The Processing and Treatment of Mentally Ill Persons in the Criminal Justice System

R E S E A R C H R E P O R T The Processing and Treatment of Mentally Ill Persons in the Criminal Justice System A Scan of Practice and Background Analysis KiDeuk Kim Miriam Becker-Cohen Maria Serakos March 2015 C R I M E A N D J U S T I C E A B O U T T H E U R B A N I N S T I T U T E The nonprofit Urban Institute is dedicated to elevating the debate on social and economic policy. For nearly five decades, Urban scholars have conducted research and offered evidence-based solutions that improve lives and strengthen communities across a rapidly urbanizing world. Their objective research helps expand opportunities for all, reduce hardship among the most vulnerable, and strengthen the effectiveness of the public sector. Copyright © March 2015. Urban Institute. Permission is granted for reproduction of this file, with attribution to the Urban Institute. Cover image from Shutterstock. Contents Acknowledgments iv Executive Summary v I. Introduction 1 II. Research Objective and Focus: Severe Mental Illness among Individuals Involved in the Criminal Justice System 3 III. Data and Methodology 5 1. Scan of Practice 5 2. Research Synthesis 5 IV. Findings 8 1. Scope of the Problem 8 2. Costs Associated with Managing Mentally Ill Individuals in the Criminal Justice System 10 3. Current Practice and Policy 14 4. Criminal Justice Programs and Interventions for Mentally Ill Individuals 26 V. Research and Policy Recommendations 39 VI. Conclusion 41 Appendix. Statutory Sources of Information 42 Notes 44 References 46 About the Authors 50 Statement of Independence 51 Acknowledgments This report was funded by Janssen Pharmaceuticals Inc. We are grateful to our funders, who make it possible for Urban to advance its mission. It is important to note that funders do not determine our research findings or the insights and recommendations of our experts. Janssen Pharmaceuticals had input into the scope but not the content of this report. E X E C U T I V E S U M M A R Y V Executive Summary Mentally ill offenders possess a unique set of circumstances and needs. However, all too often, they cycle through the criminal justice system without appropriate care to address their mental health. According to the Bureau of Justice Statistics, individuals with mental health needs make up a large proportion of the US correctional population. An estimated 56 percent of state prisoners, 45 percent of federal prisoners, and 64 percent of jail inmates have a mental health problem. These individuals often receive inadequate care, with only one in three state prisoners and one in six jail inmates having received mental health treatment since their admission (James and Glaze 2006). Offenders with severe mental illness place even more strain on the criminal justice system as a whole, in terms of their unique case-processing requirements and treatment needs and their increased risk of recidivism (Baillargeon et al. 2009; Cloyes et al. 2010; Feder 1991). Housing mentally ill offenders in the criminal justice system is costly. In addition to high health care costs, mentally ill inmates tend to have higher rates of prison misconduct and recidivism (Fellner 2006; Toch and Adams 2002). Despite the evidence that mental illness in the criminal justice system is a pressing concern, our comprehensive effort to identify cost-effective, evidence-based programs and policies for managing and treating mentally ill persons in the criminal justice system brought to light how limited current knowledge is on this topic. There have been only a few rigorous evaluations of criminal justice programs and policies targeted at mentally ill offenders. This limitation, in and of itself, is a notable finding, as it shows what more needs to be done to better understand how to effectively alleviate the costs and challenges of treating and processing offenders with mental illness in the criminal justice system. Given these challenges and their financial consequences for society and governments, it is important to understand how to identify and provide early intervention for those who suffer from mental illness in the criminal justice system. This report focuses on the societal and economic costs of holding mentally ill offenders in jails and prisons. It also presents a detailed discussion of how mentally ill offenders are processed in the criminal justice system, highlighting the diversity of protocols and practices outlined in state statutes to address these challenges. Further, it discusses several promising criminal justice interventions and policies for mentally ill offenders, including the following:  Diversionary mechanisms, such as mental health courts, that route mentally ill offenders to community-based mental health treatment programs instead of prison or jail E X E C U T I V E S U M M A R Y VI  Community-based reentry programs providing coordinated services and case management for mentally ill offenders transitioning into the community  P