Jail Recidivism in a Forensic Case Management Program

Article excerpt

Since the de-emphasis on custodial hospitalization and consequent focus on community-based care and treatment of people with severe mental illness, the proportion of people with severe mental illness who have experienced arrest and jail detention has increased (Mulvey, Blumstein, & Cohen, 1986). People who show signs of a mental disturbance at the time of a police encounter are more likely to be arrested (Durham, 1989; Teplin 1984a, 1984b), and people with serious mental illness are likely to spend a longer time in jail than people without mental illness (Belcher, 1988; Goldmeier, Wise, & Wright, 1986; Steadman, McCarty, & Morrissey, 1989). Some researchers call this process transinstitutionalization, which differentially affects older people with mental illness, who are moved from mental institutions into other custodial institutions such as nursing homes and boarding homes, and younger people, who have less opportunity for long-term state hospital stays and have numerous short community hospitalizations and often find themselves in the criminal justice system (Johnson, 1990; Scull, 1981). Because many of these people live in marginal situations and have limited social networks, an arrest often means a protracted jail stay in situations in which other people receive bail, are released on their own recognizance, or are not arrested (Steadman et al., 1989). In large urban areas, crowded legal institutions and logistical logjams prolong the criminal justice process for everyone. Defendants with mental illness, who may also undergo competency procedures, are at a further disadvantage (Hiday, 1992).

For some people with serious mental illness, jails are a site for treatment and care (Belcher, 1988; Durham, 1989; Morrissey & Levine, 1987). The growing number of people with serious mental illness who have experienced arrest points to the need to see jails as a part of the community mental health service environment (Steadman et al., 1989) and to examine the needs of people with mental illness who have been incarcerated. The prevalence of substance abuse among people detained in jails (Guy, Platt, Zwerling, & Bullock, 1985; Petrich, 1976) and people with mental illness (Abram & Teplin, 1991; Drake, Osher, & Wallach, 1989; Test, Willisch, Allness, & Ripp, 1989) is an additional concern for this group. Housing concerns are also complicated by the double stigma of mental illness and criminal involvement (Benda, 1991).

Case management - the engagement of a client in a system of services by an accountable professional or team of professionals who advocate on the client's behalf - is an effective response to the service needs of people with serious mental illness (Bond, Miller, Krumwied, & Ward, 1988; Stein & Test, 1980). Case management is particularly useful for clients who experience unique hindrances to community integration, such as homelessness, substance abuse, and criminal involvement (Griffin, 1990; Levine, Lezak, & Goldman, 1986, Rog, Andronovich, & Rosenblum, 1987). The components of a case management program based on assertive community treatment (ACT) - aggressive outreach with an in vivo locus of treatment and care (that is, in the settings where clients live, work, and socialize) - are effective in meeting the needs of marginal groups (Bond et al., 1988).

BACKGROUND

The present analysis arose during a randomized clinical trial from 1989 to 1994 of an ACT-based team model of case management for seriously mentally ill people who also were homeless and leaving a large urban jail system. Homelessness was defined as being without a permanent (more than one month) home at entrance to or exit from jail. Two hundred people were randomly assigned to three conditions before their release from jail: 60 to the ACT team of case managers, 60 to individual case managers at community mental health centers, and 80 to the usual aftercare referral from the jail to community mental health centers. …