In this paper we have identified some shortcomings of the prevailing “criminalization resulting from service failure model” of offending among persons with mental illness and suggested that this perspective alone may be insufficient as the basis for developing an adequate understanding of the full range of that offending. In advancing this case we are not suggesting that service system inadequacies have no influence on offending; clearly, adequate mental health services are necessary, if perhaps not sufficient to enable individuals with mental illness to achieve stable lives in their communities without risk of criminal justice involvement. In advancing our notion of a “criminologically-informed” mental health services research and policy framework, we seek to foster identification of a set of risk factors and intervention points that might be used by mental health system agents in planning services and tailoring individual service plans that reduce the probability of offending and re-offending.
Opportunities for implementing a criminologically informed research agenda clearly abound. The constantly proliferating array of diversion, case management and re-entry programs engage thousands of individuals nationally. Each person has a mental health history and clinical profile, as well as basic community needs for housing, treatment and income maintenance that are must be met if their re-entry is to be successful. Each individual also has a set of pre-arrest routine activities and local life circumstances that could be captured as well. If data on these factors were jointly examined with measures of mental health system engagement and treatment compliance, better data about the interaction of these factors might result. Such data would be a boon for both mental health services researches and criminologists.
If research guided by this perspective were indeed found to yield useful data on risk factors, how might that information be incorporated into the design and delivery of mental health services? One answer to that question can be found in mental health system design practices that have evolved in the context of planned state hospital census reductions occurring over the past 30 years. In pursuing the goal of shifting persons with mental illness from state hospitals to community residential programs, state mental health agencies have often employed careful assessments of individuals' problematic behaviors, medical issues, physical disabilities, need for supervision, social skill deficits and other attributes and needs and incorporated data from these assessments into the design of residential programs that would target these concerns. Persons leaving the hospital thus could be placed in settings where their identified constellation of needs might best be met (Geller, Fisher, Wirth-Cachon, et al., 1991; Geller & Fisher, 1993
). It was typically felt that efforts invested in such placement design would realize returns in residential stability and reduced need for rehospitalization (see for example, Northampton Consent Decree
, 1978). The perspective advanced here argues for identification and incorporation of another range of issues—risk factors related to offending. If the variables associated with risk for offending among persons with severe mental illness were well understood and could be made part of individuals' risk profiles, arguably better placements, offering reduced exposure to such risks could be created. Applying a full “life span” perspective to the assessment of individuals being considered for residential placement might reveal, for example, that individuals are at risk for involvement in certain kinds of offending, or for offending in general, and might be most successfully placed in a setting in which factors such as criminogenic social networks, and opportunities for engaging in criminal behaviors were minimized.
Similarly, new approaches to case management for offenders reentering the community, as exemplified by Massachusetts's “Forensic Transition Team” effort (Hartwell & Orr, 1999
), might also benefit from increased availability of information about risks for recidivism that are not aspects of individuals' mental health treatment needs but instead arise from their return to pre-incarceration routine activities or local life circumstances. As we describe them, these patterns reflect the interaction of psychological tendencies and social environments. Case managers, and other who work with individuals with criminal histories need to understand these dynamics as part individuals' profiles. As we discussed above, such information could be factored into decisions about housing, employment, and other aspects of community re-integration. This approach could help break the patterns of recidivism exhibited by some clients of these programs who, despite receiving mental health services, are repeatedly rearrested (Hartwell, 2003
). Whether and to what extent these criminologic factors are the “missing variables” in the “equation” predicting the outcomes of such efforts should become an important focus of research for investigators working in this area.
Increased familiarity on the part of mental health services researchers and policy makers with the conceptual environment in which the criminal justice system operates carries an additional benefit. As we noted earlier, mental health service systems whose agents are not familiar with law enforcement, and who do not take into account the exigencies of policing, probation and other criminal justice work may see more of their clientele involved with the criminal justice system. In arguing for the new legislation highlighted at the start of this paper, Senator DeWine noted that the solution to the problem of the “mentally ill offender” rested in part with increased collaboration between the mental health and criminal justice systems, an endeavor that the bill's proposed funding would help to support. Such collaboration will require the development by both systems of a shared conceptual vocabulary and viewpoint. As actors in the criminal justice system learn more about the needs of individuals with mental illness, it is important that their counterparts in the mental health system also develop a perspective informed by some of the perspectives discussed here.
The problems posed by so-called “mentally ill offenders” are complex. They result from a confluence of social, legal, political and clinical issues. It is not our goal in this paper to introduce new levels of complexity; however, it is our goal to highlight factors that arguably deserve consideration as we seek to reduce offending among persons with mental illness to the greatest extent possible. This is a worthy goal, the pursuit of which will, it is hoped, benefit persons with mental illness, their families, and the systems charged with their care.