Session: Coercion vs. Choice in Services for People with Serious Mental Illness in the Criminal Justice System (Society for Social Work and Research 14th Annual Conference: Social Work Research: A WORLD OF POSSIBILITIES)

The prevalence of serious and persistent mental illness (SPMI) in jails and prisons has been estimated at 16%, about 4-5 times higher than the prevalence rate in the general population (Lamb & Weinberger, 1998). Nationally, an estimated 100,000 people with SPMI are released from prison each year, thereby representing a sizeable proportion of the population of people under correctional supervision (Ditton, 1999; Wolff, 2005). Reducing the “criminalization” of people with SPMI will require finding new strategies to prevent incarceration (by reducing criminal behavior or diverting individuals into treatment rather than incarcerating them) and/or prevent the recurrence of criminal behavior that might lead to a return to jail or prison. An important component to any such strategy is to engage these individuals in mental health treatment and encourage their adherence to treatment.

Because many dually involved individuals resist engagement into services, the perennial controversy over whether to override the choice not to use mental health treatment becomes especially salient in this context, because individual rights must be balanced with the need to protect public safety. A recent survey of people with mental illness receiving publicly funded treatment found that over their lifetimes, nearly half of respondents reported experiencing one or more forms of coerced or “leveraged” treatment in the community, including outpatient commitment, the threat of losing access to one's housing or money if not adherent, or treatment mandates as a condition of probation or parole (Monahan et al., 2005). As involuntary or coercive treatment strategies are increasingly viewed as possible solutions to the problem of criminal justice involvement among people with SPMI, it is important to examine whether these strategies are in fact effective and to what extent viable alternatives that preserve choice and autonomy are available.

This symposium addresses these questions through three presentations, each addressing a type of coercive intervention and/or an alternative method for treating SPMI persons with criminal justice involvement or who are at high risk for such involvement. The first presentation assesses the effectiveness of coercive treatment, using quantitative methods and data from a study of outpatient commitment in New York City to examine to what extent receiving outpatient commitment reduces arrest rates. The second presentation analyzes data from an ethnographic study of individuals leaving prison who are being served by a forensically adapted assertive community treatment program, to examine to what extent treatment provider engage in efforts to enforce parole mandates and the range of alternative strategies used to engage clients. The third study focuses upon a different potential alternative to coerced treatment, psychiatric advanced directives, by examining to what extent corrections officials are aware of such alternatives and to what extent they see them as viable options for working with offenders who have SPMI. Collectively, these studies use diverse methods and settings to bring new evidence to bear on the question of whether coercion is the appropriate solution to the growing problem of criminal justice involvement among people with SPMI.