Understanding and Treating SMI Offenders 1
Understanding and Treating Offenders with Serious Mental Illness in Public Sector Mental
Health
Humphrey Doku
Liberty University
CJUS700: Theories of Crime (C02)
Dr. Latreace Flynt
March 3, 2024
Abstract
For years, there has always been talk about the intersection of mental illness and the criminal
justice system. People with serious mental illness (SMI) have always had issues with healthcare
and confinement in hospitals and prisons. This problem reflects the prevailing attitudes and
policies of the time. Notwithstanding, the last half of the twentieth century saw a massive shift
with the coming of deinstitutionalization, powered by progressions in mental treatment, changes
in legal frameworks, and socioeconomic factors. While deinstitutionalization held a guarantee for
reintegrating people with SMI back into society, the truth missed the mark for some, prompting
their unbalanced portrayal inside the criminal justice system. Against this backdrop, the article
under examination investigates the mind-boggling elements encompassing the criminalization of
people with SMI and the difficulties presented by their release back into society. Drawing on
historical context, current trends, and empirical research, the authors navigate the multifaceted
issues, including the expectations placed on the public mental health sector, the role of diversion
and mental health courts, and the efficacy of community interventions in mitigating recidivism
risks. The authors advocate for effective, evidence-based interventions based on a practical
Understanding and Treating SMI Offenders 2
ethical framework that guides their analysis. They dig into the heterogeneous nature of people
with SMI, recognizing this populace's diverse needs and intricacies. In addition, the article
reveals the ethical implications and systemic obstacles mental health professionals and agencies
face when meeting the needs of SMI patients who are involved in the criminal justice system,
offering insights into policy responses, treatment modalities, and systemic reforms aimed at
promoting social justice and holistic care for vulnerable populations. The text outlines the
historical trajectory of the rise and fall of state hospitals for individuals with serious mental
illness (SMI) in the United States, leading to their deinstitutionalization and subsequent
criminalization. It highlights how deinstitutionalization, driven by factors such as advancements
in medication, community treatment interventions, and civil rights movements, led to the closure
of state mental hospitals and the discharge of individuals into the community. However, due to
inadequate planning and resources, many individuals with SMI struggled to adapt, leading to
homelessness or involvement in the criminal justice system. The narrative also discusses the
challenges faced by mental health professionals in providing effective communitybased care,
particularly for those with a history of incarceration. It explores the emergence of diversion
programs and mental health courts aimed at reducing the incarceration of individuals with SMI.
It emphasizes the importance of providing asylum, sanctuary, and structured support for
successful community reintegration. The text is organized chronologically, starting with the
historical context of state hospitals and deinstitutionalization, followed by the challenges and
consequences of community-based care, and concluding with recommendations for addressing
the needs of individuals with SMI in the criminal justice system and the community.
Premise
Understanding and Treating SMI Offenders 3
The article explores the notion that the rise and subsequent decline of state mental
hospitals contributed to the criminalization of individuals with serious mental illness (SMI). It
argues that the closure of these hospitals and the subsequent deinstitutionalization of patients
with SMI led many of them to become involved in the criminal justice system. Before
deinstitutionalization, which began around 1955, the United States housed approximately
559,000 individuals in state mental hospitals. Committing persons with SMI to these hospitals
was a common practice. However, starting in the late 1950s, there was a decline in hospital beds,
influenced by various socio-political factors such as advancements in medication and federal
funding for community treatment programs. Consequently, the number of individuals in state
mental hospitals significantly decreased.
Deinstitutionalization in the 20th century involved discharging persons with mental
illness from large psychiatric institutions into the community. This movement was underpinned
by the belief that individuals with SMI could receive adequate treatment in community mental
health centers. Despite the promise of thriving community living for persons with SMI, there was
a failure in planning and allocating resources for community-based care. As a result, many
individuals did not receive appropriate treatment or housing, worsening their mental conditions
and leading to increased involvement with the criminal justice system. The rise in incarceration
rates, including among individuals with mental illness, created significant financial burdens on
states and counties. To address overcrowding in correctional institutions, laws were enacted to
modify sentencing and increase diversion programs like drug courts, veterans' courts, and mental
health courts.
Mental health courts emerged as a means of diverting persons with mental illness from
the criminal justice system to the mental health system. These courts emphasize therapeutic
Understanding and Treating SMI Offenders 4
jurisprudence and aim to provide specialized treatment and support to individuals with mental
illness. Releasing incarcerated individuals with SMI into the community presents challenges for
mental health clinicians, including insufficient support services, lack of vocational skills, and
resistance to treatment. Consequently, the mental health system is increasingly expected to take
on the responsibility for the care and treatment of these individuals. Assisted outpatient treatment
(AOT) is a court-ordered commitment for persons with SMI to comply with an individualized
treatment plan in the community. It aims to prevent relapse and deterioration. However, its use is
limited due to financial constraints and legal controversies surrounding its implementation.
Synthesis of the Article with Personal Experience
In my experience working with people with mental illness when I was in law
enforcement, I witnessed firsthand the challenges faced by individuals with SMI who are
involved in the criminal justice system. The lack of adequate community-based resources often
leads these individuals to fall through the cracks and become entangled in legal issues.
Additionally, the stigma surrounding mental illness exacerbates their difficulties in accessing
proper care and support. The article resonates with my observations, particularly regarding the
importance of holistic interventions and the need for collaboration between mental health and
criminal justice systems to effectively address this population's complex needs.
Critical Evaluation
Strengths:
The article provides a comprehensive overview of the factors contributing to the
criminalization of individuals with serious mental illness (SMI), tracing the historical evolution
from the era of state mental hospitals to the present-day challenges within the criminal justice
system. It effectively highlights the multifaceted nature of the issue, discussing factors such as
Understanding and Treating SMI Offenders 5
deinstitutionalization, lack of community resources, public resistance to community treatment,
and the impact of policies like the "war on drugs" and "tough on crime" initiatives. The article
offers valuable insights into the complex interplay between mental health and criminal justice
systems by incorporating historical context and relevant research findings.
Additionally, the article acknowledges the limitations and shortcomings of current
approaches, such as the inadequacy of community mental health services and the challenges
faced by mental health professionals in treating individuals with SMI. It emphasizes the
importance of addressing structural issues, such as the need for asylum and sanctuary for those
overwhelmed by stress, as well as the necessity of providing structured support and intensive
treatment for individuals transitioning from correctional facilities to the community. The article
advocates for more effective strategies to prevent recidivism and promote successful
reintegration into society by advocating for a holistic approach that considers the individual's
clinical needs.
Moreover, the article offers practical recommendations for addressing the complex needs
of individuals with SMI, including implementing assisted outpatient treatment (AOT),
conservatorship, and guardianship. By discussing these interventions' potential benefits and
challenges, the article encourages a nuanced understanding of involuntary psychiatric
commitment and the balance between individual liberties and public safety. Furthermore, the
article emphasizes the importance of collaboration between mental health and criminal justice
systems, highlighting the need for coordination and communication to ensure effective treatment
and supervision of offenders with SMI.
Weaknesses:
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One potential weakness of the article is its limited discussion of socioeconomic factors
contributing to the criminalization of individuals with SMI. While the article acknowledges the
role of financial resources and funding priorities in shaping mental health policies, it could
benefit from a more in-depth analysis of systemic inequalities and structural barriers that
disproportionately affect marginalized communities. Moreover, the article could explore the
intersections of race, ethnicity, and socioeconomic status in the criminal justice system's response
to mental illness, providing a more nuanced understanding of how these factors intersect with
mental health outcomes.
Additionally, while the article advocates for expanding community-based services and
adopting evidence-based practices, it must address the challenges of implementing these
recommendations. Issues such as workforce shortages, funding constraints, and resistance to
change within institutional settings are significant barriers to improving mental health care
delivery. By acknowledging these challenges and discussing strategies for overcoming them, the
article could offer a more comprehensive and realistic approach to addressing the needs of
individuals with SMI in the community.
In conclusion, the article gives a far-reaching examination of the variables adding to the
criminalization of people with serious mental illness (SMI), following the verifiable direction
from state mental clinics to contemporary difficulties inside the criminal justice system. It
effectively draws attention to the issue's many facets. It promotes holistic treatments considering
the individual's clinical requirements, stressing the significance of collaborating with the criminal
justice and mental health systems. While recognizing the constraints of current methodologies,
the article proposes practical proposals for tending to the intricate requirements of people with
SMI, as well as social justice and holistic care for vulnerable populations. Generally, it is an
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essential asset for understanding and tending to the difficulties faced by people with SMI in the
criminal justice system and the community.
References
Snipes, J. B., Bernard, T. J., & Gerould, A. L. (2019). Vold's Theoretical Criminology (8th ed.).
Oxford University Press Academic US.
https://mbsdirect.vitalsource.com/books/9780190940522
Lamb, H. R., & Weinberger, L. E. (2017). Understanding and Treating Offenders with Serious
Mental Illness in Public Sector Mental Health. Behavioral Sciences & the Law., 35(4),
303–318. https://doi.org/10.1002/bsl.2292
