Abstract
The presence of mentally ill offenders in society has been a problem since the closure of the mental institutions in the 1960s. Due to the erratic and often antisocial behaviors caused by the ups and downs of their illness, they often violate societal rules and end up in jail. Thus, the jail has become the repository of the mentally ill (Adler, 1986; Palermo, Gumz, & Liska, 1992). The treatment received in most jails and prisons was and too often continues to be the bare minimum. Even though some states and cities, both in the United States and abroad, organized psychiatric services that were able to care for the flood of mentally ill offenders in an adequate way (Palermo, Smith, & Liska, 1991), the majority of the deinstitutionalized mentally ill received, and continue to receive, poor treatment and a minimum of follow-up care on discharge. The latter is at times a consequence of the mentally ill offender’s deception in attempting to escape from psychiatrization (Palermo et al., 1992).
Following the period of deinstitutionalization, the problem of transinstitutionalization ensued and it persists today throughout the world. Once discharged from jail or prison, these mentally ill persons often find it difficult to reintegrate into society and behave, as before, antisocially. On apprehension they are returned to the jail or prison which they have often just left. This revolving door has been present for the past 50 years: social reintegration fails and recidivism follows.
In this issue, Jeffrey Abracen and colleagues present a study of mentally ill offenders in Canada, assessing the frequency of mental illness in a high-risk population and their risk for reoffending. This well-written article and the good methodology they used assure the validity of their study. The authors found a high rate of mental illness among offenders and, more importantly, found that those who carried a diagnosis of Borderline Personality Disorder (BPD) and Attention Deficit Disorder (ADA) were either the highest on a recidivistic scale or the highest in suspension, while those diagnosed with pedophilic disorders had a very low rate of recidivism. The sample was drawn from a non-psychiatric, security halfway house, which, even though a reputable institution, was insufficient to meet the mental health needs of the high-risk offender. Unfortunately, this is a problem for many released prisoners.
Recidivism is also common in those prisoners who are not overtly mentally ill. Indeed, a reported study by the Bureau of Justice Statistics (2002) showed high recidivism rates in two thirds of a population of 108,580 released prisoners within the 3-year-period taken into consideration and another study reported that more than two thirds of 272,111 prisoners also recidivated within 3 years. As for the mentally ill offenders and the non-overtly mentally ill offenders, appropriate screening at the time they enter the correctional system will aid in designing the appropriate treatment and/or reeducation program during the period of incarceration and, at the same time, it could assess their recidivistic risk. Recidivism is associated with static and dynamic factors. The dynamic factors, which are changeable, include the personality disorder of the individual, the mental illness, a criminogenic neighborhood or family, and the use of alcohol and drugs can and should be treated with dynamic psychotherapy. In addition mentally disordered inmates should be helped by social workers and psychologists to achieve better self-esteem, a personal determination to change, and better social behavior. Psychiatrists should also be involved in their treatment, especially in the supervision of any necessary medication. Further, treatment plans should be drawn up prior to release and should comprise, among other things, plans for all necessary outpatient management, including adequate housing, continuation of psychological treatment, and supervision of any medication. Only if treated in a holistic manner can offenders, and especially mentally ill offenders, hope to overcome their recidivistic antisocial tendencies, and then the revolving door may close for them.