Mental Illness and Criminal Behavior

The tragic events in Aurora, CO and Newtown, CT have renewed public perception of mentally persons as ‘dangerous’ and ‘criminal.’ Unfortunately, this perception is based more on conjecture and fear than research. The following essay takes stock of the empirical research on mental illness and criminal behavior. Three noteworthy trends emerge from this literature. First, the prevalence of mental illness is substantially higher among individuals who have come in contact with the criminal justice system relative to the general population. Second, individuals with psychotic and externalizing behavioral disorders, particularly those who also abuse drugs and alcohol, tend to engage in higher levels of violence than individuals with other forms of mental illness. Third, mental illness does not determine whether someone will break the law; rather, it is but one of many criminogenic risk factors that interact in complex ways to influence individual behavior.     

The career of the mentally ill: an integration of psychiatric, labeling/social construction, and lay perspectives

This paper provides a new way of conceptualizing the career of the mentally ill. Most persons who experience an episode of a serious mental disturbance lead a normal life, while a few persons lead lifetimes that revolve around their mental disorders. The processes leading to either result can only be understood by integrating the traditional labeling and psychiatric perspectives with lay understandings of the concepts of "mental illness" and "nervous breakdowns." A selection of key concepts from these perspectives leads to a better understanding of the different paths persons take as they move through the pre-patient, inpatient, and post-patient phases of the "career of the mentally ill." This perspective makes understandable a number of counterintuitive relationships. For example, it explains why most hospitalized mental patients (1) have a negative stereotype of the "mentally ill," (2) do not perceive themselves as "mentally ill, yet (3) perceive themselves as benefiting from treatment, and (4) do not progress into a career of secondary deviance.     

ATTITUDES TOWARD THE MENTALLY ILL:

Labeling theory posits that people labeled mentally ill experience negative societal reactions. Past research on this question is contradictory, due primarily to methodological problems. This study overcomes some of these problems by having respondents indicate their willingness to interact with a person with a specific mental disorder, or with an identically behaving person with a specific physical disorder. As expected, respondents reject the mentally ill significantly more than identically behaving physically ill persons, as supports labeling theory. Respondents also consider the mentally ill less predictable and to have less positive outcomes than those with physical illness. These beliefs highly correlate with rejection and account for some, but not all, of the effects of label on rejection.     

Mental Illness in Assisted Living: Challenges for Quality of Life and Care

ABSTRACT

An unknown number of mentally ill elders in the United States receive care in assisted living, along with persons facing physical or cognitive challenges. While dementia is familiar in assisted living, our data indicate that neither staff nor residents are prepared to work or live with the mentally ill. Challenges are created for professionals, since these residents bring diverse needs. Daily interresident interactions are also disrupted or stressful. Qualitative data describe the impacts on quality of resident life as well as care and management dilemmas identified within five assisted-living settings having varying presence of mental illness among residents.     

The impact on taxpayer costs of a jail diversion program for people with serious mental illness

Mental illness is prevalent among those incarcerated. Jail diversion is one means by which people with mental illness are treated in the community – often with some criminal justice system oversight – instead of being incarcerated. Jail diversion may lead to immediate reductions in taxpayer costs because the person is no longer significantly engaged with the criminal justice system. It may also lead to longer term reductions in costs because effective treatment may ameliorate symptoms, reduce the number of future offenses, and thus subsequent arrests and incarceration. This study estimates the impact on taxpayer costs of a model jail diversion program for people with serious mental illness. Administrative data on criminal justice and treatment events were combined with primary and secondary data on the costs of each event. Propensity score methods and a quasi-experimental design were used to compare treatment and criminal justice costs for a group of people who were diverted to a group of people who were not diverted. Diversion was associated with approximately $2800 lower taxpayer costs per person 2 years after the point of diversion (p < .05). Reductions in criminal justice costs drove this result. Jail diversion for people with mental illness may thus be justified fiscally.     

Meeting the Needs of the Mentally Ill Homeless in Massachusetts-Based Emergency Shelters

A statewide survey (response rate = 79.5%) of the emergency shelters designed for homeless individuals was conducted in Massachusetts to determine the prevalence of serious mental illness among residents and extent to which they received psychiatric services. An average prevalence rate of 22%, ranging from 1% to 70%, was reported despite the fact that 87% of the shelters restricted admission of those exhibiting severe behavioral problems. Nearly three-quarters of the shelters reported providing some mental health services as part of their program, and 80% had established ties with professional mental health agencies. Linkages with these mental health agencies greatly enhanced placement options for mentally ill persons. When queried on the most pressing community-based service needed for the homeless mentally ill, nearly two-thirds of the shelters reported a need for additional housing alternatives.     

“A Geography of Disparate Spirits”: Pathology as Oppression in “A Woman is Talking to Death” and “Mental”

This article foregrounds Judy Grahn's commitment to social justice and chiefly considers her nine-part poems: “A Woman is Talking to Death” and “Mental.” These poems illuminate the socially constructed nature of mental illness and challenge readers to consider how and why the characters within them are deemed mentally ill. Little, if any, scholarship has been devoted to using Grahn's poetry, and particularly “Mental,” as a framework for analyzing the pathologization of people, especially women, relative to the system of mental health. Her work remains relevant to critical conversations that illuminate contemporary issues of oppression that still haunt us today.     

From Fragmentation to Integration

Abstract

Within the mental health field, there is an increased attention to issues of diversity. However, this awareness has not yet been applied to racially and culturally diverse gays and lesbians who are chronically mentally ill. Some of the reasons for this include the long history of homogeneity of American institutions; the underutilization of mental health services by minority groups; the stigmatization of the mentally ill; and homophobia, within both the psychiatric community and society at large. As a result, there is a need for mental health professionals to acknowledge minority gays and lesbians with chronic mental illness, and begin to provide programs that affirm their sexual orientation, race, and cultural identities.     

Forensic Assertive Community Treatment: Recidivism,hospitalization, and the role of housing and support

While Assertive Community Treatment (ACT) is considered an evidence-based service model, there is limited evidence regarding the effectiveness of an adaptation of the model, Forensic Assertive Community Treatment (FACT), for persons with serious mental illness who also have significant criminal justice system involvement. Using a multimethod approach, this article combines quantitative and qualitative data to review baseline information and nine-month follow-up recidivism, hospitalization, and housing outcomes for individuals enrolled in a FACT program. Findings suggest substance use, housing, and FACT team members’ support played an important role in clients’ prison reentry experiences.     

Problem‐Solving Courts: Theory and Practice

Problem‐solving courts (PSCs) are a popular and fast‐growing alternative to the usual way of handling criminal cases. In place of the adversarial process, they provide court‐supervised treatment to certain groups of offenders by addressing the underlying causes of criminal behavior. They take on a variety of forms including drug courts, mental health courts, domestic violence courts, veterans’ courts, and homeless courts. PSCs, as relatively new innovations in the criminal justice system, are still evolving in scope and in practice. This article then attempts to synthesize what we know about these specialty dockets. To do so, this article (1) explores the origins and developments of PSCs as well as highlights their defining characteristics; (2) examines the theoretical approaches and empirical findings of contemporary research on problem‐solving courts; (3) critically discusses whether this new approach to old problems compromises core judicial principles; and (4) suggests directions for further research to better understand the cautionary promise of problem‐solving justice.     

Brain Abnormalities and Violent Behavior

Abstract

Introduction: It is difficult to rationally discuss the question of whether violent behaviour is a disorder because violent actions engender very strong emotional reactions in the public. But there are good reasons to believe that a variety of social and biological factors predispose the individual toward criminal behaviour. This study concerns the question, whether there is an association between violent behaviour and brain abnormalities.

Method: Ninety-six mentally ill offenders of a high security prison consecutively underwent magnetic resonance imaging of the brain (MRI). The number of sex offenders was 62.5%. Fourteen offenders were excluded because they had a neurological disease, a psychotic disorder, a severe organic mental disorder or they were older than 60 years. All scan reports were in narrative format, and they were reviewed and coded according to presence or absence of brain abnormality. Neuroradiologists were blind to clinical diagnoses and offence history. Offenders were distributed either to a “high violent group” or to a “no or low violent group.” There was no significant difference in age between both groups.

Results: In the included sample (n = 82; 50 sex offenders) 48.8% had MRI abnormalities. In the high violent group 65.5% showed MRI abnormalities. In the low violent group 16.6% had MRI abnormalities. This difference is significant (p = 0.001). The high violent sex offender group showed a MRI abnormality rate of 59.4%, and the low violent sex offender group 22.2%. The difference is significant (p = 0.011). There is no significant difference in MRI abnormality rate between the sex offender and the “non sex offender.”

Conclusions: The results indicate that there is an association between unspecified brain anomalies and high violent behaviour in the whole sample as well as in the sex offender group. There is no association between sexual offence and unspecified brain abnormalities. Modern brain imaging techniques such as magnetic resonance imaging should be included in the diagnostic procedure of mentally ill offenders.     

Factors in the transition to homelessness in the chronically mentally Ill

Although there is a great deal of literature on homelessness and mental illness, few studies have examined the factors which may lead to homelessness in the mentally ill. The objective of this research was to examine the factors in the length of time between when a client of the Los Angeles County Department of Mental Health entered the system and when he or she was first homeless on admission to a service (time before homelessness, TBH). Past psychiatric records of 142 currently homeless clients were examined through the Automated Information System of LACDMH. Results showed that total admissions to any service and total admissions to prison services were predictors of shorter TBH; being younger and being both African-American and female were predictors of longer TBH. TBH shortened dramatically from 1973 to 1993; mental health funding levels for theprevious year were significantly correlated with TBH. Results show that demographic, clinical, and system variables all impact on homelessness in the chronically mentally ill.     

Helping children cope with parental mental illness through use of children's literature

Children of mentally ill parents are often vulnerable, partly because they may not receive adequate nurturing and partly because they feel stigmatized by their parents' disabilities. The author recommends use in treatment of several children's books that show realistic, positive role models of children coping with parental mental illness.     

Health status risk factors of people with severe and persistent mental illness.

High rates of medical comorbidity and premature death have become normative health outcomes for individuals with mental illness. On average, people with mental illness die 10 to 15 years earlier than the general population. To date, little research and programmatic attention has focused on the health promotion and prevention needs of people with mental illness. Many factors have been cited as contributing to this problem, including the stigma of being mentally ill, poverty, and limited knowledge and access to health promotion services. Future health planning interventions should restructure the funding mandates of current health care delivery system from an illness and treatment model to one of illness prevention and health promotion.     

The experiences of youth serving as caregivers for mentally ill parents: a background review of the literature

Young caregivers of mentally ill parents are a vulnerable population. These vulnerabilities include risks for developmental issues, poor socialization, and poor school performance. The purpose of this background review of the literature is to explore the experiences of young caregivers of mentally ill parents and detect the gaps in the literature. The guiding research questions were: What is the experience of young caregivers of mentally ill parents? and What is the experience for those who witness or must assist their parent during a crisis? The majority of research has been conducted outside the United States, primarily in the United Kingdom, and studies have focused mostly on young caregivers of parents with physical rather than mental illness. No studies focused on young caregivers who witnessed or assisted their mentally ill parent in crisis. Information gained through this review will add to the body of knowledge for child mental health and build a case for additional research.     

Using Child Advocacy Center Tracking Data to Examine Criminal Disposition Times

Given the difficulty of obtaining criminal justice data on child abuse cases, information from child advocacy centers could be an important resource for answering questions about criminal justice outcomes for child abuse cases. In this exploratory study, we use data from one child advocacy center (N = 632) to examine the feasibility of using NCAtrak, a national computerized, Web-based case tracking system, to examine criminal disposition timeframes in child abuse cases. The system data indicated that the time frame for the cases to be criminally resolved varied widely. About one in four child physical and sexual abuse cases with adult offenders took more than one year to reach a final disposition. About 11% of child sexual abuse cases with juvenile offenders took more than one year to reach a criminal disposition. We encourage child advocacy centers using computer-based data systems to think of additional ways they might use this potentially rich source of data.     

Factors in the Transition to Homelessness in the Chronically Mentally III

Although there is a great deal of literature on homelessness and mental illness, few studies have examined the factors which may lead to homelessness in the mentally ill. The objective of this research was to examine the factors in the length of time between when a client of the Los Angeles County Department of Mental Health entered the system and when he or she was first homeless on admission to a service (time before homelessness, TBH). Past psychiatric records of 142 currently homeless clients were examined through the Automated Information System of LACDMH. Results showed that total admissions to any service and total admissions to prison services were predictors of shorter TBH; being younger and being both African-American and female were predictors of longer TBH. TBH shortened dramatically from 1973 to 1993; mental health funding levels for the previous year were significantly correlated with TBH Results show that demographic, clinical, and system variables all impact on homelessness in the chronically mentally ill.     

Justice involvement among homeless individuals with mental illnesses: Are self-report and administrative measures comparable?

Individuals with mental illnesses who experience homelessness have frequent interactions with the criminal justice system. Correctly measuring this involvement is essential to develop and evaluate the efficacy of intervention programs. Criminal justice involvement is typically assessed through administrative records or self-reported accounts. The aims of this study are to: 1) assess agreement between self-report and administrative data related to court appearances, and 2) identify individual characteristics that affect discrepancies between sources. Participants were 468 homeless persons with mental illness from the Montreal site of the At Home/Chez Soi randomized controlled trial, in Canada. Self-reported data was collected through an interviewer-administered questionnaire. Administrative data was collected through provincial and municipal court databases. Overall, agreement was good. Discrepancies were more common among those with a diagnosis of mood disorder with psychotic features, and those with a criminal history. Increased age and interviewer’s perception of sincerity and interest increased likelihood of concordance. Generally, high agreement between self-report and administrative data suggests that either source can provide reliable information. Further work to understand predictors of discrepancies could further enhance the quality of data collected through these different sources.     

SORTING OUT THE CUCKOO'S NEST: A FACTORIAL SURVEY APPROACH TO THE STUDY OF POPULAR CONCEPTIONS OF MENTAL ILLNESS

Research relevant to understanding how mental illness is popularly conceptualized owes much to the methods pioneered by Star in 1950. However, while her six vignettes have been used extensively over the last 30 years to test the public's ability to recognize mental illness, subsequent research has provided little insight into which factors contribute most to the judgment process. This study introduces a factorial survey research method that is more appropriate for the task. A sample of 143 college undergraduates responding to the experimentally designed vignettes were found to be most influenced by a vignette person's behavioral impairment, followed by the psychological attributes of depression, obtrusive thoughts, beliefs, conflict, engagement/withdrawal, fear, and anxiety. Other factors that significantly affected mental illness ratings included a vignette person's past history of mental illness and the relationship of the vignette person to the rater. These ten dimensions were found to be considerably more important than sociodemographic characteristics in judging persons mentally ill.     

Wearing two hats. Consumer & provider.

To change public attitudes toward people with mental illness, consumers need positive visibility and a strong community voice. We are making progress, although slowly, to eliminate the stigma surrounding mental illness. Progress can be attributed to the fact that the mentally ill are now living in our communities among us, and people are beginning to understand them more.