Successfully Managing Mentally Ill Offenders: Thoughts and Recommendations
Norton, Steven C., Corrections Today
The mentally ill offender presents a complex set of problems for correctional institutions and staff. These offenders require specialized services, increased staff and unique regulations. Correctional populations continue to increase, with the concomitant increase in numbers of mentally ill offenders.
Mentally ill offenders comprise a diverse group of inmates. One of the initial difficulties in discussing the mentally ill offender is one of definition. Different research studies incorporate different categories of mentally ill offenders, and different statistical summaries incorporate different categories. This creates obvious problems when comparing various studies and groupings in an attempt to develop a cohesive picture.
Typical groupings of mentally ill offenders have included those with major mental illnesses. Such mental illnesses have been defined based on the diagnostic system of the American Psychiatric Association Diagnostic and Statistical Manual, Fourth Edition (DSM-IV). This system has a five-axis/level structure. The most significant disorders are on the first axis and are termed Axis I disorders, which include schizophrenia, bipolar disorders and major depression, among others. Mentally ill offenders are at times identified by these Axis I disorders.
Substance abuse disorders of all types are also included on Axis I. Mental retardation is another diagnosis of many incarcerated individuals and incorporates those inmates with substantially lower intellectual abilities than average. Personality disorders are a diagnosis also commonly found within correctional populations. Personality disorders are by definition chronic personality characteristics that are dysfunctional in nature, but involve choices and decisions somewhat under the individual's control. Mental retardation and personality disorders are both placed on Axis II of the DSM-IV diagnostic system and generally would not be considered major mental illnesses.
For the purpose of this article, mentally ill offenders will be defined as those with an Axis I disorder. These major mental illnesses do not include substance abuse disorders, mental retardation or personality disorders. However, many mentally ill offenders have substance abuse, mental retardation and/or personality disorders as significant components of their overall psychological organization. This combination and multilayered diagnosis adds greatly to the difficulties in the management of mentally ill offenders.
The numbers for mentally ill offenders reflect the confusion in terminology, with estimates ranging from 8 percent to 17 percent of the total inmate population. Taking a middle approach to these estimates and using 10 percent of the total inmate population provides a reasonably accurate estimate of the number of mentally ill offenders. There are currently 1.9 million individuals incarcerated in U.S. correctional institutions. A 10 percent estimate identifies 190,000 mentally ill offenders--a significant population group.
The number of mentally ill offenders is increasing for a variety of reasons. Historically, those individuals with a mental illness who committed a crime were often placed in a state hospital system or simply released back to the community. As the state hospital population decreased due to the de-institutionalization movement and closure of the hospitals, these individuals found themselves incarcerated rather than hospitalized. Mentally ill offenders in the past 10 years are also much less likely to simply be released for alleged or committed crimes. Courts are reluctant to simply drop these charges, which then increases the number of convictions and incarceration rates for mentally ill offenders. This statement is not an implication of a higher crime rate for mentally ill individuals, but rather a reflection on the courts' movement toward conviction and the public's demand for higher accountability for mentally ill offenders. …