Jennifer Skeem, Ph.D. November 18 th , 2009

1. Individuals with Mental Illnesses in the Criminal Justice System: Addressing Both Criminogenic Risks and Mental Health Needs Jennifer Skeem, Ph.D. November 18th, 2009 Justice and Mental Health Collaboration Program Webinar

2. Overview; introducing criminogenic risk into the policy discussion Statement of the problem Root of the problem Model of intervention

3. People with serious mental illness are overrepresented in U.S. criminal justice system % Steadman, Osher, et al. (2009): 14% men and 31% women Source: Teplin, 1990; Teplin, Abram, & McClelland, 1996

4. Most have co-occurring substance abuse disorders Source: The National GAINS Center, 2004

5. Most are supervised in the community…and often “fail” Probation Prison Parole Jail Sources: Bureau of Justice Statistics (2007); Skeem, Emke-Francis, et al. (2006)

6. -Council of State Governments Criminal Justice/Mental Health Consensus Project (2002) “The current situation not only exacts a significant toll on the lives of people with mental illness, their families, and the community in general, it also threatens to overwhelm the criminal justice system.”

7. Overview; introducing criminogenic risk into the policy discussion Statement of the problem Root of the problem Model of intervention

8. The perceived root of the problem “People on the front lines every day believe too many people with mental illness become involved in the criminal justice system because the mental health system has somehow failed. They believe that if many of the people with mental illness received the services they needed, they would not end up under arrest, in jail, or facing charges in court”

9. Implicit model of “what works”

10. Symptom change often unrelated to recidivism Same as in multi-site jail diversion & mental health court evaluations Steadman & Naples (2005); Steadman et al. (2009) Not revoked M= -1.29, sd= .60 Revoked M=-1.23, sd= .80 Skeem et al. (2009)

11. Research indicates that the root of the problem is more complex • Increased mental health services often do not translate into reduced recidivism, even for “state of the art” services • Caslyn et al., 2005; Clark, Ricketts, & McHugo, 1999; Skeem & EnoLouden, 2006; Steadman & Naples, 2005 • Untreated mental illness is a criminogenic need for only a small proportion of offenders with serious mental illness • Junginger et al. (2006), Peterson et al. (2009) • Strongest criminogenic needs are shared by those with- and without- mental illness • Bonta et al., (1998); Skeem et al. (2009)

12. Offenders with mental illness have significantly more “central 8” risk factors for crime ** ….and these predict recidivism more strongly than risk factors unique to mental illness (e.g., diagnosis, symptoms, treatment compliance) Source: Skeem, Nicholson, & Kregg (2008)

13. “Central eight” for criminal behavior (Andrews, 2006) ***p<.001, **p<.01, *p<.05, PMI > Non-PMI, Skeem, Nicholson, & Kregg (2008)

14. Integrating alternative views about the root of the problem • Some people with serious mental illness may “engage in offending and other forms of deviant behavior not because they have a mental disorder, but because they are poor. Their poverty situates them socially and geographically, and places them at risk of engaging in many of the same behaviors displayed by persons without mental illness who are similarly situated” • Fisher et al. (2006), p. 553

15. Moderated Mediation Effect of Mental Illness on Criminal Behavior Moderator (age of onset for criminal behavior?) Evidence-based psychiatric services Evidence-based corrections Direct Relationship (One-Dimensional Model) Fully Mediated Relationship (Criminological & Social Psychological Models) (late?) (early?) Skeem, Manchak, & Peterson (2009)

16. Overview; introducing criminogenic risk into the policy discussion Statement of the problem Root of the problem Model of intervention

17. Evidence-based corrections- Target: recidivism • Focus resources on high RISK cases • Target criminogenic NEEDS like anger, substance abuse, antisocial attitudes, and criminogenic peers (Andrews et al., 1990) • RESPONSIVITY - use cognitive behavioral techniques like relapse prevention (Pearson, Lipton, Cleland, & Yee, 2002) • Consider packaged programs like “Reasoning and Rehabilitation” (Young and Ross, 2007) • Ensure implementation (Gendreau, Goggin, & Smith, 2001)

18. Some evidence-based psychiatric services - Target: symptoms & functioning • http://mentalhealth.samhsa.gov/cmhs/CommunitySupport/toolkits/about.asp • Integrated dual diagnosis treatment (IDDT) • Supported employment • http://consensusproject.org/updates/features/GAINS-EBP-factsheets • Supported housing • Trauma interventions

19. High: Increase emphasis on EBP for mental health Integration of EBPs for mental health and corrections High: Increase emphasis on EBP for corrections

20. What to do… Screen and assess Target criminogenic risk & clinical needs with EBPs • Identify offenders with mental illnesses, using a validated tool like the K-6 or BJMHS • http://www.hcp.med.harvard.edu/ncs/k6_scales.php • http://gainscenter.samhsa.gov/HTML/resources/MHscreen.asp • Or MAYSI, for youth http://www.maysiware.com/MAYSI2Research.htm • Assess risk of recidivism, using a validated tool like the LS/CMI (includes youth version)

21. What to do… Coordinate or Integrate Above all • Particularly for high risk, high need cases • But…target RISK • Avoid bad practices • Low thresholds for revocation • Sanction threats • Authoritarian relationships Skeem, J., Manchak, S., & Peterson, J. (2009). Correctional policy for offenders with mental illness: Moving beyond the one-dimensional approach to reduce recidivism. Under review

22. Compliance strategiesConsider “Mike” Traditional …talk with him to identify any obstacles to compliance (like transportation problems), remove those obstacles, and agree on a compliance plan. Problem-solving strategies Not Traditional • Bark at him…chew him up one side and down the other...you basically lie to them, “You’re looking at prison” • The “big bluff”- threats and reminders

23. Compliance strategies Non-traditional Traditional

24. Negative pressure predicts failure over 12 months(bad is stronger than good) **p<.01, ***p <.001: Manchak, Skeem, et al., 2008

25. Relationship quality Colors every interaction and affects outcomes Authoritarian “Actually the first question he asks when I step into his office is, ‘How are you doing?’ And he really wants to know…” “For me, we all need encouragement sometimes to do the right thing – and it’s okay with me as long as it’s done in the right way…talk to me first of all…if you think that I’m going in a direction that you feel is going to be harmful to me” “She talks to me the right way” Relational • “The first time I met this particular probation officer, he let me know that he owns me…” • “The first time I met him, he threatened to put me in prison…I got so damned scared, okay? And I didn’t do anything” • “He is chuckling to the other one…and nods his head over towards me and says, ‘You can tell when he’s lying cause his lips are moving.’”

26. A closer look at dual role relationship quality • Relationship quality in mandated treatment • Therapeutic role • Surveillance role Skeem, EnoLouden, Polaschek, & Camp (2007); Skeem & Manchak (2008); Kennealy, Skeem, et al. (2009)

27. .83 X cares about me as a person .78 I feel safe enough to be open and honest… .78 X explains what I am supposed to do… .77 I feel free to discuss the things that worry… Trust .84 X tries very hard to do the right thing by me .78 X trusts me to be honest with him or her .83 When I’m having trouble, X talks with me… .75 X knows that he or she can trust me .74 If I break the rules, X calmly explains what… .87 X is someone I trust .81 X is enthusiastic and optimistic with me .87 X encourages me to work with him or her .90 Dual-Role Relationship Inventory (CFI=.91) .86 X really considers my situation when… .85 X seems devoted to helping me overcome… Caring- Fairness -.76 .85 X is warm and friendly with me .87 X treats me fairly .90 X really cares about my concerns -.88 .78 X praises me for the good things I do .76 If I’m going in a bad direction, X will talk… .86 I know that X truly wants to help me .79 X expects me to do all the work alone… .85 X considers my views .77 X makes unreasonable demands of me .83 X gives me enough of a chance to say… Tough- ness .87 I feel that X is looking to punish me .86 X takes enough time to understand me .78 X puts me down when I’ve done…wrong. .87 X takes my needs into account .76 X talks down to me .85 X shows me respect in absolutely all…

28. Firm but fair relationships help protect against failure over 12 months *** *** *p<.05; **p<.01

29. Justice Center Publications http://consensusproject.org/issue_areas/corrections

30. skeem@uci.edu Thanks MacArthur Research Network Council of State Governments Justice Center Criminal Justice and Mental Health Lab Probationers, officers, and supervisor participants

31. Thank You! The webinar recording and PowerPoint presentation will be available on www.consensusproject.org within a few days. This material was developed by presenter for this webinar.Presentations are not externally reviewed for form or content and as such, the statements within reflect the views of the authors and should not be considered the official position of the Bureau of Justice Assistance, Justice Center, the members of the Council of State Governments, or funding agencies supporting the work.