Drug-Related Arrests in a Cohort of Public Mental Health Service Recipients

We examined data on a cohort of individuals age 18 years and older (N=13,816) receiving adult inpatient, residential, or case management services from the Massachusetts Department of Mental Health during July 1991 through June 1992. Eligibility for these services was based on having a diagnosis of serious and persistent mental illness, a history of functional disability, and multiple psychiatric hospitalizations. Arrest data for cohort members spanning just less than ten years following the cohort's identification were obtained from the Massachusetts Criminal Offender Record Information (CORI) system. (A more complete overview of the cohort and its arrest patterns is available in a study by Fisher and colleagues [19].)

This project was reviewed and approved by the institutional review board of the University of Massachusetts Medical School and by the Central Office Research Review Committee of the Massachusetts Department of Mental Health. Access to the CORI data was granted after review of the project by the Massachusetts Criminal History Systems Board, which oversees the use of those data.

Several factors must be considered in viewing these data. First, we should point out that we have not taken into account loss to follow-up, loss to mortality, or out-of-state arrests among cohort members in estimating rates of drug arrest. It is unclear what effects any of these factors might have on those estimates. We also emphasize that arrests reflect only actions taken by police officers in response to perceived violations of the law; they are neither findings of guilt nor convictions. It is also important to note that drug arrests are not an accurate reflection of the prevalence of drug use in this cohort or in similar populations. It is likely that many persons' drug use escapes the attention of police; likewise, some individuals may be present where drugs are kept or processed and, though not using them, be arrested if police believe they knew drugs were present. Finally, it is important to keep in mind that our cohort's members are persons whose psychiatric illnesses were severe and persistently disabling enough to meet the state's stringent eligibility criteria for receiving services. This point should be recalled when considering the generalizability of these data to the broader population of persons with serious psychiatric disorders who may be involved with illicit substances.

These data speak to three issues: drug possession, involvement with drug distribution or manufacture, and other patterns of offending. Many of the simple possession charges involve marijuana or other recreational drugs and may simply reflect either being in the "wrong place at the wrong time" or casual recreational use similar to that found in many segments of the population. These charges may carry only minor penalties, especially on a first offense (although in some jurisdictions even these minor drug crimes carry lengthy prison sentences). But as we noted earlier, arrests for simple possession of "harder" drugs can have significant legal and service-eligibility outcomes, and clientele of mental health agencies should be reminded of the problems that can arise from involvement with such substances.

Manufacturing and distributing reflect a much more consequential set of behavioral patterns. Convictions on these charges carry the harsh criminal penalties and postconviction denial of benefits described above. As we noted, roughly 20% of individuals with drug-related arrests also had arrests for conspiracy. Although we cannot be certain that these conspiracy arrests were drug related, the 20% figure corresponds roughly to the percentage of persons arrested on charges involving more than simple possession. If these are in fact related, they suggest a serious level of legal entanglement that can have profound problems for those arrestees.

Equally troubling is the strong relationship between drug-related arrests and arrests on other charges. As we noted, only about 5% of persons with drug-related arrests were charged solely with drug-related offenses over the observation period. This pattern is consistent with that observed in the general offending population, suggesting that among persons with serious mental illness, as in the general population, drug involvement may be embedded in a larger pattern of offending, a finding consistent with the Bureau of Justice Statistics data cited above ( 10 ).

What do these data tell us? The data on drug possession are essentially a reminder of the extent to which individuals with serious mental illness have opportunities for involvement with illicit drugs. The clustering of charges in the younger age cohorts suggests that these individuals may have peers who use drugs or frequent settings where drugs are easily obtained. As we noted, this should not come as a surprise, given the drug-infested environments in which some persons with mental illness reside and the lifestyle patterns these environments may induce ( 11, 12, 13, 14, 15 ).

Whether the more serious charges observed here, involving manufacture and distribution, are simply an extension of these behaviors arrived at through the same pathways and resulting from the same risk factors is unclear. We might safely assume that these arrestees are not major drug dealers; it is more likely that they work as processors or as "mules," transporting drugs on behalf of dealers in exchange for drugs or cash. But given the serious consequences sometimes associated with convictions on these charges, additional research in this area might be profitable.

Because it deals with arrest patterns only, our data cannot help us in directly identifying risk factors for engaging in more serious drug offending. There are, however, descriptions of pathways to such behaviors (apart from simply using substances) in the literature that resonate with our understanding of the lifestyles of some persons with severe mental illness and which may help in contextualizing our findings.

Journalist Adrienne LeBlanc ( 20 ), in her accounts of life among young Puerto Ricans in the Bronx, describes a social environment occupied by persons who, like many persons with serious mental illness, are poor and socially disenfranchised. Many of the youths she observed became involved with the drugs and drug dealing pervading their neighborhoods; however, this involvement was not simply because of the attractions of the drugs themselves. As LeBlanc's account suggests, drug-related activities hold multiple attractions: large-scale drug dealers may have significant social status in their communities as well as enormous financial resources and the ability to convey numerous favors, including employment at wages that vastly exceed those obtainable through legal employment. (For persons with mental illness living on public assistance such wages will, of course, go unreported, boosting their "disposable income" while not affecting their entitlements.) In addition, the dealer's local operation, as LeBlanc described it, conveyed significant social standing to those involved with it. Importantly, LeBlanc's account also suggests that some persons working in this operation were themselves not drug users, and some, including many juveniles, were used as operatives because they would not be credible witnesses.

How might persons with serious mental illness come to be involved with such operations? Are they taken advantage of in these situations? Are they enticed by potential social and economic benefits? Are they viewed by drug dealers as "expendable" or seen as attractive employees because if apprehended they might not be regarded as credible prosecution witnesses? Addressing such questions takes us well beyond the scope of our data, but doing so is essential in framing efforts to help individuals understand both the attractions and the serious risks attending involvement with drugs and drug dealing.

Also disturbing is the 95% prevalence of non-drug-related arrests among persons charged with drug offenses, a rate nearly identical to that of drug arrestees in Massachusetts's general offending population over the same period. It would be tempting to infer that many of these arrests are associated with drug involvement. Indeed, it is virtually a given that persons who use drugs, particular those with serious addictions, engage in a variety of unlawful behaviors—including property crimes, crimes against persons, and prostitution—to support their drug use. However, our data cannot directly support the point that this pattern is the one that would be most commonly observed among the cohort members arrested on drug charges. Clearly, a next step in research in this area would be to determine where the drug arrests fit within a larger pattern of offending and what subpatterns are identifiable on the basis of temporal and other factors.

Our data lack the detail required to make definitive statements about the nature and etiology of drug-related behaviors. We would hope, however, that these findings would stimulate further research in this area. From the perspective of the mental health service system, it would be useful to understand how individuals with severe mental illness become involved in drug-related activities. If it has to do simply with drug use, then the legal ramifications of that behavior need to be made clear as part of substance abuse treatment protocols. Such protocols might include strategies for identifying and coping with the pressures of social networks as well as the predatory drug dealers operating within some neighborhoods. If it is the economic or social attractiveness of such involvement that lures these individuals, additional social skills training protocols might be developed that would help in resisting those attractions, making clear the risks of incarceration and other penalties and their potential effects on their lives. Indeed, although many persons with serious mental illness live a life marked by poverty, drug convictions can make their plights even worse ( 15, 16, 17 ). For interventions in these areas to be effective, however, they must take into account the demographic, cultural, and socioenvironmental characteristics of those at greatest risk and tailor clinical and social prevention strategies to those individuals ( 21 ). That said, the factors that increase exposure to illicit drugs—poverty, discrimination in housing choice, unstable housing, homelessness, lack of meaningful prosocial engagement—are part of a larger constellation of problems confronting persons with mental illness ( 10 ). Addressing those problems is a bigger challenge.

This study was supported by grant RO1-MH-65615 from the National Institute of Mental Health. The authors also acknowledge the contributions of their late colleague and dear friend Steve Banks, Ph.D., who passed away suddenly in August of this year. None of the work on this project could have been carried out without his enormously valuable contributions. Mental health services research has sustained a personal loss that will profoundly affect the work of an untold number of investigators for years to come.

The authors report no competing interests.

All the authors except for Dr. Wolff are affiliated with the Department of Psychiatry, University of Massachusetts Medical School, where the late Dr. Banks was also affiliated. Send correspondence to Dr. Fisher at the department at 55 Lake Ave. N., Worcester, MA 01655 (e-mail: [email protected]). Dr. Wolff is with the Center for Mental Health Services and Criminal Justice Research, Rutgers University, New Brunswick, New Jersey.