The approach used in this study enabled us to identify arrest patterns for a statewide, well-defined cohort observed over a fixed period. We point to several caveats for interpreting these findings. The population we examined consisted of individuals whose psychiatric illnesses were sufficiently serious and disabling that they had been deemed eligible for services under the relatively stringent eligibility criteria typical of state mental health agencies in the early 1990s. As we indicated, this cohort included many individuals who were poor and who also met criteria for substance abuse. As such, it was likely representative of the populations served by such agencies in many states during that period. However, because these findings were based on observations of state mental health agency service recipients, they may not be generalizable to persons served in other types of systems or to individuals not receiving services from any provider.
We should note that our estimates are based on the assumption that all cohort members were at risk for the full observation period, an assumption that is probably incorrect. This group likely experienced spells of incapacitation, that is, periods when patients were hospitalized, incarcerated, or otherwise prevented from engaging in certain types of criminal activities. We have not adjusted for this risk, nor have we adjusted for mortality. The impact of this nonadjustment is unclear. We can assume that persons found guilty of serious crimes would likely experience some type of institutional commitment. This incapacitation would not affect the observed percentage of individuals with at least one arrest but might affect recidivism patterns. (We note that one potentially incapacitating intervention—hospitalization—does not always prevent offending. Cases of inpatients charged with assault, arson, theft, and other offenses have been reported, and there is growing sentiment that patients committing such offenses should be prosecuted [26
In viewing these arrest data, one also should be mindful of potential period effects. The observation period for this study spanned the 1990s, an era marked by significant upheavals in public mental health systems, including the advent of managed care and intensified efforts to close state hospitals (27
). Although previous analyses observed minimal criminal justice impact associated with the introduction of managed care in Massachusetts (29
), the cumulative effects of these interventions may have altered the risk of criminal contact for some individuals. It was also during this period that the development of jail diversion, specialized police units, reentry programs, and other such services began. It is unclear whether such nascent diversion mechanisms or even simply the emerging policy perspective that drove their development affected the risk of arrest in this group.
Finally, arrest is a measure of criminal justice involvement and not necessarily of criminality. The arrests observed here reflect the perceptions and responses of police to observed deviant behavior, not the outcome of the full criminal justice process.
With these factors in mind, we discuss our findings’ implications for policy makers and for future research. A potentially important direction for future analysis concerns the interaction of known criminological risk factors and severe mental illness. The observed arrest patterns indicate considerable criminal justice contact in this population but also reveal substantial variation across individuals and demographic subgroups. The direction of these effects—elevated risk of arrest for persons who are male, young, and not white—is consistent with that typically observed in the general population (30
However, the strength of these effects appears, at least for one variable—gender—to be considerably weaker among members of this cohort than in the general offender population. In our sample, the percentage of men arrested was slightly more than double that of women. However, analysis of data from the Uniform Crime Report showed a larger male-to-female arrest ratio of roughly 3.8 to 1 (31
). For several reasons, these two data sources cannot be directly compared, and in any case further explanation of what appears to be an interaction effect between gender and mental illness is beyond the scope of this article. Nonetheless, this trend warrants further investigation, as do other potential interactions of mental illness with age and race.
Draine and colleagues (32
) have observed that many persons with serious mental illness offend not because they are mentally ill but because they are poor and share with other similarly situated persons exposure to various criminogenic risk factors. Our data reflect this perspective in the prevalence of property and motor vehicle arrests—the kind of offenses likely committed by economically disadvantaged persons who need or desire goods they cannot afford. Examining these socioenvironmental issues in a large cohort such as this one could be useful in determining how these risk factors are expressed and lead to the design of mental health services that might moderate such risk.
These data have further implications for the development of diversion mechanisms. As we noted, much attention has been focused on persons arrested for so-called nuisance crimes, offenses we categorized as crimes against public order. Indeed, the use of arrest in managing these behaviors has been a major focus of the “criminalization” discussion and of efforts to develop programs to divert such arrestees from the criminal justice system to the mental health system (16
). Whether many of the “nuisance” charges reported here resulted from efforts by police to resolve situations in which mental health interventions were unavailable or deemed ineffective cannot be discerned from our data. These charges were the most common among this group, however, and, as such, these data lend support for ongoing efforts to develop better linkages between mental health and criminal justice agencies for managing such low-level offenders.
But although nuisance crimes comprised the modal offense category, other, more serious offenses were nearly as prevalent. Two categories, serious violent crimes and serious property crimes, are of particular concern because they include felonies that constitute serious threats to public safety. Persons charged with felonies have typically been ineligible for standard diversion programs. Data from the Nathaniel Project, which was mentioned above, have shown considerable success in preventing reoffending in this group (15
). These programs have yet to become widely adopted, however, and many arrestees with mental illness facing felony charges who are found guilty will become the clientele of correctional mental health services and later, perhaps, of reentry programs.
Much of the discussion surrounding the criminalization of mental illness has focused on the failure of treatment systems to engage and retain persons who, as a result, become involved with the criminal justice system (33
). It is important to point out that the entire cohort we observed was, at least when identified, receiving critical services such as case management and residential placement. This raises the question of whether and to what extent the arrests reported here are attributable to individuals’ disengagement from those services or whether those services failed to prevent criminal activity among some recipients. Further research will examine in greater detail the relationship between receipt of services and likelihood of arrest and describe how socioenvironmental factors might mediate such effects.
Finally, as we have noted, the frequently arrested constitute a small subgroup of individuals and less than 2 percent of our cohort. These persons obviously present major clinical and economic challenges to both the mental health and criminal justice systems. Data on their behavior patterns and risk factors need to be obtained and incorporated into the planning of efforts to reduce their criminal justice involvement.