This article offers a review of the literature that exists on individuals with dual diagnosis and discusses policies creating the trajectories for mentally ill individuals with substance abuse problems and their community reentry after involvement with the criminal justice system. For this analysis, basic comparisons are made across mentally ill individuals involved with the criminal justice system and the dually diagnosed portion of the population and an analysis of the current trajectory and post-incarceration disposition of the dually diagnosed group. The differences between offenders with mental illness and the dually diagnosed are pronounced. The dually diagnosed are more likely to be serving sentences related to their substance use, to be homeless and violate probation after release, and recidivate to correctional custody. An examination of substance abuse histories, short-term community outcomes, and service trends 3 months postrelease suggests public policy and social service directions.

The data do not suggest that offenders with dual diagnoses have a distinct clinical background, but rather that substance abuse is an important feature that affects their real or perceived level of functioning, engagement with the criminal justice system, and dependence on social service institutions in the community.

Criminal justice, mental health, and social service professionals face a myriad of role expectations in working with prisoners with mental illness to facilitate community re-entry. These expectations include those related to law enforcement, social welfare, and administrative efficiency. The challenge for front line workers and the multiple systems that employ them is to integrate all these expectations effectively on behalf of the individual as well as the community. Current models of re-entry for individuals leaving prison with mental illness focus on the management and interaction of service systems. This paper presents a model of prisoner re-entry that incorporates a larger social context, illustrating dynamics related to both individuals with mental illness leaving prison and their interaction with the community setting. This model was generated through an interdisciplinary team effort. It was refined through a focus group process that included advocates, community members and other informants from mental health and criminal justice systems in five states. The model is designed to generate new questions for research that address both individual and community level issues.

On April 1, 1998, the Massachusetts Department of Mental Health established the forensic transition program for mentally ill offenders. The primary goal of the statewide program, which follows clients for three months after their release from correctional facilities, is to coordinate services and assist in community reintegration. In the first year of the program, 233 mentally ill offenders received services. Seventy-four clients had been discharged as of April 1, 1999. At discharge 42 of the 74 clients (57 percent) were living in the community and were receiving mental health services. The other clients were hospitalized immediately after release (20 percent), reincarcerated (10 percent), hospitalized after a brief stay in the community (3 percent), or lost to follow-up (11 percent).

Using data on 247 offenders with mental illness, this analysis seeks to identify characteristics that distinguish those who are returned to prison or a psychiatric hospital with those who remain in the community. Sociodemographic, mental health, criminal history, and service variables are compared across a range of outcome categories with a focus on those reinstitutionalized and those reincarcerated. Those returning to institutions have somewhat different mental health service and criminal justice histories than the engaged/community group. In particular, the group that is reincarcerated is more likely released from misdemeanor sentences, and the group being released from felony sentences is more likely to be found in a psychiatric hospital after release from correctional custody. These findings have implications regarding the cumulative effects of engagement with the criminal justice system and the process through which persons with mental illness and a criminal history cycle through institutions.