Criminalization of Mental Illness: Crisis and Opportunity for the Justice System

As public psychiatric facilities have moved from institutions to community settings in the United States over the past 40 years, we have experienced a marked increase in the incarceration of persons with serious mental illness. Recent estimates are that we book over two million persons with serious mental illnesses into jails annually ( 1 ), with many of these persons later being moved to prisons for longer-term stays. The rapid transfer of responsibility of care for this population from the mental health establishment to the criminal justice system has been accompanied by significant problems. These problems have been exacerbated by an unfortunate failure to find meaningful interaction between the mental health system and those working in the criminal justice sector.

Nevertheless, the past decade has seen some significant changes. More mental health professionals have begun to pay attention to the plight of persons with mental illness who are involved with the criminal justice system. Mental health courts and specialized mental health training for the police are being established across the country. Laws governing the ability to treat persons who have mental illness and are resistive to treatment have arguably been improved. Initiatives to improve the availability of treatment for incarcerated persons with mental illness also are being implemented. Many of these recent changes have been largely driven by the advocacy efforts of consumers and family members.

Criminalization of Mental Illness provides an excellent overview of these recent developments from a variety of perspectives. Senior author Risdon N. Slate is a criminal justice faculty member at Florida Southern College, and as he points out, he is a seasoned advocate and person in recovery from serious mental illness. His coauthor, W. Wesley Johnson, is a former criminal justice professor and is currently president of the Academy of Criminal Justice Sciences. These criminal justice academics lay out their work in ten well-written chapters, beginning with a brief history outlining how such a very large proportion of persons with serious mental illnesses came to be under the auspices of the criminal justice system. Given that dangerousness is so frequently perceived to be associated with mental illness in the public mind, it is refreshing to see these authors stress early in their volume that persons with mental illness are much more likely—by as much as a factor of 14—to be victims of violence than they are to initiate it against others.

After their initial overview, the authors cover various approaches that police departments have taken to better address the problems of the population with serious mental illness. This section is followed by one describing the development of the several types of mental health courts, which they describe as being similar to the drug courts that preceded them in the late 20th century. Both drug and mental health courts started in southeast Florida, and both are described as relying heavily on the principles of therapeutic jurisprudence. Subsequent chapters then focus on planning for discharge from incarceration and on various approaches to handling violations among those with mental illness outside the jails and prisons, including those related to parole, probation, and contact with specialized forensic assertive community treatment teams.

The book includes numerous real-life examples of individuals caught up in the interface between mental illness and criminal justice. Somewhat refreshingly, these authors tend to draw their examples from Florida and other parts of the country, in contrast to the more typical custom of disproportionately taking examples from the more densely populated, northeastern region of the country.

Additional chapters are contributed by professionals who have perspectives outside the book's primary authors. Three psychiatrists who had served with Dr. Slate on the board of directors of the National Alliance on Mental Illness (NAMI)—Anand Pandya, H. Richard Lamb, and Suzanne Vogel-Scibilia—contribute an excellent chapter on how persons with mental illness are affected by the experiences and attitudes of criminal justice practitioners. They lament that too often mental health professionals tend to avoid those most in need of their care. They present an urgent call for a change in the attitudes and biases of mental health professionals with regard to persons with mental illness in the criminal justice system.

Ronald Honberg, J.D., the long-time legal director for NAMI, writes the excellent penultimate chapter. He describes legal difficulties that arise for persons with mental illness, including various aspects of determining trial competency, insanity, and prisoners' rights both to receive and to refuse treatment. His description of Eighth Amendment rights and how these extend to discharge planning is of particular interest.

Overall this very readable book provides a good survey of the various sectors of the criminal justice system and their response to the substantive changes that have affected persons with mental illness during the recent past. These authors provide a valuable guide for mental health professionals interested in appropriate treatment and placement of persons with mental illness.