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Research Questions

  1. What challenges do correctional facilities and agencies face in managing individuals with serious mental illness, and how can these challenges be addressed?
  2. What are the key needs associated with improving outcomes so that the system performs as it should?

A disproportionate number of individuals with serious mental illness (SMI) become involved in the criminal justice system and ultimately fall under some form of correctional control. Although some jurisdictions are making great strides with respect to how the criminal justice system deals with individuals with SMI, significant challenges and opportunities for improved outcomes remain. In light of the ongoing challenges the corrections sector faces in managing individuals with SMI, RAND researchers convened an expert workshop to better understand the challenges and identify the high-priority needs associated with how these individuals become justice-involved and how to achieve better outcomes before and after these individuals come under correctional control.

The majority of needs identified in this report are not new. Indeed, several issues closely mirror previous recommendations made by national advocacy groups and correctional health care organizations. This would seem to imply that the practitioners who work with this population essentially understand what is required to improve outcomes. Like many other issues, the gap appears to be a matter of prioritization and insufficient resources. That said, the needs identified in this report represent a strong and diverse agenda that can serve as a foundation for transformational change, given the social and political will to pursue this direction.

Key Findings

High-priority needs identified by the workshop on managing the seriously mentally ill in corrections

  • Society needs to prioritize mental illness and dedicate sustainable treatment resources accordingly. The justice system should advocate for better access to treatment in the community.
  • Individuals with SMI need comprehensive, coordinated supportive services (e.g., housing, employment) as well as interventions targeting criminogenic needs (e.g., substance use disorders, antisocial thinking) pre- and post-justice involvement.
  • Greater emphasis is needed on prevention, early detection, and intervention, particularly for children.
  • Law enforcement agencies need training for better response to incidents involving individuals with SMI and for alternatives to jail.
  • The courts need guidance on effective diversion strategies.
  • For those who must be incarcerated, institutions should be resourced so that they can effectively treat and manage the population (e.g., meet both mental health and criminogenic needs); effective alternatives to administrative segregation are required.
  • Coordinated discharge planning is needed to ensure continuity of care between agencies and providers. Inmates should leave with "warm hand-offs," referrals, an ample supply of medication, and uninterrupted benefits.
  • Barriers to collaboration and information-sharing among entities with a "need to know" must be removed.
  • The divide between the criminal justice system and the mental health system (e.g., treatment focus, approaches, duplication of efforts) needs to be bridged to provide better care to individuals with SMI.
  • Cost-benefit analyses are required to support the redistribution of funding to the most effective intervention points (e.g., pre-justice involvement, diversion, and reentry).

Recommendations

  • Prioritize the needs of the seriously mentally ill. More-focused efforts, perhaps in collaboration with diverse groups, might help increase awareness and spark a shift in public attitudes about mental illness and those who suffer from it.
  • Invest in early detection and interventions. Many individuals with chronic mental illness first experience symptoms in adolescence, but a significant proportion go untreated. It is therefore critical to develop strategies to identify symptoms early and make the appropriate referrals.
  • Improve community-based mental health care and supportive services. Models are needed to help communities determine the levels of mental health care and supportive services needed to meet demand. These services should be comprehensive, person-centered, coordinated, and sustainable.
  • Focus on treatment rather than punishment. Whenever possible, individuals with SMI should be transported to fully funded community-based crisis centers rather than to jail. Correctional institutions must be resourced so that they can provide safe environments in which to deliver treatment that targets both mental health and criminogenic needs. The goal should be the improvement of the individual, not merely stabilization.
  • Reinvest public funding. Diverting lower-risk individuals from jails and prisons into community-based services that can meet their individual needs can achieve better outcomes at lower costs and without compromising public safety.
  • Bridge the divide between the justice and mental health systems. Efforts to better understand the different perspectives and facilitate greater collaboration are needed. Improving mental health and reducing justice system involvement are not competing interests; they are interrelated. Thus, a unified approach could be more effective.

Research conducted by

The research described in this report was prepared for the National Institute of Justice (NIJ) and conducted by the Justice Policy Program within RAND Social and Economic Well-Being.

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