(Apr. 11, 2017) More than half of former inmates with serious mental illness are reincarcerated within one year of their release from jail or prison compared with fewer than one in three parolees who are not mentally ill. A subset of these individuals become super utilizers: high-need individuals who make frequent and repeated use of the criminal justice system.
The role of mental illness in super utilization of the criminal justice system is one of several impacts the Treatment Advocacy Center examines in its upcoming study, A Crisis in Search of Data: The Revolving Door of Serious Mental Illness in Super Utilization, scheduled for release April 18.
Interrupting the Cycle
Writing in the February issue of the Journal of the American Medical Association (JAMA), Drs. Matthew E. Hirschtritt and Renee L. Binder, summarize several steps that could be or are being taken to interrupt the cycle.
- Prevent criminal justice involvement with diversion.
The lifetime arrest rate of homeless individuals with serious mental illness ranges from 63% to 90% compared with 15% in the general population, according to data reported by the authors. Research indicates that housing combined with assertive community treatment significantly reduces arrest rates in this population. Even for individuals with stable housing, Crisis Intervention Training (CIT) to provide law enforcement with de-escalation techniques and mobile crisis teams to send medical personnel on mental health calls with police result in more diversion and fewer arrests. - Increase use of special courts that incentivize treatment adherence.
Mental health courts, drug courts and Veterans Treatment Courts offer specialized court dockets believed to reduce criminal justice involvement by individuals with serious mental illness. - Provide comprehensive psychiatric care in correctional settings.
"Jails and prisons tend to be understaffed and ill equipped to manage the multifaceted needs of many individuals with serious mental illness," the authors write. "Despite increases in psychiatric staffing in jails and prisons in the past decade, comprehensive care including coordination between psychiatrists, psychologists, counselors, and case managers is still a rarity." Policies are needed to address the needs of the population. - Prepare inmates for reintegration into their communities.
Helping inmates build problem-solving skills, promoting treatment adherence before release from jail or prison and coordinating case management services immediately following release into the community are proposed to reduce the 53% rate of re-incarceration for inmates with serious mental illness compared to 30% other among parolees.
The viewpoint in JAMA also notes several provisions of the 21st Century Cures Act that, if funded, could reduce recidivism among detainees with serious mental illness. These include federal grant funding for new assisted outpatient treatment (AOT) programs, enhanced treatment services for mentally ill inmates, CIT and others.
"Multiple nonprofit and governmental agencies are working to address this issue," the authors note.
These include the Treatment Advocacy Center, which proposed the federal AOT grant program, worked with members of Congress to shape other provisions of the 21st Century Cures Act and recently released a mathematical model to help counties and states reduce the logjam of pretrial mentally ill detainees in US jails.
Doris A. Fuller
Chief of Research and Public Affairs
References:
- Hirshtritt, M.E. & Binder R.L. (21 February 2017). "Interrupting the mental illness-incarceration-recidivism cycle." Journal of the American Medical Association.
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Research Weekly is a summary published as a public service of the Treatment Advocacy Center and does not necessarily reflect the findings or positions of the organization or its staff. Full access to research summarized may require a fee or paid subscription to the publications.
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