Screening for Serious Mental Illness among Criminal Offenders

Date08 August 2005
Pages137-161
Published date08 August 2005
DOIhttps://doi.org/10.1016/S0196-1152(05)12007-9
AuthorJames A. Swartz,Arthur J. Lurigio
SCREENING FOR SERIOUS
MENTAL ILLNESS AMONG
CRIMINAL OFFENDERS
James A. Swartz and Arthur J. Lurigio
ABSTRACT
Resource constraints at all levels of the criminal justice system as well
as the lack of a widely accepted, validated screening scale have made
it difficult to screen adequately for serious mental illnesses (SMI) in
offender populations. This study examined the use of the K6 scale, a
recently developed and validated screening tool for SMI, using a sample
of past-year arrestees. Among the main findings were that 18% of the
sample screened positive for SMI. In contrast, commonly used screening
questions misidentified a large proportion of arrestees with SMI. Based
on these findings, we recommend the use of K6 scale to more accurately
identify offenders with SMI.
Large- and small-scale epidemiological studies have shown that dispropor-
tionate numbers of offenders, compared with persons in the general pop-
ulation, have serious mental illnesses (SMI) such as schizophrenia, bipolar
disorder, and major depressive disorder (Abram & Teplin, 1991;Abram,
Teplin, & McClelland, 2003;Bureau of Justice Statistics (BJS), 1999;
The Organizational Response to Persons with Mental Illness Involved with the Criminal Justice
System
Research in Social Problems and Public Policy, Volume 12, 137–161
Copyright r2005 by Elsevier Ltd.
All rights of reproduction in any form reserved
ISSN: 0196-1152/doi:10.1016/S0196-1152(05)12007-9
137
Diamond, Wang, Holzer, Thomas, & des Anges, 2001;Human Rights
Watch (HRW), 2003). The influx of large numbers of individuals with
mental illnesses into the criminal justice system – precipitated, in part, by the
closing of state psychiatric hospitals – resulted in a shifting of inpatient
psychiatric treatment to criminal justice settings (Lamb, 1998;Lamb &
Weinberger, 1998;Torrey, 1995). Presently, the three largest providers of
psychiatric treatment services are urban jails: the Los Angeles County Jail,
the Cook County Jail (CCJ) in Chicago, and the jail at Riker’s Island in
New York (Insel, 2003).
These continuing trends highlight the need for appropriate and effective
mental health treatment services in criminal justice settings. Federal courts
have consistently ruled that jails and prisons are legally obligated to provide
mental health services (Diamond et al., 2001;Veysey & Bichler-Robertson,
2002). Without treatment, offenders with SMI often have trouble adapting
to the daily routines and obeying the rules of prisons and jails (HRW, 2003;
Torrey, 1995). Furthermore, inmates and detainees with mental illnesses
are at increased risk for suicide, disciplinary infractions, and victimization
(Dicataldo, Green, & Profit, 1995;HRW, 2003). In addition, mentally ill
persons on community supervision can have problems adjusting to their
sentences. For example, mentally ill probationers might have trouble
complying with their probation orders (e.g., finding employment, reporting
to officers) and are at an increased risk for re-arrest for a technical viola-
tion or a new offense (Solomon & Draine, 1999). Thus, from an organi-
zational standpoint, treatment of mental illnesses is not only a legal and
clinical requirement; it can also improve offender management and reduce
recidivism.
Despite the clear legal and clinical obligations to provide mental health
services, many mentally ill offenders are unidentified and untreated while
under the authority of the criminal justice system (HRW, 2003;National
Commission on Correctional Health Care (NCCHC), 2002;Steadman &
Veysey, 1997). Moreover, as noted by Lurigio and Swartz (2000), because
linkages between the criminal justice and mental health systems are often
tenuous, the mentally ill involved in these systems often ‘‘fall through the
cracks’’ and become both chronic patients and arrestees (see also Lamb,
Weinborger, & Gross, 2004).
Multiple factors are related to the failure to provide adequate mental
health treatment to correctional populations (Lurigio & Swartz, 2000). An
important problem is the failure to properly screen and assess offenders for
mental health services. In many criminal justice settings, screening is not
standardized, resulting in invalid and unreliable diagnostic information
138

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