From Cell Blocks to City Blocks: Understanding Incarceration Among Individuals with Serious Mental Disorders

Background and Purpose: Individuals with serious mental disorders (SMD) are incarcerated at rates approximately three times higher than those without SMD (Steadman, et al., 2009; Teplin, 1990).  Comprising 15% of inmates nationally, these individuals pose serious problems for criminal justice systems, as they require specialized care from facilities, experience disproportionately high rates of exploitation and violence in detainment and in the community, and are at greater risk of recidivism (Haney, 2006; James & Glaze, 2006; Steadman, et al., 2009). Two frameworks are frequently used to explain the hyperincarceration of people with SMD—the “criminalization” of mental disorders and the “deinstitutionalization” of mental hospitals.

Recently, researchers have argued against these explanations, finding that arrests directly related to symptoms are rare and that the availability of psychiatric hospital beds is a poor predictor of the probability of incarceration.  Thus, one such scholar concludes, “these offenders are at risk not because they are mentally ill, but because they disproportionately experience key factors… [that] establish and maintain ongoing criminal activity” (Skeem, et al., 2011, p. 117). While these “key,” or criminogenic, factors are shared with non-mentally disordered individuals, researchers acknowledge the way in which they become overrepresented among individuals with SMD remains “opaque” and “invisible” in quantitative studies (Frank & McGuire, 2009; Skeem, et al., 2011). This study addresses this gap, asking (1) What are the experiences of arrest and carceral involvement among people with SMD? And, (2) How do these experiences and other life events inform our understanding of the criminogenic factors facilitating arrest and re-arrest for individuals with SMD?

Methods: Data for this study include twenty semi-structured interviews with individuals with SMD with recent and repeated incarcerations in an urban, California County Jail and four interviews with mental health service providers (n=24). The researcher employed two qualitative methods. First, a phenomenological approach was utilized to produce an essential description of carceral experience, staying as close as possible to descriptions provided by participants (Moustakas, 1994). Secondly, a constructivist grounded theory approach was used to develop a population-specific theory of incarceration among individuals with SMD.  The researcher used Dedoose, qualitative data analysis software, to conduct coding of interview transcripts and analytic procedures.

Results: Phenomenological analyses produced an essential description of arrest experiences characterized by social conflict with others, property crimes, and substance abuse, and incarceration experiences characterized by solitude, stagnancy, subjugation and disempowerment. Grounded theory analysis gleaned a life course theory of incarceration for individuals with SMD.  Histories of institutionalization and social exclusion, pre-dating carceral involvement and varying in effect by other life experiences, were found to limit social and economic capacity and stigmatize.  In turn, these experiences facilitate desistance from normative life course events, engagement in criminal activity, and development of a “non-member” social status. 

Implications: Findings contribute a deeper understanding of hyperincarceration among individuals with SMD with practical application to carceral and mental health policies and service delivery.  As states make needed efforts toward decarceration, such stakeholder grounded research is fundamental to developing appropriate reentry and recidivism-reducing social welfare interventions.