[Show abstract][Hide abstract] ABSTRACT: The purpose of this paper is to cast a vision for the next generation of behavioral health and criminal justice interventions for persons with serious mental illnesses in the criminal justice system. The limitations of first generation interventions, including their primary focus on mental health treatment connection, are discussed. A person–place framework for understanding the complex factors that contribute to criminal justice involvement for this population is presented. We discuss practice and research recommendations for building more effective interventions to address both criminal justice and mental health outcomes.
International Journal of Law and Psychiatry 09/2014; 37:427-438. · 1.19 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: With the large and growing number of persons with mental illnesses under probation supervision, a form of specialized probation called specialized mental health caseload (SMHC) has been implemented. This study explores the effectiveness of a prototypic SMHC implemented statewide. A quasi-experimental design was used to compare criminal justice, mental health, and community engagement outcomes among three caseloads: a newly established SMHC supervising no more than 30 clients per officer (N = 1367); an established SMHC supervising roughly 50 clients per officer (N = 495); and a traditional caseload of clients receiving mental health treatment and supervised by officers with average caseloads of over 130 clients (N = 5453). Using a mixed methods approach, we found that the SMHC was implemented with high adherence to fidelity, and comparisons based on different caseload samples generally support the effectiveness of the specialized mental health caseload, particularly on criminal justice outcomes. Future studies using random assignment are needed to examine the connection among mental health symptoms, compliance with treatment and probation supervision, and recidivism.
International Journal of Law and Psychiatry 09/2014; · 1.19 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: The effectiveness of specialized interventions depends in part on the target population and whether those selected for admis-sion to interventions (i.e., specialized programs) and recruited to participate in research evaluations are representative of the target population. This article describes the process by which clients were selected to participate in a specialized mental health caseload (SMHC). The study focuses on the referral and selection process at the program level and the factors influencing acceptance and rejection. Using a mixed methods approach, we found that selection was guided by a three-stage process: The first was a general education phase, followed by an informal pre-screening stage, and finally a formal screening stage. Once clients were referred, client selection was informed principally by the program's formal criteria. Informal processes appeared consistent with the formal selection criteria. Further research is necessary to assess potential bias prior to the formal referral process.
Criminal Justice and Behavior 09/2014; 41:536-552. · 1.71 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Trauma exposure and trauma-related symptoms are prevalent among incarcerated men, suggesting a need for behavioral health intervention. A random sample of adult males (N = 592) residing in a single high-security prison were screened for trauma exposure and posttraumatic stress disorder (PTSD) symptoms. Trauma was a universal experience among incarcerated men. Rates of current PTSD symptoms and lifetime PTSD were significantly higher (30 to 60 %) than rates found in the general male populations (3 to 6 %). Lifetime rates of trauma and PTSD were associated with psychiatric disorders. This study suggests the need for a gender-sensitive response to trauma among incarcerated men with modification for comorbid mental disorders and type of trauma exposure. Developing gender-sensitive trauma interventions for incarcerated men and testing them is necessary to improve the behavioral health outcomes of incarcerated men who disproportionately return to urban communities.
Journal of Urban Health 05/2014; · 1.89 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Adults with serious mental illness (SMI) experience criminal victimization at rates higher than the general population whether they reside in the community or correctional settings. This study examines the past-six month prevalence and correlates of criminal victimization among a large community sample (N = 2,209) of consumers with SMI newly admitted to outpatient mental health services during 2005 through 2008. A cross-sectional design was used with self-report and clinical data collected from administrative records. Victimization was determined by responses to direct questions about experiences in the previous 6 months with respect to victimization of a non-violent and/or violent crime. Socio-demographic, clinical and criminal correlates of victimization were abstracted from a quality of life survey and clinical assessment interview conducted at admission. Overall, 25.4 % of consumers reported being a victim of any crime (violent or non-violent) in the past 6 months, with 20.3 % reporting non-violent and 12.3 % violent victimization. The risk of victimization was elevated for those who were female, White, not taking atypical psychotropic medication, not feeling safe in their living arrangement, and were arrested or homeless in the six-months prior to engaging in mental health outpatient treatment. Policy and practice implications of these findings are discussed.
Community Mental Health Journal 12/2013; · 1.03 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: This study examines the relationship between behavioral health problems and criminogenic thinking, aggression, self-control, and hopelessness, controlling for other demographic and criminal behavior characteristics among incarcerated persons. Male (n = 3,986) and female (n = 218) inmates expected to be released within 24 months from prisons affiliated with a northeastern state department of corrections completed the Criminal Sentiments Scale–Modified, Buss–Perry Aggression Questionnaire Short-Form, Brief Self-Control Scale, and Beck Hopelessness Scale. Results indicated that behavioral health variables were significantly and substantially correlated with antisocial thinking, aggression, self-control, and hopelessness. For male inmates, serious mental illness and substance abuse problems significantly increased antisocial attitudes, aggression, and hopelessness scores and decreased self-control scores. In preparing incarcerated persons with and without mental illnesses for reentry to the community, it is critical to develop and implement evidence-based interventions that respond to attitudinal and emotional risk factors that predict relapse and recidivism.
Criminal Justice and Behavior 10/2013; 40(10):1092-1108. · 1.71 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Specialized interventions, such as police and jail diversion, mental health courts, specialized probation, forensic assertive community treatment, designed to engage justice-involved persons with serious mental illnesses, have expanded over the past two decades. Some of these "first generation" interventions have demonstrated efficacy and several have earned recognition as evidence-based practices. Yet, overall, they have not appreciably reduced the prevalence of persons with serious mental illnesses involved in the criminal justice system. To understand how to make the next generation of interventions more effective, a survey of a national sample of community-based programs serving these clients was conducted. Surveys were completed on-line by direct service staff affiliated with 85 programs and collected data on the characteristics and needs of the client base; characteristics and challenges associated with difficult-to-engage clients; service needs and obstacles; and recommendations for improving program effectiveness. A sample of the survey participants (19 programs from 18 states) attended a day-long workshop to discuss the survey findings and ways to improve treatment adherence and client services. Respondents reported that their clients have a constellation of problems with different origins, etiologies, and symptoms, often crossing over the boundaries of mental illness, addictions, and antisocial pathologies. According to the practitioners working with justice-involved clients with mental illnesses, responding effectively requires knowledge of many different problems, expertise to respond to them, and an understanding of how these problems interact when they co-occur. The poly-problems of these clients suggest the need for an integrated and comprehensive approach, which is challenged by the fragmented and diverse ideologies of the behavioral health, criminal justice, and social service systems.
International Journal of Law and Psychiatry 11/2012; · 1.19 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: An open trial design was used to examine the implementation and effectiveness of a cognitive-behavioral intervention (Seeking Safety) for comorbid post-traumatic stress disorder (PTSD) and substance use disorder (SUD) for incarcerated women with Axis I mental disorders who self-referred for specialty trauma treatment. The study sample was female inmates aged 18 and old who were primarily minority, had experienced childhood-based trauma, committed violent crimes, had a serious mental illness, and resided in maximum, medium, and minimum compounds of a women's prison. A total of 74 women completed the group intervention, with the average attending 23 of the 28 sessions (82%). Implementation feasibility was demonstrated by the ability to recruit, screen, assign, and retain participation. Effectiveness was supported by changes pre-post intervention on the PTSD Checklist (ES=0.56) and Global Severity Index (ES=0.47). Of the 19 completers with PCL scores of 50 or higher pre-intervention, 16 (84%) had scores below 50, the "cut score" consistent with or supportive of a PTSD diagnosis. Three-quarters or more of participants reported that Seeking Safety was helpful in each of the following areas: overall, for traumatic stress symptoms, for substance use, to focus on safety, and to learn safe coping skills. Future directions include the need for larger scale randomized controlled trials in medium or maximum security prisons and fidelity evaluations of non-research dissemination efforts.
Journal of anxiety disorders 06/2012; 26(7):703-10. · 2.68 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: This study examined weight and weight-related medical conditions of soon-to-be released inmates with and without a mental disorder. The sample included 4,204 males and females aged 18 or older residing in 11 state prisons. Three quarters or more of the inmates were overweight or obese. Mental health status was not found to be a significant factor in the presence or absence of overweight or obesity. Male inmates with mental disorders had higher rates of breathing, walking, and intense pain problems compared to those without mental disorders. Obese male inmates with schizophrenia or bipolar were more likely than those without a mental disorder to report medication treatment for diabetes, cardiovascular problems, arthritis, and intense pain. Evidence-based interventions are needed to monitor weight and obesity during incarceration and to teach weight management skills as part of an integrated psychiatric and medical program.
Journal of Correctional Health Care 05/2012; 18(3):219-32.
[Show abstract][Hide abstract] ABSTRACT: Rates of childhood and adult trauma are high among incarcerated persons. In addition to criminality, childhood trauma is associated with the risk for emotional disorders (e.g., depression and anxiety) and co-morbid conditions such as alcohol and drug abuse and antisocial behaviors in adulthood. This paper develops rates of childhood and adult trauma and examines the impact of age-of-onset and type-specific trauma on emotional problems and behavior for a sample of incarcerated males (N~4,000). Prevalence estimates for types of trauma were constructed by age at time of trauma, race and types of behavioral health treatment received while incarcerated. HLM models were used to explore the association between childhood and adult trauma and depression, anxiety, substance use, interpersonal problems, and aggression problems (each model estimated separately and controlling for age, gender, race, time incarcerated, and index offense). Rates of physical, sexual, and emotional trauma were higher in childhood than adulthood and ranged from 44.7% (physical trauma in childhood) to 4.5% (sexual trauma in adulthood). Trauma exposure was found to be strongly associated with a wide range of behavioral problems and clinical symptoms. Given the sheer numbers of incarcerated men and the strength of these associations, targeted intervention is critical.
International Journal of Environmental Research and Public Health 05/2012; 9(5):1908-26. · 2.00 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: While reentry funding is flowing into states, its target efficiency and effectiveness depends on whether it goes to the right people in the right ways. The purpose of this study was to examine whether and how the amount of time incarcerated affects reentry readiness.
A population-based survey was conducted. Approximately 4000 soon-to-be-released male inmates were drawn from a state correctional system. Readiness is described in terms of feeling ready and material, social, and treatment resources available for reentry by time served on current conviction (episode effect) and since age 18 (cumulative effect). Generalized hierarchical linear models were used to estimate the effects of demographic, criminological, and time served variables on reentry readiness outcomes.
Reentry vulnerability increased with time served since turning 18 (cumulative effect) but not with time served on the current conviction (episode effect). Inmates serving more than 10 years since turning 18 were at greatest reentry risk.
The findings indicate that inmates who have served more prison time over their lifetime have more pronounced needs and risks suggesting that reentry funding be targeted towards those who have served more time over the course of their lifetime.
Journal of Criminal Justice 01/2012; 40(5):379-385. · 1.24 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: This study explored criminal thinking styles and feelings of aggression and hopelessness among male and female inmates who reported mental disorders and those who did not.
A total of 4,204 respondents (3,986 males and 218 females) who were expected to be released from prison within 24 months completed an hour-long audio computer-assisted self-interview survey that included the Beck Hopelessness Scale, Buss-Perry Aggression Questionnaire Short-Form, and Criminal Sentiments Scale-Modified. Weights were constructed to adjust the sampled population to the full population of the prison.
A mental disorder was reported by 19.8% of male and 46.1% of female participants, with 6.6% of males and 19.4% of females reporting a serious mental disorder. The criminal thinking patterns of male and female inmates who reported mental disorders were consistent with those of inmates who reported no mental disorders; however, levels of criminal attitudes were significantly higher among males reporting serious mental disorders than males reporting other mental disorders or no disorders. Inmates reporting mental disorders scored significantly higher on measures of aggression and hopelessness.
Results of this study suggest that inmates who report mental disorders have antisocial attitudes consistent with inmates who do not report mental disorders but have levels of aggression and hopelessness that are higher than their counterparts who do not report mental disorders. These findings are vital to the development of evidence-based interventions that respond accurately and holistically to the complex constellation of needs among persons with mental disorders who are involved in the justice system.
[Show abstract][Hide abstract] ABSTRACT: Diverting potential arrestees with serious mental illnesses from the criminal justice system to mental health services has become a mainstay of public policy. Federal funding for local diversion and mental health court programs mandates that recipients of funds focus on "nonviolent misdemeanants," allowing more serious offenders to proceed through the justice system. This study explored the potential effects of applying such exclusions to a group of arrestees with serious psychiatric illnesses.
Data on charges in a cohort of mental health service recipients (N=13,816) were analyzed.
Episodes of felony arrest, including some involving violence toward others, outnumbered misdemeanors. Under federal funding policies, many such cases would be processed through the justice system.
Expanding inclusion criteria is necessary if diversion is to significantly affect incarceration rates among persons with mental illnesses. Policy makers should heed the accumulating evidence in this area in determining priorities for funding.
[Show abstract][Hide abstract] ABSTRACT: This study examined the traumatic and stressful event exposure history and psychiatric health characteristics of soon-to-be released female inmates who self-referred to specialty posttraumatic stress disorder (PTSD) treatment.
The final sample (N=209) included female prison inmates aged 18 or older who were assessed for trauma exposure and axis I disorders with standardized clinical instruments.
The rate of serious mental disorders was high. Presence of psychiatric disorders was significantly associated with a history of traumatic event exposure and full or subthreshold PTSD, and high rates of overall traumatic event exposure (88%) and childhood sexual or physical trauma (74%). Descriptive profiles of specific lifetime traumatic and stressful events were associated with psychiatric disorders.
Findings suggest strong behavioral effects associated with lifetime traumatic and stressful event histories and indicate major psychiatric health care needs among female prison inmates that are likely unmet by existing services.
[Show abstract][Hide abstract] ABSTRACT: This study compared arrest rates on a broad range of offenses in a cohort of public mental health service recipients and in the general population.
Administrative data from a state mental health agency were merged with data capturing arrests over a 9.5-year period in a cohort of persons with severe and persistent mental illness who used public mental health services and were aged 18-54 (N=10,742). The cohort's arrest rates for eight offense categories were compared with those of the general population for persons in the same age group over the same period (N=3,318,269). The data for the cohort that received mental health services were weighted by age and gender to align the cohort's demographic characteristics with those of the general population.
The service use cohort members' odds of experiencing at least one arrest in any charge category were significantly higher than those of the general population (odds ratio [OR]=1.62, 95% confidence interval=1.52-1.72); odds were higher across all charge categories, with ORs ranging from 1.84 for drug-related offenses to 5.96 for assault and battery on a police officer. Aside from the crime of assault and battery on a police officer, the largest ORs were associated with misdemeanor crimes against persons and property and with crimes against public decency. ORs associated with felony charges, while significant, tended to be slightly smaller in magnitude.
The offenses for which persons with serious mental illness are at greatest risk of arrest are many of those targeted by current diversion programs. These findings suggest the need for additional research addressing the ways in which individual psychopathology and socioenvironmental factors affect risk of offending in this population.
[Show abstract][Hide abstract] ABSTRACT: Little is known about the patterns of sexual victimization inside prisons and their relationship to inmates’ feelings of safety. This study examined patterns of sexual victimization with and without co-occurring physical victimization and feelings of safety as reported by 6,964 male and 564 female inmates. Respondents completed a computerized survey with questions about type of victimization (sexual/physical) and source of victimization (inmate/staff). Compared to sexual assault, inappropriate sexual touching was more common, especially among female inmates (22% versus 4%), whereas sexual assault was relatively less common for male and female inmates (< 2%). Sexual victimization often involved one to three types of sexually inappropriately behavior. Victimization perpetrated by staff was more frequently reported by male inmates. Most inmates, independent of gender and sexual victimization, reported feeling safe inside prison. Inmates who felt the most unsafe reported sexual victimization by staff or concurrent sexual and physical victimization (n = 150).
[Show abstract][Hide abstract] ABSTRACT: Drug courts are quite popular but admit relatively small percentages of eligible offenders. Some participants may also not be appropriate for available treatment, further affecting the validity of evaluation findings. The authors used qualitative data from six representative drug courts to examine screening and admission processes in detail. Two distinct screening models were identified: (a) the prosecutor as key initial gatekeeper in diversion drug courts and (b) drug court staff as gatekeeper in postplea courts. Each had three stages: initial eligibility screening using formal eligibility criteria, evidence-based eligibility assessment incorporating clinical assessments and other screening, and judicial and client approval. Drug court admission is complex, with many decision points, gatekeepers, formal and informal criteria, and opportunities for rejection or refusal. The findings help explain drug courts’ low population penetration and suggest the importance of documenting admission processes to identify selection effects in evaluations and inform strategies to improve targeting and admissions.
Criminal Justice and Behavior 01/2011; 38(12):1222-1243. · 1.71 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Admission into mental health courts is based on a complicated and often variable decision-making process that involves multiple parties representing different expertise and interests. To the extent that eligibility criteria of mental health courts are more suggestive than deterministic, selection bias can be expected. Very little research has focused on the selection processes underpinning problem-solving courts even though such processes may dominate the performance of these interventions. This article describes a qualitative study designed to deconstruct the selection and admission processes of mental health courts. In this article, we describe a multi-stage, complex process for screening and admitting clients into mental health courts. The selection filtering model that is described has three eligibility screening stages: initial, assessment, and evaluation. The results of this study suggest that clients selected by mental health courts are shaped by the formal and informal selection criteria, as well as by the local treatment system.
Law and Human Behavior 10/2010; 35(5):402-12. · 2.16 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: At least half of the women inside prison have mental health problems, have experienced physical, sexual, or emotional abuse
during their formative years and often in adulthood, and have addiction problems. Only a minority of these women receive treatment
for their behavioral health problems associated with trauma while incarcerated, even though these problems are risk factors
for returning to prison after release. This study focuses on the traumatic experiences and behavioral health problems of a
group of female inmates who volunteered in August 2009, to be screened for admission into an integrated trauma-reentry program
implemented at an adult female correctional facility. Of the 278 women who self-referred for screening, 196 preliminarily
met the time eligibility criterion of residing at the prison for eight to 24 more months. Half of these women (n = 97) were actually time-eligible for screening and agreed to be screened. Of this sample of treatment-seeking soon-to-be-released
female prisoners, the vast majority (93%) reported significant and complex histories of traumatic event exposure and high
rates of either posttraumatic stress disorder (PTSD) or sub-threshold PTSD, past alcohol and other substance abuse or dependence,
other axis I psychiatric disorders, and subjective distress. Identifying trauma exposure histories and associated behavioral
health problems within this population and providing effective interventions holds potential promise for preparing incarcerated
women to manage their post-release lives in ways that will keep them safe, healthy, and in the community.
KeywordsTraumatic event exposure-Axis I mental disorder-Behavioral health disorders-Incarcerated females-PTSD-Abuse-Addiction
Psychological Injury and Law 06/2010; 3(2):155-163.