Criminal Justice System Involvement Among People with Schizophrenia

Abstract

There is growing concern that people with schizophrenia and other severe mental illnesses are increasingly at risk for unnecessary criminal justice system (CJS) involvement. There has been limited examination, however, of which individual characteristics predict future CJS involvement. This study uses data from the Clinical Antipsychotic Trials of Intervention Effectiveness on sociodemograhic characteristics, baseline clinical status, and service use among patients diagnosed with schizophrenia to prospectively identify predictors of CJS involvement during the following year. A series of bivariate chi-square and F tests were conducted to examine whether significant relationships existed between CJS involvement during the first 12 months of the trial and baseline measures of sociodemographic characteristics, psychiatric status, substance abuse, and other patient characteristics. Multivariate logistic regression analysis was then used to identify the independent strength of the relationship between 12-month CJS involvement and potential risk factors that were found to be significant in bivariate analyses. Multivariate logistic regression analyses indicated that past adolescent conduct disorder, being younger and male, symptoms of Akathisia (movement disorder, most often develops as a side effect of antipsychotic medications), and particularly drug abuse increase the risk for CJS involvement. Since CJS involvement among people with schizophrenia was most strongly associated with drug abuse, treatment of co-morbid drug abuse could reduce the risk of stigma, pain, and other adverse consequences of CJS involvement as well as save CJS expenditures.

Hoping Against Hope: The Prison-to-Community Transition Experience of Men With Co-Occurring Severe Mental Illness and Substance Use Disorder

“…An Australian study found that only those people with a mental illness and a co-occurring substance use, and those people with substance use problems alone had significantly higher offending and incarceration rates compared to people with a mental health impairment who did not use substances (NSW Bureau of Crime Statistics and Research, 2010). The relationship between substance use, offending and schizophrenia has also been demonstrated in several studies, including studies where drug and/or alcohol use was identified as the most significant variable in relation to offending (Fazel & Yu, 2011;Greenberg et al, 2011;Mullen, Burgess et al, 2000). Recent work found there is a primary link between schizophrenia, substance use and offending, and also proposes some tentative suggestions about links between substance use, paranoid symptoms, command hallucinations and offending (Heinrichs & Sam, 2012).…”

“…While there is ongoing unresolved debate in the literature as to the relationship between untreated mental illness and criminal justice involvement (Greenberg et al, 2011), there is a high level of consensus that cooccurring mental health and substance use disorders place individuals at high risk of reoffending and reincarceration Messina et al, 2004;Proctor & Hoffmann, 2012;Swartz & Lurigio, 2007).…”

“…The US data is in stark contrast to other industrialised countries such as Sweden, Denmark, Switzerland, Germany and Japan, which all have prison populations of less than 85 prisoners per 100,000 of their adult population (Walmsley, 2009). The phenomenon in the United States of a total of seven million people incarcerated or under supervision in the community (Wakai, Shelton, Trestman, & Kesten, 2009) has been described as "mass incarceration" (Travis & Visher, 2005) and is causing widespread attention and concern by community members and policy makers (Greenberg et al, 2011).…”

“…There is a growing consensus that there is a strong association between homelessness and incarceration and that these factors increase the risk of each other, often complicated by mental illness and substance use (Greenberg et al, 2011;Tsai, Mares, & Rosenheck, 2012). In the first major study on the housing status of released prisoners in Australia, Baldry et al (2006) found a significant association between homelessness and reincarceration in released prisoners.…”

“…While people with a mental illness have no higher rates of offending than the general population, there appears to be a growing consensus that a combination of severe mental illness and substance use disorder is strongly related to offending and incarceration (Cloyes et al, 2010;Greenberg et al, 2011;Heinrichs & Sam, 2012). An Australian study found that only those people with a mental illness and a co-occurring substance use, and those people with substance use problems alone had significantly higher offending and incarceration rates compared to people with a mental health impairment who did not use substances (NSW Bureau of Crime Statistics and Research, 2010).…”