There are various active efforts to attenuate the criminalization of mental illness. These include drug courts, mental health courts, “competency courts,” and a range of other diversion and reentry approaches that are described as part of the Sequential Intercept Model.12-15 If we think of criminal justice system involvement (CJSI) as a “disorder” for which people with mental health problems are at risk, we can think in terms of primary, secondary, and tertiary prevention strategies.
The existing use of tertiary prevention of CJSI, such as jail diversion and community reentry programs, at the front and back doors of the criminal justice system involves extensive coordination between criminal justice and mental health service systems.16 These interventions will certainly expand as they demonstrate impressive reductions in criminal recidivism and in increased cost savings.
Secondary prevention programs (eg, crisis intervention teams) in which mental health providers train and provide support to local police agencies, direct individuals with mental illness to treatment rather than arrest and incarceration.17,18 Such interventions will also continue to expand in the next decade.
The biggest area for growth will be the challenges of primary prevention of CJSI among people with severe mental illness. To accomplish this goal, we will need to reinforce mental health systems to make them more accessible and to equip clinical staff members with skills to deal with risk-relevant deficits (ie, criminogenic needs) as specific foci for treatment interventions on an individual case basis.15,19-21 Our mental health systems must—and will—become more pro-active in addressing CJSI, rather than participating mostly in developments that are reactive to the political and economic pressures of the criminal justice system. In the next 10 years, much more significant progress will be made on this front.
We are doing much worse in the area of managing sex offenders. We continue to expand the misuse of psychiatry to enable preventive detention of persons we have already punished for their criminal acts. Most of this activity is fueled by fearsome publicly sensationalized details of individual cases of sexual abuse of children. Despite the fact that the rate of substantiated cases of child sexual abuse decreased 49% between 1992 and 2004, and instances of rape decreased 82% from 1979 to 2005, we have nonetheless expanded our use of sexually violent predator laws, especially since the Supreme Court ruled such laws constitutional in 1997.9,22,23
Twenty-two states, the District of Columbia, and federal jurisdictions now have enacted legislation that requires the acknowledged legislative invention of a new category of “mental abnormality” to justify using mental health commitment as the vehicle for incapacitation beyond a full prison sentence. Such a practice is otherwise prohibited in our system of justice. We experience the stress of civilization in turmoil and externalize our anxiety in part by demonizing certain classes of people, such as sex offenders.22-27