Decriminalizing severe mental illness by reducing risk of contact with the criminal justice system, including for forensic patients

Abstract

Risk of contact with the criminal justice system (CJS) is greater among those with mental illness, including severe mental illness—an observation that many argue reflects a process of “criminalizing” mental illness. Forensic patients represent a subgroup at one end of a spectrum of such criminalization, typically with histories of serious violence and psychotic illness. Strategies for decriminalizing mental illness in this context should consider a range of approaches, including intervening to prevent CJS contact in those with severe mental illness, particularly in the early or emerging stages of psychosis. However, it may be that even gold standard mental healthcare applied universally is insufficient to address CJS contact risks. While there is now an extensive literature documenting the relatively low rates of repeat CJS contact for forensic patients released from secure care, appropriate comparison groups are lacking and the key ingredients of any benefits of treatment are unknown. The CJS may well have something to learn from forensic mental health systems and services given the abject failure to stem rates of prison-release reoffending internationally. Understanding how to best identify risk and effectively intervene to prevent CJS contact in those with mental illness, whether early in the course of psychosis or following release from secure care, remains a priority for those seeking to address the criminalization of mentally illness in our communities.

Forensic mental health issues for women in contact with the criminal justice system

“…This service uses the consultation liaison model and works collaboratively with the custodial, court liaison and local health district mental health teams to provide continuity of mental healthcare in the community to prevent women falling through service gaps. 28…”

“…This service uses the consultation liaison model and works collaboratively with the custodial, court liaison and local health district mental health teams to provide continuity of mental healthcare in the community to prevent women falling through service gaps. 28 The NSW Health Connections Program provides a prerelease assessment and post-release integration into health and welfare related services for people with alcohol and/or drug related issues. Many women will commence opiate substitution treatments in custody (in NSW custody this is usually the long-acting depot injection buprenorphine), and continuity of this treatment supports social reintegration and stability of their mental health.…”

Aggressive Incidents by Incarcerated People With Psychiatric Illness and Their Relationship With Psychiatric Symptoms

“…Detainees with SMI score relatively high on characteristics that are known to be risk factors for aggressive behavior. For instance, they have lower educational and economical statuses, more often a history of childhood abuse, and more often comorbid conduct disorder and antisocial traits than those without criminal records (Bo et al, 2011; Cullen et al, 2011; Dean et al, 2020). Among detainees with SMI, Black and minority groups are overrepresented (Denzel et al, 2016).…”

From Inside to Insight

“…conduct disorder and antisocial traits than those without criminal records(Bo, Abu-Akel, Kongerslev, Haahr, & Simonsen, 2011;Cullen, Soria, Clarke, Dean, & Fahy, 2011;Dean, Singh, & Soon, 2020). Among detainees with SMI, black and minority groups are overrepresented.…”