Mental Illness In Jails Research Articles

Implementing a Treatment for People with Serious Mental Illness in Jail: A Mixed-Methods Study of Stakeholder Perspectives on Feasibility and Acceptability.

People with mental illness are over-represented in the U.S. criminal legal system. Jail presents an optimal opportunity to provide needed mental health care as the entry point to corrections. However, there is a lack of programming available in jails, which may be partly due to limited understanding of how to successfully implement interventions in this complex setting. We implemented a nine-session psychotherapeutic intervention for people with serious mental illness in a county jail. As part of a larger implementation-effectiveness hybrid study, we gathered mixed-methods data from stakeholders (treatment recipients and jail administrators) on the feasibility and acceptability of the intervention's implementation. In focus group discussions and qualitative interviews, treatment recipients (n = 29) provided qualitative and quantitative data on their perceptions of the implementation's feasibility and acceptability. Jail administrators (n = 6) completed two quantitative self-report measures on their perceptions of the treatment's feasibility and acceptability. Qualitative analyses were conducted by two coders using inductive thematic template analysis; seven global themes relating to treatment recipients' perceptions of the assets and hindrances to feasibility and acceptability were developed and are presented with supporting quotations. Quantitatively, all treatment recipients endorsed the intervention's feasibility (100%), and nearly all (97%) endorsed its acceptability. On both self-report measures, jail administrators' mean scores fell above a-priori thresholds indicating feasibility and acceptability. We found qualitative and quantitative support for the use of this intervention in jail from both sets of stakeholders. These results have implications for clinical service and policy in jail, where service providers struggle to meet the considerable demand for mental health services.

Prevalence of Psychiatric Disorders by Demographics in Jail Populations.

Many individuals incarcerated in jails suffer from psychiatric disorders and require mental health treatment. However, there has yet to be a study which comprehensively described the prevalence of mental illness diagnoses by demographic variables or compared results to the general population. Data for this study were the Survey of Inmates in Local Jails, 2002. Binary logistic regression was run to compare the prevalence of diagnoses to demographic variables of the jail population. Results were compared to studies in the general population. Males were less likely than females to report five of the seven disorder categories, and employed individuals were less likely to report all seven disorders. The results were consistent with research on the general population. It is important to understand the population of individuals with mental illness in jail so we can better serve them and catch psychiatric disorders early while they are more easily treatable.

Protocol for a quasi-experimental, 950 county study examining implementation outcomes and mechanisms of Stepping Up, a national policy effort to improve mental health and substance use services for justice-involved individuals

BackgroundThe criminal justice system is the largest provider of mental health services in the USA. Many jurisdictions are interested in reducing the use of the justice system for mental health problems. The national Stepping Up Initiative helps agencies within counties work together more effectively to reduce the number of individuals with mental illness in jails and to improve access to mental health services in the community. This study will compare Stepping Up counties to matched comparison counties over time to (1) examine the effectiveness of Stepping Up and (2) test hypothesized implementation mechanisms to inform multi-agency implementation efforts more broadly.MethodsThe study will survey 950 counties at baseline, 18 months, and 36 months in a quasi-experimental design comparing implementation mechanisms and outcomes between 475 Stepping Up counties and 475 matched comparison counties. Surveys will be sent to up to four respondents per county including administrators of jail, probation, community mental health services, and community substance use treatment services (3800 total respondents). We will examine whether Stepping Up counties show faster improvements in implementation outcomes (number of justice-involved clients receiving behavioral health services, number of behavioral health evidence-based practices and policies [EBPPs] available to justice-involved individuals, and resources for behavioral health EBPP for justice-involved individuals) than do matched comparison counties. We will also evaluate whether engagement of hypothesized mechanisms explains differences in implementation outcomes. Implementation target mechanisms include (1) use of and capacity for performance monitoring, (2) use and functioning of interagency teams, (3) common goals and mission across agencies, and (4) system integration (i.e., building an integrated system of care rather than adding one program or training). Finally, we will characterize implementation processes and critical incidents using survey responses and qualitative interviews.DiscussionThere are few rigorous, prospective studies examining implementation mechanisms and their relationship with behavioral health implementation outcomes in justice and associated community behavioral health settings. There is also limited understanding of implementation mechanisms that occur across systems with multiple goals. This study will describe implementation outcomes of Stepping Up and will elucidate target mechanisms that are effective in multi-goal, multi-agency systems.

A Legal Right to Clozapine Therapy for Incarcerated Individuals With Treatment-Resistant Schizophrenia.

People with serious mental illnesses increasingly are being treated in jails and prisons, and during incarceration are afforded a constitutional right to medical care. This right pertains to both general medical and mental illnesses and both acute and chronic conditions. However, incarcerated patients with treatment-resistant schizophrenia (TRS) often are not offered clozapine, the only medication for this debilitating illness approved by the U.S. Food and Drug Administration. In this column, the authors argue that incarcerated individuals with TRS have a statutory and constitutional right to treatment with clozapine.

Alabama company uses Zumbathon to promote Stepping Up initiative

Observing May is Mental Health Month, Alabama‐based behavioral health care provider AltaPointe Health is raising awareness about the Stepping Up initiative by promoting good physical health for people with mental illness. The health and human services organization and psychiatric hospital system held a Zumbathon May 18, according to a company news release. Stepping Up is a national initiative to reduce the number of people with mental illnesses in jails. The program was launched in May 2015 by the National Association of Counties, the Council of State Governments Justice Center and the American Psychiatric Foundation. Case managers identify individuals who are not a threat to the community but have frequent contact with law enforcement and local emergency departments. More than 425 counties across 43 states have signed on to join the Stepping Up initiative. AltaPointe Health partnered with the Alabama Department of Mental Health for guidance and technical support regarding the Stepping Up initiative.

The indistinguishables: determining appropriate environments for justice involved individuals.

Criminalizing those with mental illness is a controversial topic with a long and complex history in the United States. The problem has traditionally been dichotomized between criminals (i.e., "bad") in need of placement in jails and prisons and the mentally ill (i.e., "mad") who are need of treatment in psychiatric facilities. Recent trends demonstrate significant increases in the rates of mental illness in jails and prisons, as well as increased rates of violence within psychiatric hospitals. This would suggest that there are a group of justice involved individuals who are "indistinguishable" within the traditional dichotomous categories of dangerousness and mental illness. The authors argue for a more nuanced model that dimensionally conceptualizes dangerousness and mental illness; increased attention to situational factors that create facilities appropriate for those who are dangerous and mentally ill and more diversion programs for those inappropriate for incarceration or hospitalization.

Building Partnerships, Leading the Way

Back to table of contents Previous article Next article From the PresidentFull AccessBuilding Partnerships, Leading the WayAltha Stewart,M.D.Altha Stewart,Search for more papers by this authorM.D.Published Online:27 Sep 2018https://doi.org/10.1176/appi.pn.2018.10a17In early September, I had the pleasure of spending an entire week seeing APA partnership building in action. The week began in the company of colleagues and working with officials of the Department of Health and Human Services in a faith and mental health collaboration effort. In addition to HHS Assistant Secretary for Mental Health and Substance Use Elinore McCance-Katz, M.D., Ph.D., and APA Immediate Past President Anita Everett, M.D., other participants included government officials, psychiatrists, psychologists, faith leaders, and family members from around the country. The day included an ambitious agenda about how to incorporate the spiritual aspects of patients’ lives into the therapeutic interventions we offer. It was clear by the end of the day that APA’s Mental Health: A Guide for Faith Leaders has proven to be a valuable resource for mental health professionals as well as faith leaders, and I am committed to assuring the guide is updated in collaboration with many of the organizations at the meeting.Following this meeting, I had the honor of doing a “fireside chat” as well as speaking at the first-ever panel on mental health held by the Congressional Black Caucus Foundation (CBCF) at its 48th legislative conference in Washington, D.C. As an organization whose aim is to advance the global black community through education and the development of new policy and leaders, the CBCF event was the perfect place to talk about the steps that are needed for black legislators and mental health professionals to work together to meet the mental health needs of black Americans. I spoke about the need for more and better cultural competency training for all psychiatrists and creating a stigma-reduction campaign to promote greater willingness to talk about mental health issues among black Americans. This exciting opportunity was followed by APA’s fall ritual known as the September component meetings. Although smaller than I remember from my own early career days, these internal “partnerships” are still the one place where members get to see the inner workings of APA going at maximum speed. Different from APA’s deliberative governance bodies, the APA components are the cogs that keep the engine of APA moving. Tasks, actions, and recommendations begin in the discussions held by these member “partnership” groups over a few days in September and result in consensus resource documents and position statements that represent a framework for all that we do in APA in support of our members and the patients we serve. If you want to join in this work, now is the time to research the various components and let President-elect Bruce Schwartz, M.D., know of your interest in this work. Please send the name of the component on which you would like to work along with a one-page description of your background, experience, and qualifications to [email protected].The week ended with a meeting to discuss how APA might develop and maintain a relationship with external groups to assure that persons with mental illness in jails and prisons receive the highest quality services available. The work begun by APA in the Stepping Up Initiative has resulted in policy and practice changes in some parts of the country, and I believe that we must now reframe that strategy into a psychiatrically driven initiative in which APA works with external groups to develop evidence-informed policies and programs for this growing population. I will keep you updated as we continue working on a proposal to support this work.I sincerely hope that APA will be a part of more events like this in the future. While it may not be a pleasant message to deliver, our representatives in government, Congress, and the philanthropic communities need to hear that the mental health care needs of thousands of Americans in many communities and practice settings are not being met. We will continue to work with all these groups to address the health inequities, workforce issues, gaps in care, and stigma experienced by those with mental illness until all Americans can access the high-quality care they deserve. ■ ISSUES NewArchived

Judge Steven Leifman awarded the 2018 Pardes Humanitarian Prize in Mental Health

The Brain & Behavior Research Foundation announced Sept. 5 that Judge Steven Leifman has been awarded the 2018 Pardes Humanitarian Prize in Mental Health for leadership in reducing the number of people with mental illnesses in jails and prisons. The award recognizes an individual or organization whose extraordinary contribution has made a profound and lasting impact by improving the lives of people suffering from mental illness and by advancing the understanding of mental health. Judge Leifman is a national leader in solving the complex and costly problem of people with untreated mental illnesses involved in the criminal justice system. In 2000, he launched a pioneering initiative in Miami‐Dade County called the Eleventh Judicial Circuit Criminal Mental Health Project, which steers people with mental illnesses, who do not pose significant threats to public safety, away from the criminal justice system and into community‐based treatment. The award will be presented at a ceremony in New York City on Oct. 26.

The development and efficacy of a group intervention program for individuals with serious mental illness in jail

Providing cost-effective means to treat the influx of individuals with serious mental illness entering the correctional system is a major challenge. Failure to provide appropriate mental health treatment may lead to poor outcomes, including recidivism and suicide. Group intervention is an effective and cost efficient way to provide mental health treatment. However, it has been understudied in jail settings. To meet the needs of jail-inmates with serious mental illness, an eight-week group-based module curriculum was developed and studied through analyses of perceived usefulness, retention of key material, and associations with cognitive ability, improvement in psychiatric symptoms, and level of motivation. One week after the completion of a group session, the participants remembered the group topic and at least one key point from the group the majority of the time. Better recall of group material was associated with better overall cognitive ability and motivation at discharge. Participants found the groups to be somewhat to extremely useful 88.4% of the time. Higher levels of usefulness were associated with reduced psychopathology and psychiatric improvement, as well as higher motivation at discharge. The findings provide support for the group intervention and implementation in a jail setting. Further implications are discussed.

The Impact of Early Detection of Mental Illness in Jails and Prisons

The research was concerned with discovering the impact of early detection of mental illness in prisons, using selected prisons across the five regions of the United States as case studies. Therefore, the research project set out with the following research questions: (a) What is psychological trauma, and how vulnerable are individuals who are experiencing an unwanted change of scene (from their homes to prisons) to becoming traumatic?, (b) Is the prison system equipped to detect mental illness among incoming inmates?, (c) What are the effects of the inability to detect mental illness among new prisoners on the prison?, (d) To what extent has the justice system contributed to mental illness of imprisoned individuals?, (e) To what extent can the actions of concerned reformed groups prevent the exacerbation of mental illness among incoming prison inmates?, and (f) What recommendations can be made to engender reformation of the prison system in order to bring about salutary benefits to the society, prison inmates, and prison administrators?. Consequently, relevant literatures were reviewed with respect to as the concept of mental illness, early signals of mental illness, symptoms and signs of mental illness and mental illness in prisons. A survey was carried out via the questionnaire method among ninety‐eight informed stakeholders in the prison system with the aim of providing solutions to the above broad research questions. Findings from the survey revealed that: (i) the American prison system is apparently not well equipped to detect mental illness among incoming inmates, (ii) the justice system contributed to mental illness among convicts, and (iii) advocacy and pressure groups have played a significant role in preventing the exacerbation of mental illness among incoming prison inmates. Thus, this study showed that the prison system must engender researches that will provide prison officers with needed technical, medical, and psychological tools for the early detecting of mental illness among incoming inmates at an early stage of their incarceration.Support or Funding InformationSupported by Institutional Resources of USAT and Einstein Medical Institute

‘Because This Is Where Our Patients Are’

Back to table of contents Previous article Next article Association NewsFull Access‘Because This Is Where Our Patients Are’Cathy BrownCathy BrownSearch for more papers by this authorPublished Online:30 Nov 2015https://doi.org/10.1176/appi.pn.2015.12a2AbstractIf a nation’s greatness is measured by how it treats its weakest members, as Mahatma Gandhi once said, then the United States has a lot of soul searching to do, according to Paul Burton, M.D., chief psychiatrist at San Quentin Prison in California. “The number of people with mental illness incarcerated in jails and prisons has been increasing exponentially in the last generation, and this situation must be changed.” These vulnerable individuals need treatment for their mental illness under appropriate conditions, not simply warehoused and cut off from their communities, he said.David HathcoxAPA President Renȳe Binder, M.D., a forensic psychiatrist, is dedicating her presidential year to seeking solutions to end what she has called “this national tragedy,” and Burton was invited to address APA’s Assembly last month in follow up to a visit that the Board of Trustees had made to San Quentin last summer at Binder’s request.Burton noted that San Quentin is the oldest prison in California, established in 1852; it also has the state’s only death row for male inmates, the largest in the United States. To help listeners understand the scope of the problem of the criminalization of people with mental illness, Burton reported that 2.2 million Americans are incarcerated, and of these, 350,000 to 500,000 have serious mental illness. Nationally there are 10 times more people with mental illness in jails and prisons than in state hospitals. That statistic is no coincidence: as the number of state psychiatric hospitals declined precipitously starting in the 1970s, the number of people imprisoned has risen proportionately. “Prisons and jails have become the 21st century state psychiatric hospitals,” he said.Correctional institutions are in dire need of psychiatrists, and one of the messages that Burton brought to the Assembly is that practicing in a correctional setting is a rewarding career path to pursue. He noted that it is a “single-payer system,” which allows psychiatrists to spend more time providing clinical care instead of dealing with administrative overload. Also, psychiatrists in this setting are able to sharpen their diagnostic skills and can assess and treat a variety of mental illnesses, including those that are uncommon in the community such as paraphilias, psychopathy, and impulse control disorders. And for psychiatrists who have an interest in the intersection of psychiatry and the law, they can collaborate, educate, and learn from attorneys and law enforcement personnel.But the most important reason that psychiatrists should consider a full- or part-time career in correctional psychiatry is “because that is where our patients are,” said Burton. “We must acknowledge that and work to change it.” ■ ISSUES NewArchived

Ohio gives ‘linkage’ grants to treat mental illness in jails

Ohio gives ‘linkage’ grants to treat mental illness in jails

Initiative Aims to Reduce Number of People With Mental Illness in U.S. Jails

Back to table of contents Previous article Next article Community NewsFull AccessInitiative Aims to Reduce Number of People With Mental Illness in U.S. JailsAaron LevinAaron LevinSearch for more papers by this authorPublished Online:28 May 2015https://doi.org/10.1176/appi.pn.2015.6a15AbstractEffort calls on county governments to collect data on the status and needs of people with mental illness in local jails, determine treatment capacity, and develop plans to reduce their overrepresentation in the criminal justice system.Two million people with mental illness cycle through America’s county jail cells every year, creating a strain on county governments that must provide them with treatment. Now, local government officials have been invited to join a national collaboration to reduce the number of people with mental illness in jails across the country.“The sheer number of people with mental illness in U.S. jails has reached crisis proportions,” said Denise O’Donnell, J.D., M.S.W., director of the Bureau of Justice Assistance in the U.S. Department of Justice, speaking last month at a meeting on Capitol Hill launching the Stepping Up Initiative.The Stepping Up Initiative—a joint effort of the National Association of Counties, the Council of State Governments Justice Center, and the American Psychiatric Association Foundation—calls on county governments to enact strategies to collect data on the status and needs of people with mental illness in local jails, determine treatment capacity, and develop plans with measurable outcomes to reduce their overrepresentation in the criminal justice system.How Counties Can ‘Step Up’The Stepping Up Initiative calls for counties to take the following six actions:Convene leaders and decision makers committed to safely reducing the number of people with mental illness in jails.Determine prevalence of adults entering jails with mental illness and assess their needs.Evaluate treatment and service capacity in counties and identify policy and funding barriers to diversions and community support.Develop a plan of action with measurable outcomes based on the above.Implement research-based approaches that advance the plan.Create systems to track progress and report outcomes.More information about the Stepping Up Initiative can be accessed here.According to a recent report, there are now 10 times as many people with mental illness in jails and prisons than in psychiatric hospitals, APA CEO and Medical Director Saul Levin, M.D., M.P.A., said during the event. “We must ensure that every one of our patients, every individual who needs and deserves treatment—particularly in the criminal justice system—receives that treatment.”The present situation grew out of the failure to develop a truly comprehensive community mental health system, said former Rhode Island Rep. Patrick Kennedy. People with mental illness have been moved out of the old asylums only to find themselves in the new asylums—America’s jails and prisons, Kennedy said.“We discriminate against people with biologically based illnesses by not treating them and then arrest them because they are not treated,” he said.Such actions can take a significant toll on local governments, Toni Carter, a commissioner of Ramsey County, Minn., explained during the event. “We know the impact these changes can have on our counties’ budgets, on our public safety, and, most importantly, on individuals with mental illnesses and their families,” Carter said. “But this battle won’t be won in individual counties. We need a national movement to change the way we treat people with mental illnesses.”In that regard, Sen. Al Franken (D-Minn.) spoke of the need for the Justice and Mental Health Collaboration Act, which would support crisis-intervention training for police and diversion programs for offenders, among other measures. Franken is cosponsoring the legislation with Sen. John Cornyn (R-Texas).“Mental health in the justice system is not a partisan issue,” said Franken, urging attendees to back the pending legislation. While some counties have made progress in their efforts to facilitate access to treatment and promote appropriate alternatives to jail, scaling up successful efforts has proven more difficult. As part of its ongoing work in the criminal justice field, the American Psychiatric Association Foundation will convene a national summit meeting on the subject in the spring of 2016.“We need sweeping change in the overrepresentation of people with mental illness in the criminal justice system,” said O’Donnell. “The current system in which our jails provide mental health services is not affordable, nor is it sustainable or right.” ■ ISSUES NewArchived

Counties Seek Help to Reduce Numbers of Mentally Ill Inmates

Back to table of contents Previous article Next article Full AccessCounties Seek Help to Reduce Numbers of Mentally Ill InmatesAaron LevinAaron LevinSearch for more papers by this authorPublished Online:14 Jan 2015https://doi.org/10.1176/appi.pn.2015.1b7Abstract“Something is wrong when we use the criminal justice system as a mental health system,” Sen. Al Franken (D-Minn.) said at a Capitol Hill briefing in December.America’s county governments, straining under the burden of caring for inmates with mental illness housed in their jails, couldn’t agree more.Sen. Al Franken declares that “the intersection of mental health and the justice system is not a partisan issue.”Aaron LevinAbout 2 million people with serious mental illnesses are booked into jails each year, and the counties—and their taxpayers—must provide them with treatment. Yet even as the numbers devastate local jail budgets, outcomes are rarely improved, according to the National Association of Counties (NACo) and the Justice Center of the Council of State Governments (CSG), which organized the briefing.While 5 percent of people in the general population have a serious mental illness, 17 percent of those booked into U.S. jails do. Within that population, 31 percent of the women and 15 percent of the men have serious mental illness, said Fred Osher, M.D., director of Health Systems and Services Policy at the CSG Justice Center in Washington, D.C. Furthermore, of those with a mental illness, 72 percent have a co-occurring substance use disorder.This population is at greater risk at every stage of the criminal justice process, said Osher: “They are arrested in disproportionate numbers, stay longer in jail, have higher recidivism rates, and have less access to health care than those without mental illness.”Tackling the problem is hampered by the constant churning of individuals in and out of jails and by a consequent lack of baseline data against which to test interventions, said Osher. “Plus, the workforce in jails is not well trained for mental health care and so needs new skills and cross-training.”“We need to make a change,” agreed Judge Steven Leifman, J.D., of the 11th Judicial Circuit of Florida in Miami and a member of the American Psychiatric Foundation’s (APF) Board of Directors. Leifman has worked closely with APF through the Judges’ Leadership Initiative for Criminal Justice and Behavioral Health to increase court officials’ understanding of mental illnesses and the ways to respond to people with them.Fred Osher, M.D., stresses that “crime rates are dropping, but the percentage of people with mental illness in jails is increasing.”Aaron Levin“The issue affects every county in the nation,” added Rep. Richard Nugent (R-Fla.), a former sheriff of Hernando County, Fla., at the same briefing. Nugent cosponsored the Justice and Mental Health Collaboration Act of 2013, intended to reduce the number of individuals with mental illness in county jails. Franken introduced similar legislation in the Senate. The bills will be refiled in the new Congress.In addition to seeking help from the federal government, counties must gather teams of local leaders not only from corrections departments but from the legal, mental health, medical, social service, and law enforcement communities, said Osher. Collecting prevalence data and formulating needs assessments are critical, as is evaluating available treatment systems and their capacity. Finally, implementing evidence-based interventions must be followed by closely tracking outcomes.Those interventions can include crisis intervention training for police, diversion programs like mental health courts, better access to community-based treatment, and improved prerelease planning before jail inmates return to their communities.“Mental health in the justice system is not a partisan issue,” concluded Franken, urging grassroots support for the pending legislation.“I don’t always agree with Al Franken, but we do agree on this issue,” said Nugent, a conservative Republican. “I’m optimistic we’ll get this done. It’s important to the people back home.”Toward that goal, NACo and the CSG Justice Center will join the APF at a summit of county officials and others later this year to discuss and disseminate best practices used by counties that have already developed plans for coping with the crisis. ■More information on CSG’s mental health programs can be accessed here. The APF’s work with the Judges’ Leadership Initiative is described here. ISSUES NewArchived

Criminal thinking styles among people with serious mental illness in jail.

The purpose of this study was to extend the investigation of criminal thinking of persons with mental illness beyond prison and community settings to a jail setting. Participants consisted of 122 individuals incarcerated in a county jail who were diagnosed with a severe mental illness, including schizophrenia spectrum and major mood disorders. Results indicated that people with mental illness in this sample of jail inmates presented with thinking styles that support a criminal lifestyle, and have criminal thinking styles that follow a pattern that is very similar to a sample of prison inmates with serious mental illness. These findings support the need for therapeutic programs for justice-involved persons with serious mental illness to develop a multipronged treatment approach that integrates interventions for individuals' criminal thinking and antisocial attitudes with treatment for their mental illness and substance abuse issues.

Prominent APA Members Call for Major MH System Reform

Prominent APA Members Call for Major MH System Reform

Commentary: not just variation in estimates: deinstitutionalization of the justice system.

T is great variation in estimates of the portion of incarcerated individuals who have mental illness. This wide variation is one of the main findings of the analysis by Prins (1) of mental illness rates in U.S. state prisons. Since at least the 1930s, social observers such as Penrose (2) have tracked the prevalence of mental illness in jails and prisons and have attempted to identify underlying clinical and social trends. In 2002, the first author and his colleagues questioned the presumption that the large number of incarcerated people with mental illness was attributable to failures in the assessment and treatment of mental illness and concluded that there is no reliable evidence that directing resources toward psychiatric treatment would have a significant impact on incarceration rates (3). In this commentary, we argue that this conclusion remains true. In the article by Prins (1), the implied logic is that there is interpretive value in examining variations in the rates of mental illnesses in jails and prisons to discern the impact of psychiatric interventions. Holding to the principle that the most parsimonious explanation is best, the factor that explains the variation in the proportions of prisoners with mental illness is variation in correctional policy and practice among jurisdictions and over time, rather than variation in access to treatment for mental illness or in how mental illness is assessed or counted in prisons and jails. The more recent variation in rates of mental illness is also likely enhanced by the beginning of a shift in correctional policy: the decline of incarceration in prisons (4). Abramson (5) laid the groundwork for examining connections between deinstitutionalization of psychiatric treatment and the rising number of incarcerated people with mental illnesses. Historically, institutions such as orphanages, poorhouses, and asylums have, each in their own time, experienced a profound increase in their populations, which was followed by a period of deinstitutionalization. Initially, the reasons given for deinstitutionalization are humane treatment, but eventually the most persuasive arguments center on cost and efficiency in state systems and the availability of plausible alternatives. In the United States, practice shifted from poorhouses to outdoor relief, charity movements, and social work; from orphanages to child welfare systems, foster care, and juvenile justice systems; from asylums to community mental health; and now from prisons to community corrections. With the emergence of community corrections and the eventual downsizing of prisons and jails, many people with mental illness once incarcerated in conventional facilities will more often be involved in various forms of community corrections. Our colleague who is incarcerated in a community correctional facility (the first author met this person at a meeting outside of any prison or jail) would be counted as incarcerated by the local Department of Corrections (DOC). This person is free to pursue work in the daytime and does not receive health care through the DOC, unlike incarcerated persons in other kinds of facilities. Correctional health care policy focused on large prisons and jails has not caught up with the impact of deinstitutionalization in the provision of psychiatric care to vulnerable populations. As a result, a growing number of individuals with serious psychiatric disorders are left without reliable access to effective psychiatric treatment. This commentary seeks to refocus attention away from efforts to establish a standard for rates of incarcerated persons withmental illness in conventional facilities with the aim of informing mental health interventions. The action is not there. The place for action in innovation, change, and planning is in community settings. Our goal should be to document variations across place and time in how the differences and changes in corrections practices interrupt effective care and to develop creative ways to recognize as a reality in the justice system the ongoing changes in corrections environments and the broad variation in incarcerated populations.

Risk of trauma exposure among persons with mental illness in jails and prisons

Traumatic victimization, particularly sexual abuse, is a serious problem in correctional facilities and those suffering from mental illnesses are especially vulnerable. This review examines our current knowledge regarding trauma victimization among persons with mental illness serving time in jails/prisons, considers methodological challenges, and provides recommendations for future research. Traumatic victimization, particularly sexual abuse, has consistently been identified as a high-frequency problem within jails and prisons. Lifetime, 6-month, and 12-month prevalence rates of physical and sexual violence among incarcerated people are quite high relative to nonincarcerated populations, and women report much higher rates of most traumatic events than men. Moreover, data show that inmates with mental illnesses are up to eight times more likely to be victims of sexual abuse than nonmentally ill inmates. Additional research is needed to improve our understanding of this issue and inform change efforts. Future research should include: epidemiological studies to improve our knowledge of risk factors and correlates of victimization; prospective studies to determine causality between trauma victimization and mental illness or other adverse outcome; and intervention studies to examine strategies for reducing violence and traumatic victimization inside correctional facilities, effective treatments for posttraumatic psychopathology, and improved re-entry outcomes.

The Impact of Mental Illness Status on the Length of Jail Detention and the Legal Mechanism of Jail Release

The Impact of Mental Illness Status on the Length of Jail Detention and the Legal Mechanism of Jail Release

Toward Successful Postbooking Diversion: What Are the Next Steps?

Toward Successful Postbooking Diversion: What Are the Next Steps?