R. W. “Mentally I11 Women in a County Jail.” Archives of Gen-
eral Psychiatry, 1983,40, 363-368.
Lamb, H. R., and Mills, M. J. “Needed Changes in Law and Procedure for the Chroni-
cally Mentally Ill.” Hospital and Community Psychiatry, 1986,37, 475-480.
Lamb, H. R., and Weinberger, L. E. “Therapeutic Use of Conservatorship in the Treat-
ment of Gravely Disabled Psychiatric Patients.” Hospital and Community Psychiatry,
Lamb, H. R., Weinberger, L. E., and Reston-Parham, C. “Court Intervention to Address the
Mental Health Needs of Mentally Ill Offenders.” Psychiatric Services, 1996,47, 275-281.
Lamb, H. R., and others. “Psychiatric Needs in Local Jails: Emergency Issues.” American
Journal of Psychiatry, 1984, 141, 774-777.
Lamb, H. R., and others. “Outcome for Psychiatric Emergency Patients Seen by an Out-
reach Police-Mental Health Team.” Psychiatric Services, 1995, 4, 1267-1271.
Link, B. G., and Stueve, A. “Evidence Bearing on Mental Illness as a Possible Cause of
Violent Behavior.” Epidemiological Review, 1995, 17, 172-181.
PERSONS WITH SEVERE MENTAL
ILLNESS IN JAILS
Martell, D. A., Rosner, R., and Harmon, R. B. “Base-Rate Estimates of Criminal Behavior by
Homeless Mentally I11 Persons in New York City.” Psychiatric Services, 1995,46,596-600.
Marzuk, P. M. “Violence, Crime, and Mental Illness: How Strong a Link?” Archives o f
General Psychiatry, 1996,53, 481-486.
McNiel, D. E., and others. “Characteristics of Persons Referred by Police to the Psychi-
atric Emergency Room.” Hospital and Community Psychiatry, 1991, 42, 425-427.
Mednick, S. A,, Brennan, P., and Katila, H. “Mental Illness, Violence, and Fetal Neural
Development.” Paper presented at the annual meeting of the American Psychiatric
Association, New York, May 4-9, 1996.
Michaels, D., and others. “Homelessness and Indicators of Mental Illness Among Inmates
in New York City’s Correctional System.” Hospital and Community Psychiatry, 1992,
Miller, R. D. “An Update on Involuntary Civil Commitment to Outpatient Treatment.”
Hospital and Community Psychiatry, 1992, 43, 79-81.
Monahan, J. “Mental Disorder and Violent Behavior.” American Psychologist, 1992, 47,
Mulvey, E. P. “Assessing the Evidence of a Link Between Mental Illness and Violence.”
Hospital and Community Psychiatry, 1994,4.5, 663-668.
Murphy, G. R. Managing Persons with Mental Disabilities: A Curriculum Guide for Police
Trainers. Washington, D.C.: Police Executive Research Forum, 1989.
Neighbors, H. W. “The Prevalence of Mental Disorder in Michigan Prisons.” DIS
Newsletter [Department of Psychiatry, Washington University School of Medicine, St.
Louis], 1987, 7, 8-1 1.
Ogloff, R. P., and Otto, R. K. “Mental Health Interventions in Jails.” In P. Keller and S.
Heyman (eds.), Innovations in Clinical Practice. Sarasota, Fla.: Professional Resource
Ogloff, R. P., and others. “Preventing the Detention of Non-Criminal Mentally 111 Peo-
ple in Jails: The Need for Emergency Protective Custody Units.” Nebraska Law Review,
Palermo, G. B., Smith, M. B., and Liska, F. J. ‘Jails Versus Mental Hospitals: A Social
Dilemma.” International journal o f Offender Therapy and Comparative Criminology,
Pasewark, R. A. “A Review of Research on the Insanity Defense.” Annals o f the American
Academy o f Political and Social Science, 1986,484, 100-1 14.
Pasewark, R. A., and Pantle, M. “Opinions About the Insanity Plea.” journal of Forensic
Psychology, 1981,8, 63-67.
Penrose, L. “Mental Disease and Crime: Outline of a Comparative Study of European
Statistics.” BritishJournal o f Medical Psychology, 1939, 18, 1-15.
Perr, 1. N. “The Insanity Defense: The Case for Abolition.” Hospital and Community Psy-
chiatry, 1985,36, 51-54.
Petersilia, J. Expanding Optionsfor Criminal Sentencing. Santa Monica, Calif.: Rand, 1987.
Rogers, A. “Policing Mental Disorder: Controversies, Myths, and Realities.” Social Pol-
icy and Administration, 1990,24, 226-236.
Rogers, J. L., Bloom, J. D., and Manson, S. “Oregon’s Innovative System for Supervising
Offenders Found Not Guilty by Reason of Insanity.” Hospital and Community Psychi-
atry, 1982,33, 1022-1023.
Sales, B., and Hafemeister, T. “Empiricism and Legal Policy on the Insanity Defense.” In
L. Teplin (ed.), Mental Health and Criminal Justice. Thousand Oaks, Calif.: Sage, 1984.
Schuerman, L. A,, and Kobrin, S. “Exposure of Community Mental Health Clients to the
Criminal Justice System: ClientKriminal or Patienflrisoner.” In 1. Teplin (ed.), Men-
tal Health and Criminal justice. Thousand Oaks, Calif.: Sage, 1984.
Sosowsky, L. “Crime and Violence Among Mental Patients Reconsidered in View of the
New Legal Relationship Between the State and the Mentally 111.” AmericanJournal uf
Psychiatry, 1978, 13.5, 33-42.
Sosowsky, L. “Explaining the Increased Arrest Rate Among Mental Patients: A Caution-
ary Note.” AmericanJouriial ojpsychiatry, 1980, 137, 1602-1605.
Steadman, H. J. “Risk Factors for Cominunity Violence Among Acute Psychiatric Inpa-
tients: The MacArthur Risk Assessment Project.” Paper presented at the annual meet-
ing of the American Psychiatric Association, San Diego, May 17-22, 1997.
Steadman, H. J., Barbera, S. S., and Dennis, D. L. “A National Survey ofJail Diversion
Programs for Mentally 111 Detainees.” Hospital and Community Psychiatry, 1994, 45,
Steadman, H. J., Cocozza, J. J., and Melick, M. E. “Explaining the Increased Arrest Rate
Among Mental Patients: The Changing Clientele of State Hospitals.” AmericanJour-
nal of Psychiatry, 1978, 135, 816-820.
Steadman, H. J., Vanderwyst, D., and Ribner, S. “Comparing Arrest Rates of Mental
Patients and Criminal Offenders.” ArnericanJournal o f Psychiatry, 1978, 135, 1218-1224.
Steadman, H. J., and others. “The Impact of State Mental Hospital Deinstitutionalization
on United States Prison Populations, 1968-1978,”Journal o f Criminal Law and Crim-
inology, 1984, 75, 474-490.
Steadman, H. J.. and others. “A Survey of Mental Disability Among State Prison Inmates.”
Hospital and Community Psychiatry, 1987, 38, 1086-1090.
Stein, L. I., and Test, M. A. “Alternative to Mental Hospital Treatment.” Archives of Gen-
eral Psychiatry, 1980,37, 392-397.
Stelovich, S. “From the Hospital to the Prison: A Step Forward in Deinstitutionaliza-
tion?” Hospital and Community Psychiatry, 1979, 30, 618-620.
Steury, E. H. “Specifying ‘Criminalization’ of the Mentally Disordered Misdemeanant.”
Journal of Criminal Law and Criminology, 1991, 82, 334-359.
Stone, A. A. “Comment.” AmericanJournal ofpsychiatry, 1978, 135, 61-63.
Stone, M. H. “Criminality and Psychopathology.” journal of Practical Psychiatry and
Behavioral Health, 1997,3, 146-155.
Survey and Analysis Branch, Center for Mental Health Services. Resident Patients in State
and County Mental Hospitals, 1998 Suwey. Washington, D.C.: Substance Abuse and Men-
tal Health Services Administration, U.S. Department of Health and Human Senices, 2000.
Swank, G., and Winer, D. “Occurrence of Psychiatric Disorders in a County Jail Popu-
lation.” ArnericanJournal ofpsychiatry, 1976, 133, 1331-1333.
Swanson, J. W., and others. “Interpreting the Effectiveness of Involuntary Outpatient
Commitment: A Conceptual Model.” Journal of the American Academy of Psychiatry
and the Law, 1997a, 25, 5-16.
Swanson, J. W., and others. “Violence and Severe Mental Disorder in Clinical and Com-
munity Populations: The Effects of Psychotic Symptoms, Comorbidity, and Lack of
Treatment.” Psychiatry, 1997b, 60, 1-22.
Teplin, L. A. “The Criminalization of the Mentally Ill: Speculation in Search of Data.”
Psychological Bulletin, 1983, 94, 54-67.
Teplin, L. A. “Criminalizing Mental Disorder: The Comparative Arrest Rate of the Men-
tally Ill.” American Psychologist, 1984, 39, 794-803.
Teplin, L. A. “The Prevalence of Severe Mental Disorder Among Male Urban Jail
Detainees: Comparison with the Epidemiologic Catchment Area Program.” American
Journal of Public Health, 1990, 80, 663-669.
Teplin, L. A., Abram, K. M., and McClelland, G. M. “Prevalence of Psychiatric Disorders
Among Incarcerated Women.” Archives of General Psychiatry, 1996,53, 505-512.
Torrey, E. F. “Violent Behavior by Individuals with Serious Mental Illness.” Hospital and
Community Psychiatry, 1994,4, 653-662.
Torrey, E. F. Out o f the Shadows: Confronting America’s Mental Illness Crisis. New York:
U.S. Department of Justice, Bureau of Justice Statistics. State and Federal Prisons Report
Record Growth During Last Twelve Months. Washington, D.C.: U.S. Department of Jus-
tice, Bureau of Justice Statistics, Dec. 1995.
PERSONS WITH SEVERE MENTAL Download full-text
ILLNESS IN JAILS
Washington. Revised Code of Washington Annotated (West), sec. 71.05.280.
Way, B. B., Evans, M. E., and Banks, S. M. “An Analysis of Police Referrals to 10 Psy-
chiatric Emergency Rooms.” Bulletin of the American Academy of Psychiatry and the
Law, 1993,21, 389-396.
Whitmer, G. E. “From Hospitals to Jails: The Fate of California’s Deinstitutionalized
Mentally Ill.” Americanlournal of Orthopsychiatry, 1980,50, 65-75.
Wilson, D., Tien, G., and Eaves, D. “Increasing the Community Tenure of Mentally Dis-
ordered Offenders: An Assertive Case Management Program.” JnternationalJournal o f
Law and Psychiatry, 1995, 18, 61-69.
Witheridge, T. F., and Dincin, J. “The Bridge: An Assertive Outreach Program in an
Urban Setting.” In L. 1. Stein and M. A. Test (eds.), The Training in Community Living
Model: A Decade ofExperience. New Directions for Mental Health Services, no 26. San
Francisco: Jossey-Bass, 1985.
Zealberg, J. J., and others. “A Mobile Crisis Program: Collaboration Between Emergency
Psychiatric Services and Police.” Hospital and Community Psychiatry, 1992, 43,
6 12-61 5.
Zitrin, A,, and others. “Crime and Violence Among Mental Patients.” AmericanJournal
ofpsychiatry, 1976, 133, 142-149.
H. RICHARD LAMB is professor ofpsychiatry and the behavioral sciences at Keck
School of Medicine, University of Southern California, in Los Angeles.
LINDA E. WEINBERGER
at the Institute ofpsychiatry, Law, and Behavioral Sciences at Keck School of
Medicine, University of Southern California, in Los Angeles.
is professor of clinical psychiatry and chief psychologist