Ira K. Packer

Community mental health services and the prevalence of severe mental illness in local jails: are they related?

The excessive prevalence of severe mental illness noted in correctional settings has sometimes been attributed to the inadequacy of community based mental health services. This study examines the prevalence of severe mental illness in two jails situated within catchment areas featuring markedly different levels of community mental health services. We use these settings to test the hypothesis that greater levels of services in a community are associated with lower prevalence of severe mental illness in the communitys jail. An epidemiologic approach, using standardized field instruments, was used to estimate the prevalence of major mental illness in detainees arriving at the two sites over a 6-month period. The hypothesis that greater levels of mental health resources in a community would be associated with lower prevalence of mental illness in the communitys jail was not supported. These findings suggest that community-based mental health services by themselves do not affect the prevalence of mental illness in jail.

Self-reported lifetime psychiatric hospitalization histories of jail detainees with mental disorders: Comparison with a non-incarcerated national sample

Lack of access to hospitalization is an often-cited risk factor for incarceration among persons with severe mental illness. This proposition is examined by comparing self-reports of lifetime psychiatric hospitalization histories of mentally ill jail inmates with data from a national sample of non-incarcerated mentally ill. Roughly 52% of mentally ill jail detainees reported at least one psychiatric hospitalization, a rate nearly three times that of the comparison group. The data call into question the notion that mentally ill jail inmates have reduced access to psychiatric inpatient treatment, without addressing the adequacy of the treatment received. Longitudinal studies are needed to explore temporal relationships to better understand the relationship between mental health treatment and criminal justice involvement.

From case management to court clinic: examining forensic system involvement of persons with severe mental illness

The study examined the flow of a state mental health agencys case-managed clients into its forensic mental health court clinic systems for evaluation of competency to stand trial (CST) for a criminal offense. An analysis of merged encounter data from the case management and court clinic systems revealed that roughly 2% of the case-managed population were referred to court clinics for evaluation of CST during a 1-year period, but that these 2% represented roughly one eighth of that years court clinic evaluees. The likelihood of this involvement was higher for males, African-Americans, and Latinos, and for persons with a history of substance abuse, and also was associated with higher levels of previous hospitalization. In addition, CST evaluees were more likely to be non-White, male, and uninsured than were case-managed evaluees. These data indicate that demographic characteristics, substance abuse, and lack of insurance are potential risk factors for forensic and, by inference, criminal justice system involvement among persons with mental illness.

Mania and Insanity: An Analysis of Legal Standards and Recommendations for Clinical Practice

ABSTRACT Significant attention has been allotted to the relationship between psychotic disorders and insanity; however, the study of manic symptoms on criminal responsibility evaluations has been virtually ignored. Given that criminal responsibility evaluations with manic defendants pose unique challenges to forensic examiners, recommendations are needed providing guidelines to insure accurate evaluation. Based on the lack of literature in this area, this article provides a critical analysis of insanity defense standards and their potential application to manic defendants. A clinical case highlights assessment techniques and provides the basis for pragmatic recommendations. A set of guidelines for conducting insanity evaluations with manic defendants is included within the article.