Sarah M. Manchak

Correctional Policy for Offenders with Mental Illness: Creating a New Paradigm for Recidivism Reduction

Offenders with mental illness have attracted substantial attention over the recent years, given their prevalence and poor outcomes. A number of interventions have been developed for this population (e.g., mental health courts). They share an emphasis on one dimension as the source of the problem: mental illness. Their focus on psychiatric services may poorly match the policy goal of reducing recidivism. In this article, we use research to evaluate (a) the effectiveness of current interventions, and (b) the larger viability of psychiatric, criminological, and social psychological models of the link between mental illness and criminal justice involvement. We integrate theory and research to offer a multidimensional conceptual framework that may guide further research and the development of efficient interventions that meaningfully reduce recidivism. We hypothesize that the effect of mental illness oncriminal behavior reflects moderated mediation (i.e., the effect is direct in the case of one subgroup, but fully mediated in another); and that the effect of mental illness on other “recidivism” is partially mediated by system bias and stigma. We use this framework to propose three priorities for advancing research, articulating policy, and improving practice.

Social Networks and Social Control of Probationers with Co-Occurring Mental and Substance Abuse Problems

Probationers with co-occurring mental and substance abuse problems (PCPs) are both subject to considerable social control, and at high risk of probation failure. In this study, we screened 601 probationers for symptoms, interviewed 82 identified PCPs about their relationships, and then followed these PCPs for eight months to record treatment nonadherence and other probation violations. First, PCPs’ social networks were small, heavily comprised of professionals and opposing forces who engaged in risky behavior, and saturated with pressure to adhere to treatment. Second, the size and composition of PCPs’ social networks were more relevant to rule compliance than social support and undermining. Third, the quality of PCPs’ relationships was key: satisfying relationships with clinicians and, to a lesser extent, officers and the core network related to low perceived coercion, high treatment adherence, and low risk of future violations. In particular, having a likable clinician who engaged in participatory decision-making reduced the risk of violations. Implications for contextually sensitive risk reduction efforts are discussed.

DOES GENDER MODERATE THE PREDICTIVE UTILITY OF THE LEVEL OF SERVICE INVENTORY-REVISED (LSI-R) FOR SERIOUS VIOLENT OFFENDERS?

A prison inmates risk of recidivism is central to decisions about whether to release her to serve a portion of her sentence on parole. Although several tools have been developed to improve accuracy in estimating the risk of future reoffense, few have been validated with the ever-growing population of female offenders. This study compared the utility of the Level of Service Inventory—Revised (LSI-R) in predicting recidivism for 70 female and 1,035 male offenders who had been convicted of serious violent offenses. The LSI-R predicted 1-year general recidivism quite well for women. Although gender did not moderate the utility of the LSI-R in predicting recidivism, risk factors that best predicted recidivism differed for men and women. Implications for risk assessment and parole decision making with female inmates are discussed.

Care, control, or both? Characterizing major dimensions of the mandated treatment relationship.

Current conceptualizations of the therapeutic alliance may not capture key features of therapeutic relationships in mandated treatment, which may extend beyond care (i.e., bond and affiliation) to include control (i.e., behavioral monitoring and influence). This study is designed to determine whether mandated treatment relationships involve greater control than traditional treatment relationships, and if so, whether this control covaries with reduced affiliation. In this study, 125 mental health court participants described the nature of their mandated treatment relationships using the INTREX (Benjamin, L., 2000, SASB/INTREX: Instructions for administering questionnaires, interpreting reports, and giving raters feedback (Unpublished manual). Salt Lake City, UT: University of Utah, Department of Psychology), a measure based on the interpersonal circumplex theory and assesses eight interpersonal clusters organized by orthogonal axes of affiliation and control. INTREX cluster scores were statistically compared to existing data from three separate voluntary treatment samples, and structural summary analyses were applied to distill the predominant theme of mandated treatment relationships. Compared with voluntary treatment relationships, mandated treatment relationships demonstrate greater therapist control and corresponding client submission. Nonetheless, the predominant theme of these relationships is affiliative and autonomy-granting. Although mandated treatment relationships involve significantly greater therapist control than traditional relationships, they remain largely affiliative and consistent with the principles of healthy adult attachment.

The Influence of Co-Occurring Mental Health and Substance Use Problems on the Effectiveness of Juvenile Drug Courts

The effectiveness of juvenile drug courts is mixed, and several factors could account for these findings. The present study examines whether and why youth with co-occurring mental health problems may have worse outcomes in juvenile drug court than youth who only have issues with substance use. In a sample of youth in juvenile drug court, 328 youth with co-occurring mental and substance use disorders were compared with 336 youth with only substance use disorders. Youth with co-occurring mental health problems had significantly worse criminal justice outcomes than youth without mental health problems. These outcomes were explained, in part, by more frequent violations of the drug court requirements, and in particular, violations surrounding treatment noncompliance. Results suggest that juvenile drug courts—as they currently operate—may be unsuccessfully managing youth who present with co-occurring mental health and substance use problems. Implications for policy and practice are discussed.

Comparing Public Safety Outcomes for Traditional Probation vs Specialty Mental Health Probation

Importance Probation is a cornerstone of efforts to reduce mass incarceration. Although it is understudied, specialty probation could improve outcomes for the overrepresented group of people with mental illness. Objective To test whether specialty probation yields better public safety outcomes than traditional probation. Design, Setting, and Participants A longitudinal observational study with group matching on age, sex, race/ethnicity, probation time, and offense at 2 urban agencies that exemplify specialty and traditional probation. Enrollment began October 19, 2005; follow-up data were complete January 26, 2013. Participants were 359 diverse probationers with serious mental health problems and functional impairment. Probationers and officers were assessed 3 times (for probationers, 6-month retention, 315 of 359 [88%]; 12-month retention 304 of 359 [85%]) and follow-up records were obtained. Machine learning algorithms were combined with a targeted maximum likelihood estimation, a double robust estimator that accounts for associations between confounders and both treatment assignment and outcomes. Statistical analysis was conducted from January 1, 2016 to May 5, 2017. Interventions Specialty probationers were assigned to small, homogeneous caseloads supervised by experts. Prior data indicate that specialty officers had better relationships with probationers, participated more in probationers’ treatment, and relied more on positive compliance strategies than traditional officers. Main Outcomes and Measures Violence during 1 year, determined by probationer report, officer report, and records, and rearrest during a period of 2 to 5 years, according to Federal Bureau of Investigation records. Results Participants were 183 specialty (73.8% of 248 eligible) and 176 traditional (56.6% of 311 eligible) probationers (205 men and 154 women; mean [SD] age, 36.9 [10.6]). Although specialty probation had no significant effect on violence (odds ratio, 0.97; 95% CI, 0.69-1.36), the odds of rearrest were 2.68 times higher for traditional probationers than for specialty probationers (95% CI, 1.86-3.84; P < .001). At 2 years, estimated probabilities of rearrest were 28.6% for specialty probationers and 51.8% for traditional probationers. Survival analyses indicate that arrest effects endured up to 5 years. Conclusions and Relevance Although it did not specifically reduce violence, well-implemented specialty probation appears to be effective in reducing general recidivism. Reform efforts for people with mental illness could leverage probation—a ubiquitous and revitalized node of the justice system.

An Examination of Multiple Factors Influencing Support for Sex Offender Policy

The general public has an influence on the creation and implementation of criminal justice policy. There is strong public support for policies targeting sex offenders, in particular, despite research evidence demonstrating their ineffectiveness. Any change in current policy will require a change in public perceptions. As such, it is important to identify the factors that influence one’s support for current sex offender policies. Using a student sample, this exploratory pilot study employed a survey with an experimental vignette component to examine the influence of personal demographic characteristics, knowledge, attitudes and beliefs about sex offenders, and offense characteristics on support for three current sex offender policies. Results from the multivariate analyses suggest that support for sex offender policy is complex and influenced by a number of factors. Greater support for sex offender policy was associated with more social distancing, higher perceptions of sex offender riskiness, offender criminal history, and younger victim age.

“Project HOPE” for Homeless Individuals with Co-Occurring Mental and Substance Abuse Disorders: Reducing Symptoms, Victimization, and Violence

Homeless individuals with co-occurring mental and substance abuse disorders are at high risk for victimization and violence, frequently cycle between the streets, jails, and emergency rooms, and are difficult to effectively treat because of their multifaceted problems. This study evaluates Project HOPE, an intensive, integrated outreach program for this population. We found that Project HOPE effectively enrolled a highly at-risk, symptomatic group of 69 clients in treatment. However, the majority (62%) of these clients discontinued treatment in less than three months. Those who completed Project HOPE showed remarkable improvement across several domains, including more stable housing, fewer psychiatric and substance abuse problems, and better relationships. In this first study of treatment-related changes in violence and victimization for this population, we found that victimization rates decreased from 67% to 16% and violence rates decreased from 46% to 20% with treatment. Implications for developing programs that better retain clients while effectively improving their symptoms, safety, and functioning are discussed.

The Role of Stigma Toward Mental Illness in Probation Officers’ Perceptions of Risk and Case Management Decisions:

Recommendations for supervising offenders with mental illness have evolved from a narrow focus on treating psychopathology to an integration of mental health treatment and correctional interventions. Probation officers likely have inflated perceptions of risk for offenders with mental illness, which may result in improper risk assessment and misinformed risk management practices. In a sample of 89 probation officers, we examined perceptions of risk for probationers with and without mental illness and explored whether stigmatizing attitudes toward mental illness affect perceptions of risk and risk management strategies. Officers did not overestimate risk for offenders with mental illness, and stigma toward mental illness bore little influence on risk ratings and case management decisions. However, officers did rate the offender with mental illness as higher risk than the nondisordered offender and chose more punitive responses to a violation he committed—despite being informed that the offenders were of the same risk classification.

Social Networks and Treatment Adherence Among Latino Offenders With Mental Illness

Mental health treatment adherence is often required for offenders with mental illness supervised on probation and parole. However, research on offenders with mental illness has largely overlooked cultural and ethnic responsivity factors that may affect adherence to treatment. Latinos are a quickly growing subgroup of offenders whose social networks differ in meaningful ways from European Americans’ (e.g., size, composition, centrality of family). Social networks are known to relate to both clinical and criminal justice outcomes for offenders with mental illness, and there are features of nonoffender Latinos’ social networks that suggest that findings distilled from work with non-Latino offenders may not apply to them. The present study examined the social networks of 86 Latino probationers with serious mental illness to (a) describe the size and composition of these networks and (b) to determine which factors of social networks are related to treatment adherence. The authors found that Latino offenders’ social networks are small (∼6 individuals), consisting primarily of family and professionals such as treatment providers and probation officers. Supportive relationships with nonprofessionals and treatment providers was related to lower likelihood of missing treatment appointments, whereas social control and pressure from family and friends to attend treatment was not related to treatment adherence. Findings are discussed within the context of improved practices for community corrections and mental health agencies in working with Latino offenders with mental illness.