Stephanie W. Hartwell

Triple Stigma: Persons with Mental Illness and Substance Abuse Problems in the Criminal Justice System

This article offers a review of the literature that exists on individuals with dual diagnosis and discusses policies creating the trajectories for mentally ill individuals with substance abuse problems and their community reentry after involvement with the criminal justice system. For this analysis, basic comparisons are made across mentally ill individuals involved with the criminal justice system and the dually diagnosed portion of the population and an analysis of the current trajectory and post-incarceration disposition of the dually diagnosed group. The differences between offenders with mental illness and the dually diagnosed are pronounced. The dually diagnosed are more likely to be serving sentences related to their substance use, to be homeless and violate probation after release, and recidivate to correctional custody. An examination of substance abuse histories, short-term community outcomes, and service trends 3 months postrelease suggests public policy and social service directions.

Short-Term Outcomes for Offenders With Mental Illness Released From Incarceration

Using data on 247 offenders with mental illness, this analysis seeks to identify characteristics that distinguish those who are returned to prison or a psychiatric hospital with those who remain in the community. Sociodemographic, mental health, criminal history, and service variables are compared across a range of outcome categories with a focus on those reinstitutionalized and those reincarcerated. Those returning to institutions have somewhat different mental health service and criminal justice histories than the engaged/community group. In particular, the group that is reincarcerated is more likely released from misdemeanor sentences, and the group being released from felony sentences is more likely to be found in a psychiatric hospital after release from correctional custody. These findings have implications regarding the cumulative effects of engagement with the criminal justice system and the process through which persons with mental illness and a criminal history cycle through institutions.

Deviance over the life course: The case of homeless substance abusers

Characteristics of the homeless population highlight current and emerging social problems in America. It is estimated there are two to three million homeless people in the United States and that between 20% and 80% have substance abuse problems. In this paper I apply Hirschis social bond theory to a qualitative study of 31 male homeless substance users from New Haven, Connecticut. I interviewed each man once in 1992 and a second time during 1993. The interview data provide evidence of non-normative attachments to families, friends, and institutions where there is little commitment to conventional goals. I conclude that for these men, being homeless and abusing substances is normative to their lives.

Treatment-Seeking Patterns of Chronic Recidivists

Many substance abusers return to substance abuse treatment. This article uses the life-history interview method to explore why chronic substance abuse recidivists, from their perspective, repeatedly access substance abuse treatment programs. This approach reveals that their intentions for accessing treatment are not based on abstinence but rather in response to other, more immediate needs. Therefore, relapsing and returning to treatment is normative for chronic recidivists and patterned by their differential social and institutional associations.

Recidivism Among Released State Prison Inmates Who Received Mental Health Treatment While Incarcerated

This study assesses the likelihood of rearrest among a cohort of all adults (N = 1,438) released from the Massachusetts state prison system who received mental health services while they were incarcerated. All individuals were followed for 24 months. The analysis focused on four classes of variables: demographic characteristics, clinical history, criminal justice history, and postrelease supervision. These analyses showed that criminal history factors—a juvenile record and a history of multiple previous incarcerations—were significant risk factors, but that clinical factors, including a history of substance abuse, were not. Overall, the models developed here look much like the ones that would be observed in the general offender population. The implications of these findings for criminal justice and mental health policy are discussed.

Predictors of Accessing Substance Abuse Services Among Individuals with Mental Disorders Released from Correctional Custody

Objective: In the context of an increasing correctional population and corresponding rates of mental illness and substance abuse among this population, this study focuses on describing the predictors of substance abuse service utilization for ex-inmates with dual disorders. Our aim is to assess the likelihood and characteristics of ex-inmates with mental disorders who access substance abuse treatment services within 2 years of correctional release. Methods: Using merged administrative data on all ex-inmates with open mental health cases released from the Massachusetts Department of Corrections and two county houses of corrections from 2007 to 2009 (N = 2,280) and substance abuse treatment outcome data through 2011, we analyze the influence of demographics, behavioral and mental disorders, and criminal justice variables on entry into substance abuse treatment within 24 months post-release. We also describe primary drug use and services utilized for all the ex-inmates who accessed substance abuse services (n = 1,383). Regression techniques were used to analyze the probability of utilizing substance abuse treatment services by various demographic, behavioral, and criminal involvement characteristics. Results: The prevalence of a history of substance use disorders is high in this population (69%, n = 1,285). Subsequently, at 24 months post release, 61% (n = 1,383) of ex-inmates with open mental health cases utilized substance abuse treatment services. This group was disproportionately female and White, with a preincarceration history of substance abuse and an increased number of previous incarcerations, and was more likely released under correctional supervision. Conclusions: Substance abuse is a chronic relapsing disorder and dual diagnosis is common among individuals with mental disorders involved with the criminal justice system. Their service needs and contacts across substance abuse, mental health, and criminal justice systems highlight individuals caught up in the institutional circuit. Study results point to the need for expanded and targeted dual diagnosis treatment approaches and relapse prevention for ex-inmates with mental disorders post correctional release.

“I Grew Up Too Fast For My Age:” Postdischarge Issues and Experiences of Male Juvenile Offenders

This study adopts a contextual approach to examine factors related to the community reentry experiences and post discharge recidivism among youth who have been placed in residential juvenile justice treatment programs for a minimum of 6 months. A total of 35 youth were interviewed: 18 youth who remained arrest free in the community after discharge from residential treatment; and 17 youth who were rearrested almost immediately after residential treatment. All subjects were interviewed with a semistructured interview, which included 71 data points and 61 qualitative responses. Findings underscore the importance of the youths perspectives, interagency collaborations to address health and service needs, and initiatives to prevent high-risk and often traumatized youth from entering the juvenile justice system, particularly services that are family based.

Emerging Adults With Psychiatric Disabilities Involved With the Criminal Justice System

Experiencing serious psychiatric problems during the transition from adolescence to adulthood intensifies the perils emerging adults confront. Emerging adults whose childhood and adolescent experiences include significant contact with the public mental health or criminal justice systems have numerous additional hurdles to overcome. Disruptions in education, few opportunities for involvement with nonpsychiatrically involved peers, and limited life experiences reflect difficulties developing normative social control, skills, and networks. This article examines the impact of age and multiple stigmatized statuses by comparing an emerging adult and older cohort of psychiatrically disabled offenders. It explores whether there are features (demographic, clinical, and criminal ) that distinguish emerging adults that should be considered in creating appropriate community services for treatment and prevention and subsequent desistance from continued criminal involvement.

Proficiency in Basic Educational Skills as Related to Program Outcome and Escape Risk Among Juvenile Offenders in Residential Treatment

Abstract This study examined the relationship of basic educational skills in Vocabulary, Reading Comprehension and Math to program outcome and escape risk among male juvenile offenders in residential care. The records of 144 youth who were treated in a residential treatment center between 1978 and 1996 were reviewed along with subsequent adult and juvenile criminal histories. Results indicated Vocabulary skills were significantly related to program outcome. Youth with Vocabulary skills at or above a 9th grade level were more likely to graduate from the program whereas youth with Vocabulary skills below a 6th grade level were at higher risk for escape. Youth with Reading Comprehension skills at or above a 9th grade level were more likely to graduate and youth with Reading Comprehension skills below a 6th grade level were more likely to escape. Math Skills were not associated with successful completion of the program or escape. Youth with Math skills at or above the 9th grade level had the lowest recidivism rate while Vocabulary and Reading Comprehension levels were not associated with recidivism. The results are discussed in relation to the development of treatment programs for juvenile offenders.

Partnership in Recovery

The Grant Street Partnership (GSP) is a new, community- developed, sheller-based program of clinical and case-management services for homeless, cocaine-abusing men in New Haven,Connecticut. The fist component of the GSP is a 90day residential program in which residents progress from one level of accomplishment and responsibility to the next, culminating in an assisted search for suitable housing and for employment or job training. Upon completion of the residential component, the clients continue in case management and clinical services for approximately six months on an ambulatory basis. The GSP has a second agenda of being an agent for improvement of housing, employment, and job-training services in New Haven Because a wide spectrum of cily institutions were involved in the development of the GSP, the partnership thus developed has continued and is being redirected toward institutional change of the type needed by the GSP clients.