Responding to the large number of people with serious mental illnesses in the criminal justice system will require more than mental health services, according to a new report.
In many ways, the criminal justice system is the largest provider of mental health services in the country. Estimates vary, but previous research has found that about 14 percent of persons in the criminal justice system have a serious mental illness, and that number is as high as 31 percent for female inmates.
Researchers are defining serious mental illnesses to include such things as schizophrenia, bipolar spectrum disorders and major depressive disorders.
"It has been assumed that untreated symptoms of mental illness caused criminal justice involvement, but now we're seeing that there is little evidence to support that claim," said Matthew Epperson, assistant professor at the University of Chicago School of Social Service Administration. Specialized interventions for people with mental illness in the criminal justice system have been developed over the past 20 years, such as mental health courts and jail diversion programs, Epperson said.
"But we need a new generation of interventions for people with serious mental health issues who are involved in the criminal justice system, whether it be interactions with police, jails, probation programs and courts," he said. "Research shows that people with serious mental illnesses, in general, display many of the same risk factors for criminal involvement as persons without these conditions."
Epperson and his colleagues are the authors of a paper in the September-October 2014 theme issue on "New Directions in Corrections and Mental Health," published by the International Journal of Law and Psychiatry.
More potent interventions are needed, the study's authors report. "First, effective and accessible mental health treatment will be an active component of any intervention for this population," said Epperson. He adds that it is vital to develop a better understanding of the many factors, in addition to mental illness, that place persons with serious mental illness at risk for criminal involvement. There is also a need to define which risk factors are modifiable as targets for the next generation of interventions.
In addition to mental illness, the researchers identified factors that contribute to a person becoming involved in the criminal justice system, including a tendency for criminal thinking, antisocial attitudes, substance abuse and addictions, and trauma exposure.
The study additionally reports that people with serious mental illnesses are frequently unemployed and homeless. They might also be receiving assistance to live in areas of poverty with few services, including mental health treatment centers.
Reacting in unhealthy ways to stress, including acting out frustration through violence, self-medication through drugs, alcohol, sex, gambling, or other reckless behavior, can result in encounters with the justice system, explained Epperson. He added that persons with severe mental illnesses often do not have good coping skills or social support systems.
"We need to move our collective thinking away from the uncomplicated notion that mental illness is the sole cause of criminal behavior and criminal justice involvement," Epperson said. The study's authors suggest an intervention program targeting multiple issues, including medication adherence, developing alternatives to criminal thinking patterns, providing supports for more stable and healthy living situations and personal relationships, decreasing substance abuse, helping to build skills to reduce stress and addressing trauma exposure and its negative effects.
Epperson said a social work perspective is extremely beneficial to these efforts, as it will be necessary to influence both the person and their environment.
Epperson is applying the lessons from this study to his classes at SSA in an effort to educate a new generation of social workers who can be at the forefront of developing more effective interventions for this population.
"The ultimate goal of these next generation interventions is to alleviate the overrepresentation of people with serious mental illnesses in the criminal justice system, and that will require significant changes to existing interventions, alongside completely new and innovative approaches," Epperson concluded.