Transcript Slide 1

Individuals with Mental Illnesses in the
Criminal Justice System: Addressing
Both Criminogenic Risks and Mental
Health Needs
Jennifer Skeem, Ph.D.
November 18th, 2009
Justice and Mental Health Collaboration Program Webinar
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Overview; introducing criminogenic risk into
the policy discussion
1. Statement of the problem
2. Root of the problem
3. Model of intervention
People with serious mental illness are
overrepresented in U.S. criminal justice system
25
20
%
Community men
15
Incarcerated men
Community women
Incarcerated women
10
5
Steadman, Osher,
et al. (2009): 14%
men and 31%
women
0
Depression
Schizophrenia
Source: Teplin, 1990; Teplin, Abram, & McClelland, 1996
Bipolar
Any
Most have co-occurring substance
abuse disorders
% Without Co-Occurring
Substance Use Disorders
28%
% With Co-Occurring Substance
Use Disorders
72%
Source: The National GAINS Center, 2004
Most are supervised in the
community…and often “fail”
Probation
Prison
Parole
Jail
Sources: Bureau of Justice Statistics (2007); Skeem, Emke-Francis, et al. (2006)
“The current situation not only exacts a
significant toll on the lives of people with mental
illness, their families, and the community in
general, it also threatens to overwhelm the
criminal justice system.”
-Council of State Governments Criminal
Justice/Mental Health Consensus Project (2002)
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Overview; introducing criminogenic risk into
the policy discussion
1. Statement of the problem
2. Root of the problem
3. Model of intervention
The perceived root of the problem
“People on the front lines every day believe too many
people with mental illness become involved in the
criminal justice system because the mental health
system has somehow failed. They believe that if
many of the people with mental illness received the
services they needed, they would not end up under
arrest, in jail, or facing charges in court”
Implicit model of “what works”
Specialty program-Treatment
mandate
Psychiatric treatmentSymptom control or reduction
Reduced recidivism
Symptom change often unrelated
to recidivism
Same as in multi-site jail
Not revoked
Revoked M=diversion
&
mental
health
court
M= -1.29, sd= .60
1.23, sd= .80
evaluations
Steadman & Naples (2005); Steadman et al. (2009)
Skeem et al. (2009)
Research indicates that the root of the
problem is more complex
• Increased mental health services often do not
translate into reduced recidivism, even for “state
of the art” services
– Caslyn et al., 2005; Clark, Ricketts, & McHugo, 1999; Skeem & Eno
Louden, 2006; Steadman & Naples, 2005
• Untreated mental illness is a criminogenic need
for only a small proportion of offenders with
serious mental illness
– Junginger et al. (2006), Peterson et al. (2009)
• Strongest criminogenic needs are shared by those
with- and without- mental illness
– Bonta et al., (1998); Skeem et al. (2009)
Offenders with mental illness have significantly
more “central 8” risk factors for crime
60
58
56
54
**
52
50
PMI
48
Non-PMI
46
44
42
40
LS/CMI Tot
….and these predict recidivism more strongly than risk factors unique to
mental illness (e.g., diagnosis, symptoms, treatment compliance)
Source: Skeem, Nicholson, & Kregg (2008)
“Central eight” for criminal behavior
(Andrews, 2006)
Risk Factor
Need
History of criminal behavior
Build alternative behaviors
Antisocial personality pattern***
Problem solving skills, anger
management
Antisocial cognition*
Develop less risky thinking
Antisocial peers
Reduce association with
criminal others
Family and/or marital discord**
Reduce conflict, build positive
relationships
Poor school and/or work performance*
Enhance performance, rewards
Few leisure or recreation activities
Enhance outside involvement
Substance abuse
Reduce use
***p <.001, **p <.01, *p <.05, PMI > Non-PMI, Skeem, Nicholson, & Kregg (2008)
Integrating alternative views about the
root of the problem
• Some people with serious mental illness may “engage in
offending and other forms of deviant behavior not because
they have a mental disorder, but because they are poor. Their
poverty situates them socially and geographically, and places
them at risk of engaging in many of the same behaviors
displayed by persons without mental illness who are similarly
situated”
– Fisher et al. (2006), p. 553
Moderated Mediation Effect of Mental Illness on Criminal Behavior
Moderator
Evidence-based
psychiatric
services
(age of onset for criminal behavior?)
(late?)
(early?)
Evidencebased
corrections
Direct Relationship
Fully Mediated Relationship
(One-Dimensional Model)
(Criminological & Social Psychological Models)
(Untreated)
Mental Illness
Criminal Behavior
Skeem, Manchak, & Peterson (2009)
Mental
Illness
Third
Variable

General
Risk
Factors
Criminal
Behavior
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Overview; introducing criminogenic risk into
the policy discussion
1. Statement of the problem
2. Root of the problem
3. Model of intervention
Evidence-based corrections
- Target: recidivism
• Focus resources on high RISK cases
• Target criminogenic NEEDS like anger, substance
abuse, antisocial attitudes, and criminogenic
peers (Andrews et al., 1990)
• RESPONSIVITY - use cognitive behavioral
techniques like relapse prevention (Pearson, Lipton,
Cleland, & Yee, 2002)
– Consider packaged programs like “Reasoning and
Rehabilitation” (Young and Ross, 2007)
• Ensure implementation (Gendreau, Goggin, & Smith, 2001)
Some evidence-based psychiatric services
- Target: symptoms & functioning
• http://mentalhealth.samhsa.gov/cmhs/CommunitySupport/to
olkits/about.asp
– Integrated dual diagnosis treatment (IDDT)
– Supported employment
• http://consensusproject.org/updates/features/GAINS-EBPfactsheets
– Supported housing
– Trauma interventions
High: Increase
emphasis on EBP for
mental health
Example:
Good
supervision +
IDDT
Integration of
EBPs for
mental health
and
corrections
Example:
RNR
supervision +
IDDT
High: Increase
emphasis on
EBP for
corrections
Good
supervision +
good
treatment
Example: RNR
supervision +
good
treatment
What to do…
Screen and assess
•
Identify offenders with mental
illnesses, using a validated tool like
the K-6 or BJMHS
– http://www.hcp.med.harvard.edu/nc
s/k6_scales.php
– http://gainscenter.samhsa.gov/HTML
/resources/MHscreen.asp
– Or MAYSI, for youth
http://www.maysiware.com/MAYSI2
Research.htm
•
Target criminogenic risk & clinical
needs with EBPs
Assess risk of recidivism, using a
validated tool like the LS/CMI
(includes youth version)
Example:
Good
supervision +
ACT
Example:
RNR
supervision +
ACT
Good
supervision +
good
treatment
Example:
RNR
supervision +
good
treatment
What to do…
Coordinate or Integrate
Above all
• Particularly for high risk,
high need cases
• Avoid bad practices
– But…target RISK
– Low thresholds for
revocation
– Sanction threats
– Authoritarian relationships
Skeem, J., Manchak, S., & Peterson, J. (2009). Correctional policy for offenders
with mental illness: Moving beyond the one-dimensional approach to reduce
recidivism. Under review
Compliance strategies
Consider “Mike”
Traditional
Not Traditional
– Bark at him…chew him up one
side and down the other...you
basically lie to them, “You’re
looking at prison”
– …talk with him to identify any
obstacles to compliance (like
transportation problems), remove
those obstacles, and agree on a
compliance plan.
• The “big bluff”- threats and
reminders
• Problem-solving strategies
Talked with you to figure out the reasons for any problems...listened
Tried to convi nce you that you would feel better if you stayed out of troubleÉ
Talked with you to help find a solution to a problem that you agreed on...
Reminded you of the conditions of probation orÉ
Praised or rewarded you when you've followed the rules
Told you th at if you followed the rules, you wouldn't have to meetÉ
Met w ith you and your therapist or case manager to try to solveÉ
Asked or got the judge to put in jail for a short time
Asked or got the judge to revoke your probation
Scolded or punished you when you've broken the rules
Took you i n for a court appearance to show that you c ould go to jail if É
Told you th at if you didn't follow the rules, you would go to jail or prison.
Made you report ( meet with him/her) more often
Tried to get you hospitalized
Traditional
Nontraditional
Compliance strategies
Prob
Sanction
Solv /+
/.77
.76
.75
.54
.34
.52
.41
.32
.73
.70
.66
.55
.25
.47
.45
.27
Negative pressure predicts failure over 12 months
(bad is stronger than good)
**p<.01, ***p <.001: Manchak, Skeem, et al., 2008
Relationship quality
Colors every interaction and affects outcomes
Authoritarian
Relational
•
•
•
•
“The first time I met this particular
probation officer, he let me know that
he owns me…”
“The first time I met him, he
threatened to put me in prison…I got
so damned scared, okay? And I didn’t
do anything”
“He is chuckling to the other
one…and nods his head over towards
me and says, ‘You can tell when he’s
lying cause his lips are moving.’”
•
•
“Actually the first question he asks
when I step into his office is, ‘How are
you doing?’ And he really wants to
know…”
“For me, we all need encouragement
sometimes to do the right thing – and
it’s okay with me as long as it’s done
in the right way…talk to me first of
all…if you think that I’m going in a
direction that you feel is going to be
harmful to me”
“She talks to me the right way”
A closer look at dual role
relationship quality
• Relationship quality in mandated treatment
– Therapeutic role
– Surveillance role
Controlling
Caring
Skeem, Eno Louden, Polaschek, & Camp (2007); Skeem & Manchak (2008); Kennealy,
Skeem, et al. (2009)
.83 X cares about me as a person
.78 I feel safe enough to be open and honest…
.78 X explains what I am supposed to do…
.77 I feel free to discuss the things that worry…
.84 X tries very hard to do the right thing by me
Trust
.78 X trusts me to be honest with him or her
.83 When I’m having trouble, X talks with me…
.75 X knows that he or she can trust me
.74 If I break the rules, X calmly explains what…
.87 X is someone I trust
.81 X is enthusiastic and optimistic with me
.87 X encourages me to work with him or her
.90
.86 X really considers my situation when…
.85 X seems devoted to helping me overcome…
.85 X is warm and friendly with me
CaringFairness
.87 X treats me fairly
.90 X really cares about my concerns
-.88
-.76
Dual-Role
Relationship
Inventory
.78 X praises me for the good things I do
(CFI=.91)
.76 If I’m going in a bad direction, X will talk…
.86 I know that X truly wants to help me
.79 X expects me to do all the work alone…
.85 X considers my views
.83 X gives me enough of a chance to say…
.86 X takes enough time to understand me
Toughness
.77 X makes unreasonable demands of me
.87 I feel that X is looking to punish me
.87 X takes my needs into account
.78 X puts me down when I’ve done…wrong.
.85 X shows me respect in absolutely all…
.76 X talks down to me
Firm but fair relationships help protect
against failure over 12 months
***
*p<.05; **p<.01
***
Justice Center Publications
http://consensusproject.org/issue_areas/corrections
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Thanks
[email protected]
MacArthur Research Network
Council of State Governments Justice Center
Criminal Justice and Mental Health Lab
Probationers, officers, and supervisor
participants
Thank You!
The webinar recording and PowerPoint presentation will be available on
www.consensusproject.org within a few days.
This material was developed by presenter for this webinar.
Presentations are not externally reviewed for form or content and as such, the
statements within reflect the views of the authors and should not be considered
the official position of the Bureau of Justice Assistance, Justice Center, the members
of the Council of State Governments, or funding agencies supporting the work.