“That’s Just the Tip of It Because It Goes Deeper Than That”: A Qualitative Exploration Into the Role of Mental Illness in Offending Onset and Subsequent Offending Behavior

Abstract

There continues to be considerable debate regarding the most effective ways to reduce the number of mentally ill offenders in the adult criminal justice system. What is often missing from this national discussion is an examination of the factors associated with their initial involvement in illegal activities. This qualitative study assesses the self-perceived role that psychiatric symptoms had in the onset and continued offending of a sample of 28 parolees with mental illness. The findings showed that psychiatric symptoms rarely played a direct role in the onset and continued offending in this sample. Furthermore, the majority of the sample started offending prior to the age of 18, highlighting the need to devote more resources toward delivering evidence-based interventions to youth at risk of becoming involved in a criminal lifestyle as one strategy for reducing the number of mentally ill who become involved in the adult criminal justice system.

Keywords

mentally ill offenders offending-onset types qualitative methods

Introduction

Prior surveys of correctional populations have clearly established the overrepresentation of the mentally ill in the adult criminal justice system. For instance, Torrey and colleagues (2014) estimated that the total number of persons with mental illness who are incarcerated is more than 10 times the number of persons with mental illness who are residing in state psychiatric hospitals. With regard to specific illnesses, major depression, schizophrenia, and bipolar disorder have been found to be the most prevalent mental disorders in the inmate population (American Psychiatric Association, 2004).

Various explanations have been given to explain why the mentally ill are so overrepresented in the criminal justice system, but among the most commonly cited is related to the deinstitutionalization of the mentally ill during the 1960s and 1970s when states began to downsize and close their mental health hospitals (Lamb & Weinberger, 2005; Markowitz, 2006; Prins, 2011). With the creation of effective antipsychotic medications, it was expected that community-based mental health centers would provide the necessary mental health services for individuals with mental illness living in the community who did not pose a clear threat to themselves or others (Gronfein, 1985). Unfortunately, the community mental health system did not have the financial or structural supports needed to meet this expectation (Lamb & Bachrach, 2001). As a result, a substantial number of individuals with mental illness did not receive the psychiatric care or other supports needed to live independently in the community and subsequently became homeless and/or incarcerated (Aderibigbe, 1997; Lamb, 1984; Lamb & Bachrach, 2001; Markowitz, 2006). Although this outcome may suggest that the deinstitutionalization movement has resulted in psychiatric care being transferred from mental health hospitals to correctional facilities, findings from a recent study suggest that deinstitutionalization is only responsible for 4% to 7% of the increase in the prison population between 1980 and 2000 (Raphael & Stoll, 2013).

Early studies examining why individuals with mental illness were increasingly becoming involved in the criminal justice system found that such offenders were being arrested for minor crimes or were arrested as a last resort due to a lack of community-based mental health alternatives (Abramson, 1972; Teplin, 1984). The criminalization hypothesis, or the belief that the untreated symptoms of mental illness were the reason behind the increased involvement of individuals with mental illness in the criminal justice system, led to the development of several policies and interventions aimed at treating mental illness, which was in turn expected to lead to a reduction in criminal offending (Epperson et al., 2014). However, there is some evidence that providing community-based mental health services does not lead to a lower prevalence of individuals with mental illness in the criminal justice system (Fisher, Packer, Simon, & Smith, 2000). In addition, findings from several other studies have shown that despite attempts to reduce criminal offending by providing mentally ill offenders with mental health treatment, mentally ill offenders continued to re-offend at higher rates than offenders without mental illness (Baillargeon, Binswanger, Penn, Williams, & Murray, 2009; Cloyes, Wong, Latimer, & Abarca, 2010; Fazel & Yu, 2011).

Findings from more recent studies suggest that these early interventions that only focused on treating mental illness did not work because the majority of offenders with mental illness appeared to be engaging in offending behavior due to factors outside of their mental disorder (Peterson, Skeem, Hart, Vidal, & Keith, 2010; Peterson, Skeem, Kennealy, Bray, & Zvonkovic, 2014). Furthermore, several studies have found that many of the strongest risk factors for crime and recidivism are the same for offenders with and without mental illness (Bonta, Law, & Hanson, 1998; Junginger, Claypoole, Laygo, & Crisanti, 2006). In a meta-analysis conducted by Bonta and colleagues (1998), they found that criminal factors (e.g., previous criminal history, substance abuse, and family problems) were more significant than clinical factors in predicting general and violent recidivism among individuals with mental illness. With regard to substance use among offenders, there is some evidence that re-offending is significantly related to having a comorbid substance use disorder and mental health disorder (Baillargeon et al., 2010). Findings from another study suggest anti-social thinking patterns may be more prevalent among offenders with mental illness than among offenders who do not have a mental illness (Carr, Rosenfeld, Magyar, & Rotter, 2009). Thus, the overall conclusion of this line of research was that interventions that targeted criminogenic needs in addition to mental illness would be the most effective in reducing criminal offending among individuals with mental illness who are involved in the adult criminal justice system (Epperson et al., 2014; Skeem, Manchak, & Peterson, 2011).

While there is growing evidence to suggest that mental illness plays a small role in offending, several researchers and practitioners have expressed concern about the under-emphasis of mental illness in recent discussions surrounding what should be done to reduce criminal justice involvement among those with mental illness (Byron, 2014; Lamb & Weinberger, 2013). What is often missing from this national discussion on how to reduce the number of those with mental illness in the adult criminal justice system is an examination of the factors associated with their initial involvement in illegal activities and whether or not mental illness played some role in that involvement. Furthermore, the focus on addressing current mental illness and criminogenic needs loses sight of the possibility that many of those with mental illness who are involved in the adult criminal justice system may have started their criminal careers prior to the age of 18 and, therefore, could have benefited from some form of intervention long before their involvement in the adult criminal justice system. Thus, understanding the reasons for their initial involvement, and continued persistence, in illegal activities can help determine the most effective strategies for reducing the number of individuals with mental illness in the adult criminal justice system.

Previous studies examining the factors surrounding offending onset among offenders in general have provided a useful framework for understanding how onset age may relate to offending behaviors throughout the life course (Farrington, Ttofi, & Coid, 2009; Moffitt, 1993; Nagin & Farrington, 1992; Piquero, Farrington, & Blumstein, 2007). For instance, Moffitt’s (1993) original study uncovered a small group of life-course persistent offenders and a larger group of adolescent-limited offenders. The members in the life-course persistent group started offending early in childhood and persisted into adulthood as a result of neurological problems interacting with environmental risk factors. The members in the adolescent-limited group started offending in adolescence as a result of delinquent peer interaction but completed their criminal careers by the time they were in their early 20s. In addition, several studies have shown how the pathways to offending among mentally ill offenders may differ depending on whether they started their criminal careers before or after the onset of their mental illness (Kooyman et al., 2012; Mathieu & Côté, 2009; Simpson, Grimbos, Chan, & Penney, 2015; van Dongen, Buck, & van Marle, 2014). Grouping offenders by the age at which they began offending can often provide a clearer picture of the underlying risk factors that drive offending behavior at each developmental stage. Although these previous studies have been able to identify several groups that have distinctive background characteristics and offending patterns, there does not appear to be much consistency in the literature that would allow us to fully establish definitive groups. What does appear to be a consistent finding is that an early age of offending onset is associated with the most adverse backgrounds and the most persistent offending patterns (Messina & Grella, 2006; Messina, Grella, Burdon, & Prendergast, 2007; Piquero et al., 2007). Considering that most of our knowledge about the onset and persistence of offending comes from quantitative research studies, some authors have advocated the use of qualitative methodology to explore this topic further (Piquero et al., 2007; Wright & Bouffard, 2016). A particular strength of qualitative methods is that they can often provide us with a rich understanding of why people engage in a particular behavior. This study used a qualitative methodology to examine the narrative accounts of why the parolees in this sample began offending. Specifically, in-depth interviews conducted with parolees receiving treatment for a psychiatric disorder were analyzed to assess reasons for why they started offending and the self-perceived role that psychiatric symptoms played in their offending behavior. A secondary aim of this study was to assess if there were any qualitative differences among the different offending-onset groups in their background characteristics that could be targeted for an intervention that reduces the likelihood that similar youth will engage in delinquent behavior.

Method

Participants and Study Design

The present study is a secondary analysis of semi-structured qualitative interviews conducted with a subsample of parolees who were participating in a randomized controlled trial that examined the effectiveness of telepsychiatry for treating psychiatric disorders (for a full description of the main study, see Farabee, Calhoun, & Veliz, 2016). As part of the main study, all parolees referred to receive psychiatric services at the participating parole outpatient clinics (POC) were eligible to participate in the main study.¹ A total of 28 study participants who indicated on their consent form that they were interested in participating in the qualitative interviews were randomly selected to participate in this portion of the study.² This project received institutional review board approval from the University of California, Los Angeles.

The in-depth qualitative interviews took place within a month of enrollment in the main study and were conducted by either the author or a research assistant on the project. The interviews were retrospective, with an interview guide covering a range of topics designed to elicit a complete life history of the respondent, with particular emphasis on their criminal activity and mental illness. The interview guide was drafted and piloted by the author. As data collection progressed, additional items were added as new areas of interest emerged. The interviews were recorded with the respondent’s consent and transcribed verbatim. The average length of the interview was approximately 45 min. At the end of each qualitative interview, background demographic information such as age, ethnicity, gender, marital status, and education was obtained from the respondents to examine the demographic context of the sample.

Data Analysis

Analyses of the transcripts were guided by the constant comparative method (Boeije, 2002; Corbin & Strauss, 2014). The interview transcripts were uploaded into Dedoose, a web-based program designed to support the analysis of qualitative data. Transcripts were sorted by offender type, which was based on the age at which their offending behavior began.³ Respondents who began offending prior to the age of 13 were classified as child-onset offenders, those who began offending between the ages of 13 and 17 were classified as adolescent-onset offenders, and those who began offending at the age of 18 or older were classified as adult-onset offenders. The age that the respondents first recognized they were experiencing mental health problems was used to establish whether the respondents were experiencing mental health problems prior to their offending onset. However, it is possible that they were experiencing mental health problems long before they were aware that something was wrong. The author read all the transcripts several times and conducted open coding to identify general themes across the transcripts. Each code was constantly compared with all other codes to identify similarities, differences, and general patterns. In the second stage of the analysis, the transcripts were recoded based on newly refined coding themes regarding family and household dynamics, trauma, mental illness, and offending behavior that emerged across transcripts. After this process, the author compared the major themes that emerged from the coding categories by offender type (based on age of offending onset), which allowed for the discovery of similarities and differences across groups. The following sections describe the themes surrounding the onset of the parolees’ offending and subsequent offending behavior for each category of offender. All names in the transcripts were replaced with pseudonyms to protect the confidentiality of the study respondents.

Sample characteristics

The sample for this article consisted of 28 parolees with mental illness who were released from a California State Prison and paroled to an area within California.⁴ Table 1 shows the characteristics of the total sample and a comparison of childhood-onset, adolescent-onset, and adult-onset offenders at the time of the interview.

Table 1.

Sample Characteristics at the Time of the Interview by Offender Category.

Characteristics	Child-onset		Adolescent-onset		Adult-onset		Total
	(n = 13)		(n = 10)		(n = 5)		(n = 28)
	%	M (SD)	%	M (SD)	%	M (SD)	%	M (SD)
Race/ethnicity
White	31		30		40		32
Black	31		30		40		32
Hispanic	39		40		20		36
Male	85		100		60		86
Current age		36 (11.4)		32 (4.1)		39 (15.5)		35 (10.3)
Education (years)		9 (2.5)		11 (1.3)		12 (2.0)		10 (2.4)
Marital status
Never married	69		50		60		61
Married	15		10		0		11
Divorced/separated	15		40		40		29
Living situation
Homeless	31		20		20		25
Lives with relatives	39		40		60		43
Employment status
Unemployed	31		50		60		43
Out of labor force	62		30		20		43
Current diagnosis
Major depression	23		80		40		46
Bipolar	62		20		40		43
Schizophrenia	15		0		20		11
No. of prior arrests		21 (26.9)		13 (12.5)		11 (9.7)		17 (20.4)
No. of incarcerations		9 (6.8)		11 (13.0)		11 (9.7)		10 (9.4)

The participants represented an ethnically mixed population where 36% of them self-identified as Hispanic, 32% as White, and 32% as Black. Their ages ranged from 23 to 61, with a mean age of 35 and men represented approximately 86% of the sample. On average, participants had completed approximately 10 years of education. The child-onset offenders reported the lowest number of education years completed followed by the adolescent-onset offenders. A majority of the respondents were unemployed at the time of the study, and most were living in a housing situation other than a home that they owned or rented. Approximately 25% of the sample reported being homeless. More than half of the participants were single (61%), and 29% reported that they were separated or divorced at the time of the interview. A majority of the participants were either unemployed or completely out of the labor force. Approximately 46% were receiving treatment at the POC for major depression disorder, 43% for bipolar, and 11% for schizophrenia. Their current diagnosis reflects the symptoms they were presenting when they met with the prison psychiatrist and thus may be unrelated to the psychiatric symptoms they reported experiencing when they first became aware that they had a mental health problem. With regard to involvement in the criminal justice system, participants had, on average, 17 prior arrests and were incarcerated about 10 times before their most recent incarceration in prison.

Results

Child-Onset Offenders

Thirteen of the respondents began engaging in illegal activity prior to the age of 13. These child-onset offenders grew up in rough, crime-ridden neighborhoods and had strained relationships with at least one of their parents. All these respondents reported strained relationships with their fathers and seven of them also reported having a strained relationship with their mother. The mothers of these respondents were either completely absent from the respondent’s life or were heavily into drugs and/or the party lifestyle. As a result, these respondents could not depend on their mothers to provide for their basic needs. As one respondent described, “I just got tired of her drinking and [being] around there partying all the time, and I didn’t have nothing to eat so I ran away from home.” Almost all of the child-onset offenders (12 of 13 respondents) were exposed to a variety of adverse childhood events such as sexual and physical abuse, domestic violence, parental incarceration, parental drug use, and divorce.

Problems in family functioning

A total of seven child-onset offenders (Adam, James, Henry, Charles, Luis, Brandon, and April) started offending after they started experiencing mental health problems. These seven were also the respondents who reported having a problematic relationship with both parents. Thus, this group of child-onset offenders did not have a stable adult figure in their lives during their early formative years. A major theme related to this was the role that family members had in the offending behavior of these respondents. Two of the respondents started using drugs because they were influenced by other family members. Others in this group started offending in response to problems they were having in the home. In addition, this group of respondents tended to engage in the most persistent and violent offending activities after their initial offending onset.

Adam was the only respondent in this group to suggest that psychiatric symptoms may have played a direct role in his offending behavior. He recalled experiencing excessive outbursts of anger approximately 4 years prior to his offending onset that he believes was related to his bipolar disorder. He also reported he was experiencing symptoms of anger and irritability immediately prior to engaging in his first illegal activity where he threw a large object at his mother with the intent to hurt her because she “embarrassed him.” He believes these symptoms associated with his mania may have contributed to his extreme response to this embarrassment. After this first incident, he continued to engage in fights, partially blaming his bipolar disorder for his quick temper, but there were times when he felt that it did not play a role in his violent behavior at all.

Mental illness did not appear to play a direct role in the offending onset of the other respondents who started offending after the onset of their mental illness. James, Henry, and Charles reported that their first illegal activity was using marijuana. James first started experiencing mania symptoms approximately 3 years prior to his offending onset but indicated that he started using marijuana because it “gave him something to do.” It also helped him to deal with the abuse he was experiencing. He eventually began to commit a series of batteries because that was his “stress reliever” from what his father was doing to him.

Henry first started experiencing mania symptoms approximately 5 years before his offending onset and Charles remembered his first depressive episode taking place approximately 3 years before his offending onset. Both men reported that they began using marijuana because they were constantly surrounded by close family members who were using it and wanted to try it. Henry stated,

I started smoking it when I was 12. My mom was a chronic weed smoker, [as were] my cousins, my aunts, and some of my uncles. That’s just something that has been around for years.

After their initial offending onset, Henry and Charles began to participate in a variety of illegal activities as a result of becoming a part of a gang, a lot of which were violent, such as assaults, robberies, shootings, and stabbings.

Luis also reported that he began to engage in a variety of illegal activities as a result of joining a gang. Although it is unclear why he committed his first illegal act of arson at 9, he did believe that his mania symptoms may have contributed to some of his offending behavior:

I tend to get into fights because I tend to get irritated and end up in fights. It doesn’t make me want to go out and steal something. It just makes me want to be alone because whenever I am around people I start to get irritated.

Brandon and April reported that their first illegal activity was a property offense. Brandon experienced his first depressive episode approximately 2 years prior to his offending onset. He reported that he began shoplifting various items such as food because “he had to eat.” He continued to shoplift after this first time for subsistence reasons. When explaining why he chose to shoplift, he said, “That was the only thing I knew how to do at the time and that’s why I did it.” April recalled experiencing her first depressive episode a couple of months before her offending onset after her father passed away. April noted that she stole a car because she wanted to escape her current environment and return to her old neighborhood, which she considered home. After this first offense, she used drugs to deal with stressors she was experiencing in her home life. It is unclear to what extent mental illness played a role in her drug use.

Friends matter

The main theme surrounding the offending behavior for the remaining six child-onset offenders (Nick, Lea, Tony, Mike, Sam, and Robert) was that their friends played a big role in their involvement in illegal activities. This group of child-onset offenders tended to have at least one stable adult figure in their lives and was less violent than the other child-onset offenders. With regard to mental health issues, these child-onset offenders reported that they did not experience mental health problems until after their offending onset. Thus, mental illness did not appear to play a role in their offending onset. However, two respondents did believe that depression played some role in their continued engagement in illegal activity. Nick and Lea reported that they continued offending as a way to alleviate feelings of depression. Nick reported that he first started using meth “because everyone else was using,” and he wanted to experience something new. He later began to rob stores mainly because he “needed money and things.” But he also reported that when he was experiencing depression he would, “just go, go with my friends and steal and just do stuff to be happy.”

Lea remembered experiencing her first depressive episode approximately 7 years after her offending onset. Lea describes why she started fighting in elementary school: “I didn’t like the way they talked to me, the way they would look at me.” She later progressed to engaging in other types of illegal activities with her friends because that was “where she fit in.” But she also noted that after the onset of her depression:

It caused me to do things that I didn’t want to do to hide it, to cover it up. I did things that I shouldn’t have done that I regret doing . . . Like getting high, stealing, breaking into peoples’ houses, and just dumb things like that.

Mental illness did not appear to play a role in the offending patterns of Tony, Mike, and Sam. Tony first started experiencing symptoms associated with mania approximately 2 years after his offending onset. For his offending-onset activity, he reported that he was passively involved in a property offense when his friend showed up with a stolen animal. He was caught playing with the stolen animal and arrested even though he did not know that it was stolen at the time. After that incident, he began engaging in a variety of illegal activities: “I sold drugs, I used drugs, I have stolen, you know, property violations against vehicles. Just small crimes like that. I don’t have a bad record.” He said that he continued to engage in illegal activities because it was a “lifestyle” and that they were just being “bad Bébé’s kids.”⁵

Mike and Sam actively participated in a property offense when they were with friends. Mike did not start experiencing symptoms associated with paranoid schizophrenia until approximately 14 years after his offending onset. During his first illegal activity, he broke into a warehouse when he was with some friends because they were “mostly just looking for trouble.” He continued to engage in illegal activity as part of a gang but mainly committed burglaries to make money.

Sam started experiencing symptoms associated with mania approximately 10 years after his offending onset. He reported that for his offending-onset activity, he stole a bike because he wanted a bike but did not have money to buy one. He continued to engage in this type of activity with friends because he wanted to make money.

Robert remembered hearing voices for the first time about 5 years after his offending onset. However, he does not believe this has influenced his offending behavior. He started fighting to become part of a gang. When asked why he began fighting, he said, “I thought they would show me love, more love than anything.” The father of this respondent had over 10 kids, which affected his ability to pay attention to the respondent. This absence of parental attention appeared to have a negative effect on this respondent, leading him to seek attention elsewhere. As part of a gang, he engaged in a variety of violent activities because he liked to “hurt people” and, according to him, there was no structure in his family.

Adolescent-Onset Offenders

Ten of the respondents started offending during their adolescence. The offenders in this group tended to live in neighborhoods with very little crime. Four of the respondents in this group reported that their family unit was broken at some point during their childhood due to paternal incarceration, divorce, or death. The respondents who reported experiencing paternal separation through incarceration and divorce tended to have a strained relationship with their fathers. About half of the respondents reported exposure to parental substance abuse and a little less than half reported exposure to domestic violence. Three of the respondents reported being physically or emotionally abused during their childhood and one respondent reported being sexually abused.

Broken homes

Four of the adolescent-onset offenders (Dave, Chris, Jay, and Aaron) started offending after their self-perceived mental illness onset. A major theme related to the home situation of this group of respondents was that their family unit was broken at some point in their lives. Although it is unclear to what extent this contributed to their offending onset, the majority in this group of adolescent-onset offenders tended to engage in very little illegal activity following their initial offending onset. Furthermore, mental illness did not appear to play a direct role in their offending onset. However, Dave believed that his depression contributed to his continued engagement in illegal activity:

I know it had a part to do with it because, like, I would be depressed sitting home, or wherever I was at, and it would make me mad, and someone would make a comment and make me mad and I would throw them off, and whatever comes across my path whether it was good or bad, I was going to get into it.

While Dave reported that his symptoms may have played some role in his continued involvement in illegal activity, he also reported that he engaged in illegal activities when he was not experiencing symptoms. Furthermore, he believed that his depression played a bigger role in his drug use:

I learned that using the drugs substituted or took away the depression. I wanted it more and more so I wouldn’t feel the way I was feeling.

Dave believed that his parents’ divorce was a major triggering event for him that “messed” him up. As he noted,

I would think that if my mom and dad never got divorced then I would have never went that route. I had it too good. I had a good family. Growing up was good. I had everything I wanted and more. But once that happened, it was like everything got thrown out of the window.

After the divorce, he began stealing to become accepted into a local gang and continued to engage in a variety of illegal activities as part of the gang largely because he liked the “excitement and thrill of being recognized.” Findings from one meta-analysis suggest that broken homes caused by parental separation or divorce are significantly more likely to result in delinquency than are broken homes caused by death (Wells & Rankin, 1991). This finding may explain why his offending patterns were so different from the others in this group of adolescent-onset offenders.

Chris experienced his first depressive episode about 1 year before his offending onset. Jay experienced his first depressive episode about 5 years before his offending onset. Aaron started hearing voices and experienced his first depressive episode approximately 3 years before his offending onset. All three men did not believe that mental illness played a role in their offending activities. They cited marijuana use as their onset offending activity because either a friend introduced them to it and/or they just wanted to try it. After this first act, these respondents reported that they did not “really” engage in any other illegal activity, in other words, any illegal activity they may have engaged in was minor, in their opinion. Chris reported that after his onset activity, he and some friends shoplifted a couple of items they needed for a party. After that he did not “really” do anything else until his current charge as an adult. Jay reported that he only did minor things such as break curfew after his initial offending-onset activity. Aaron reported that he did not do anything else until about 2 years after his onset activity, when he robbed a person because he needed money. He said he did not “really” engage in illegal activity after this robbery.

A mixed bag

Six of the adolescent offenders (Vince, Will, Matt, George, Alex, and Joe) started offending before their self-perceived onset of mental illness. There was no dominant theme for this group of adolescent-onset offenders. However, those respondents who reported strained relationships with their father and/or exposure to adverse events in the home tended to engage in more illegal activities than those who did not. In addition, those who were passive participants in their first illegal activity did not engage in any other illegal activities until after they were adults.

Overall, mental illness did not appear to play a role in their offending onset nor did it play a role in their continued engagement in illegal activities. Vince and Will reported that their first onset activity was theft. Vince reported that he started experiencing mood swings associated with bipolar disorder approximately 5 years after his offending onset. He reported that he stole candy for his first illegal activity because he was “bored and tired of being broke all of the time.” He continued to steal things because he was rebelling and dealing with the trauma of finding out about his “real mother on the other side of the family that [he] never knew about.” He was also one of the respondents who reported having a strained relationship with his father.

Will was the other respondent who reported a strained relationship with his father. He reported experiencing his first depressive episode approximately 17 years after his offending onset. He started stealing cars because “everyone was stealing cars” as part of the gang he belonged to. He continued to steal cars “to get what [he] could out of it” and because he “didn’t really have anyone to check in” on him. He explains why he originally joined a gang:

Interviewer:

Why did you join a gang?

Participant 2:

You know, I can’t really say . . . My dad was always in prison and basically all of my friends were like my brothers, so it’s just what I did.

Matt and George reported that their first onset activity was using marijuana at the age of 13 because they were curious and wanted to try it. However, after this act, their offending patterns diverged, with Matt refraining from any illegal activity until after he turned 18, when he started selling drugs. He explained that he started doing this to make extra money in addition to the income he was obtaining while working at McDonald’s:

At that time, my life was good. I was just trying to get some extra money so I could get my own little apartment. I was just trying to get out in the world too fast. My mom used to tell me, “Slow down—you know the world is not going nowhere.” But you know I didn’t listen.

According to him, mental illness did not play a role in his involvement in selling drugs because he did not experience symptoms of depression until after he was in prison for the first time for drug dealing.

George became involved in a gang after his offending onset and ended up engaging in a variety of illegal activities that were often violent. As he had a mixture of friends who did and did not engage in illegal activity, he had the opportunity to take a more legitimate path but in the end chose to be a part of a gang:

Interviewer:

Why do you think you chose that path?

Respondent:

I think it’s because I liked fighting, that had a lot to do with it. I think I related more to that, so it just came with it, you know.

He also blames his involvement in illegal activity on “growing up around gangs and stuff like that,” but he also had experienced trauma as a result of witnessing violence in his home. However, he did not experience his first depressive episode until approximately 12 years after his offending onset.

Alex and Joe claimed that they got caught up in friends’ cases when those friends picked them up after engaging in an illegal activity. Thus, they were not actively participating in the activities. However, they were arrested because they were with their friends who had stolen property in their possession. After this arrest, Alex and Joe did not engage in illegal activity until they were adults. Their first and only incarceration was for having sex with a minor. Alex experienced his first depressive episode approximately 18 years after his offending onset and Joe started experiencing mood swings associated with bipolar disorder approximately 2 years after his offending onset.

Adult-Onset Offenders

Five of the respondents started offending as an adult. All the respondents in this group reported having a good relationship with their mothers, but the majority reported they were not very close to their fathers and/or “bumped heads” with them. All the respondents grew up in neighborhoods that appeared to be relatively free of crime. However, three of the respondents reported that they grew up in very isolated areas. One of the respondents reported that he was molested by a cousin when he was younger and was exposed to domestic violence. The other adult-onset offenders did not report exposure to any abuse or domestic violence.

Mental illness matters

Josh, Pete, and Liz started offending after their mental illness onset. The main theme surrounding the offending patterns for these adult-onset respondents was that mental illness was a contributing factor in their engagement in illegal activities. Josh experienced his first depressive episode approximately 11 years before his offending onset. Pete experienced his first depressive episode a couple of months before his offending onset. Liz started hearing voices approximately 1 year before her offending onset. Josh believed his mental illness may have played a role in his onset activity of marijuana use. He was the one who was molested and exposed to domestic violence when he was younger. When explaining why he started using marijuana, he said, “I was depressed and felt like killing myself and I wanted to try that before I tried to kill myself.” However, his depression appeared to play a minor role in his decision to commit robbery later on:

I had been fired a couple of months before that from a job, and I couldn’t find any work, and my apartment rent was due. I didn’t have any money for food or anything so I was just stressing really bad, and my depression was getting really bad as well. So I just felt it was the only thing to do—the best thing to do at that moment.

Mental illness did not seem to play a role in Pete’s onset activity, which was fighting with a weapon. He said that he did this in response to being called names by someone he was hanging out with:

Because he called me some real bad names that I don’t appreciate in my mind, and at the time, being a knuckle head, I didn’t like those words.

However, he did say that to alleviate the symptoms associated with bipolar disorder, he would steal so that he could obtain money to get his medication:

If I wasn’t on my medicine, I was always wanting other ways to get money to get my medicine back on, causing me to commit crimes to get my meds.

Liz reported that all she ever did was steal clothes that she could not afford because she likes designer clothes:

I was a clothes freak. I liked the nice stuff and didn’t have the money to buy it, you know. And I was trying to be just like the Joneses. They got new cars, and new shirts, and new this . . . I was just trying to be just like them.

Although mental illness did not appear to play a role in the majority of her shoplifting excursions, she did report that on occasion she would hear voices that encouraged her to steal:

. . . it could be the voices just telling me I need some clothes because sometimes, I have stolen something I can’t even much fit, you know. I just stole it and got home and go, wow.

In addition, she noted that her mental illness affected her ability to obtain a job that would allow her to purchase the things she desires:

It affects my life too . . . I can’t get a job because I flip in a minute . . . Voices would tell me to do stuff in a minute, or they would just tell me to drop everything, and I just drop whatever is in my hand and break it up. Don’t care what it is, how much it costs, or whatever, you know. It got to the point where she keeps me out of the kitchen. She don’t ask me to do nothing . . . So I have no household cleaning to do or nothing because she never know what mood I’m at.

Not a criminal

Two of the adult-onset offenders did not experience symptoms of their mental illness until after their involvement in the criminal justice system. Mary experienced her first depressive episode a couple of months after her offending onset while Ray started experiencing mood swings associated with bipolar disorder approximately a year after his offending-onset activity. The dominant theme for these two adult-onset offenders is their belief that they were not really a criminal. According to Mary, mental illness never played a role in her offending activities because she never did anything illegal. She just got caught up in the punishment of crimes committed by people she was associating with at the time the illegal act took place. For example, she describes the activity that led to her first arrest:

When I met my boyfriend, he was stealing from the store. When we walked out, he had a bottle with him, and because I was with him, I got in trouble.

Ray’s first illegal activity was marijuana use, which led to his first arrest approximately a year later. He started using because, according to him, that was what everyone was doing at the time during the early 70s. After his first arrest, he said, “They turned me into a rebel,” leading him to engage in activities that were attempts to change the system. Thus, most of his contact with the criminal system had to do with disorderly conduct. But he also began to drink heavily after repeated exposure to the criminal justice system many years after his offending onset. As a result, he has been arrested for public intoxication as well. He believes that he occasionally gets into trouble because of his drinking and mania:

Whenever I am stable, I do good. Police don’t even know I am around. When I go into mania and I can’t sleep for four or five days and drink beer, then I act stupid.

So it appears that the combination of both elements is responsible for his violating the rules of social conduct. But he also claims that he has, on occasion, been beaten by the police as a result of his behavior during his mania phase:

Police don’t understand that. They see someone in mania, they just want to beat me up. I have been beaten up several times all over the country.

Discussion

Overall, the themes uncovered in this study are consistent with earlier findings that suggest that most mentally ill offenders are offending for reasons unrelated to their mental illness (Bonta, Blais, & Wilson, 2014; Peterson et al., 2010; Peterson et al., 2014; Skeem, Kennealy, Monahan, Peterson, & Appelbaum, 2016). The majority of respondents believed that their psychiatric symptoms did not play a direct role in their decision to engage in illegal activity, even during periods when they were actively experiencing those symptoms. In the instances where mental illness did play a direct role in their offending behavior, it seemed to play the biggest role in assaults, theft, and drug use. Specifically, two of the child-onset respondents who began offending after their mental illness onset reported that symptoms associated with mania may have played a role in their violent behavior. In contrast, two of the child-onset respondents who started offending before their mental illness onset reported that they would go out and steal things as a way to alleviate the symptoms of their depression. Only one adolescent-onset offender reported that mental illness played a direct role in his engagement in illegal activity, saying that he often used drugs as a way to alleviate the symptoms of his depression. Similarly, an adult-onset offender who began offending after his mental illness onset also reported that he used drugs to alleviate the symptoms of his depression.

Mental illness appeared to play more of an indirect role in the offending behavior of two of the adult offenders who began offending after the onset of their mental illness. In one case, the respondent reported that he would steal to obtain enough money to purchase his psychiatric medication. The other respondent reported that she would sometimes steal because of voices inside her head encouraging her to do so, but in many cases, she would steal just because she wanted to have things that she could not afford to buy on her own. She cites her mental illness as a huge barrier in her ability to earn money in a legitimate job. For the other adult-onset offenders who began offending before the onset of their mental illness, their involvement in the criminal justice system appears to have had a greater effect on their mental illness than their mental illness has had on their engagement in major forms of illegal activity. Furthermore, the use of alcohol by one of the adult-onset offenders when he was in the mania stage of his bipolar disorder would often lead him to behave in a way that was deemed to be disruptive to those around him.

Findings from several studies highlight the heterogeneity of the mentally ill offender population based on offending onset in relation to mental illness onset (Kooyman et al., 2012; Mathieu & Côté, 2009; Simpson et al., 2015; van Dongen et al., 2014). Kooyman and colleagues (2012) found that there were several differences in the background characteristics between those who started offending after the onset of their mental illness and those who started offending before, with the pre-morbid offenders being more likely to be male, have a lower pre-morbid IQ, a history of neurological abnormality, and a high engagement in criminal activity. In another study, van Dongen and colleagues (2014) found that offenders who began offending before their mental illness onset were more likely to have been emotionally and physically abused when compared with offenders who began offending after their mental illness onset.

Similar to the previous findings, there were distinctive differences in the background characteristics of the three offending-onset groups created for this study. Specifically, the child-onset offenders reported highly traumatic childhoods in which they had problematic relationships with at least one parent. The child-onset offenders also reported greater exposure to a number of adverse childhood events, such as parental drug use, parental incarceration, domestic violence, neglect, sexual abuse, and/or physical abuse. There is some evidence that the cumulative effects of childhood adverse events increases the likelihood of early drug use and other offending behavior (Messina & Grella, 2006; Messina et al., 2007). Other studies have shown that abuse and neglect during childhood is associated with an increased likelihood of involvement in criminal activity, especially violent crimes (Maxfield & Widom, 1996; Mersky & Reynolds, 2007). In addition, there is substantial evidence that exposure to adverse events during childhood can lead to mental health problems (Messina & Grella, 2006; Rosenberg, Lu, Mueser, Jankowski, & Cournos, 2007; Schilling, Aseltine, & Gore, 2007), which in turn might directly or indirectly influence youth’s involvement in illegal activities.

Consistent with prior research that has examined the relationship between adverse childhood events and offending, the child-onset offenders in this study started offending at an early age, and the majority of these offenders tended to engage in violent behavior in the years directly after their offending onset. This suggests that neglect by both parents and cumulative adversity may account for some of the offending patterns found among this group of child-onset offenders. However, respondents affiliated with gangs across all offender groups were often the most persistent in their offending and engaged in a variety of violent and non-violent illegal activities, regardless of their mental health status. This finding is consistent with other research showing that gang involvement often facilitates delinquent behavior (Battin, Hill, Abbott, & Catalano, 1998; Thornberry, Krohn, Lizotte, & Chard-Wierschem, 1993).

Policy Recommendations

Considering that the majority of the mentally ill parolees in this study started offending prior to the age of 18, policy discussions geared toward reducing the number of mentally ill in the adult criminal justice system should also include prevention and intervention strategies for reducing offending behavior among youth who have a high risk of engaging in criminal activity. The child-onset offenders in this study experienced the most adversity, which in turn was associated with the most persistent engagement in serious and violent activity. Part of this may be related to their involvement in gangs, which was associated with increased criminal activity across both child- and adolescent-onset offenders. Prior research suggests that critical life events, such as parental divorce, antisocial tendencies, weak parental monitoring, and peer delinquency, are consistent risk factors for gang membership, and a culmination of multiple risk factors increases the likelihood of someone joining a gang (Maxson, 2011; Vigil, 2007). Thus, eliminating some of the risk factors associated with gang membership would help to reduce offending among this group of offenders.

Adopting evidence-based programs to improve outcomes of disadvantaged youth in general can help improve not only their mental health outcomes but also their offending outcomes. The Blueprints registry, which was created by the University of Colorado in 1996 to provide a readily available source of information about effective programs and practices for improving child outcomes, lists model programs that have been empirically shown to promote healthy development among youth (Mihalic & Elliott, 2015). Within the Blueprints registry, a program is designated as a “model program” if findings from evaluations of the program using an experimental design show that it is effective in improving child outcomes. In addition, the effects have to be maintained for at least 12 months after the intervention has been completed and the findings have to be successfully replicated in another study.

The majority of the respondents who started offending prior to the age of 18 tended to experience problems in their home environment. Findings from the literature suggest that improving family functioning and/or parenting practices is an effective way to improve the mental health and behavioral outcomes of children at risk for delinquency (Calhoun, Conner, Miller, & Messina, 2015; Piquero, Farrington, Welsh, Tremblay, & Jennings, 2009; Vigil, 2007). Thus, the model programs described below were selected because they have been found to be effective in addressing the issues within the home that puts children at risk of becoming involved in delinquent behavior.

As mentioned previously, the child-onset offenders tended to experience problems with one or both parents and were exposed to a variety of adverse events. Thus, interventions that provide parenting training to at-risk families might help to create a more stable home life for these children and prevent them from being drawn to gangs and other illegal activities. The Nurse–Family Partnership (NFP) is one intervention identified by the Blueprints registry that may be effective in preventing youth from engaging in delinquent behaviors (Olds et al., 1998). The NFP program provides weekly visitations by nurses to high-risk first-time mothers. Visitations start during the prenatal period and last through the first 2 years of the child’s life, with the aim of promoting positive health-related behaviors and effective parenting practices.

A number of the respondents who started offending prior to the age of 18 were incarcerated in juvenile correctional facilities at some point in time and continued offending after they were released. Some of these respondents might have benefited from a program that provided them with an alternative to incarceration such as the Treatment Foster Care Oregon (TFCO) program. TFCO is another model program identified by Blueprints that has been found to be effective in improving the outcomes of youth who engage in chronic antisocial behavior (Chamberlain, Leve, & DeGarmo, 2007; Eddy, Whaley, & Chamberlain, 2004; Sinclair, et al., 2015). This particular program removes youth from their homes and places them with foster parents. The TFCO program provides the foster family with special training and supports while the children receive interventions (e.g., family and individual therapy, school-based interventions, academic support, and mental health treatment) that address problems within multiple areas of their life. In addition, family therapy is provided to the biological parents with the goal of eventually reuniting them with their children.

Multi-systemic therapy (MST) is another model program that could have been provided to the respondents who came into contact with the juvenile justice system throughout their childhood. It has been shown to be effective in reducing involvement in delinquent behaviors among youth who have taken part in this program (Borduin et al., 1995). A fundamental aspect of MST is that it is based on the idea that juvenile offending is often very closely tied to problems in family relationships (Henggeler, Melton, Smith, Schoenwald, & Hanley, 1993). As a result, improving family functioning is expected to improve the outcomes of the minors in the family. MST also endorses the idea that family dynamics and individual delinquency are the result of a complex interaction of systems, including but not limited to, the neighborhood community, the school community, the extended family, and friends.

The findings for the three adult-onset offenders who started offending after their mental illness onset suggest that mental illness in combination with financial/employment problems played a major role in their offending behaviors. The other two adult-onset offenders reported experiencing mental health problems after being incarcerated, and in one case, the mental health problems contributed to the offender’s inability to successfully remain out of the adult criminal justice system. These findings highlight the importance of not only increasing access to mental health care and employment opportunities for offenders suffering from mental health problems but also the need for correctional systems to provide more mental health supports during and after incarceration to help improve the mental health and offending outcomes of those coming out of incarcerated settings.

Limitations

These study findings should be interpreted relative to several important limitations. The sample size was small and not representative of the general population of mentally ill offenders, due to the fact that the parolees in this sample were paroled to either rural or suburban areas in California and had recently been convicted of very serious crimes, including violent and sex offenses. In addition, the sample included few female participants and adult-onset offenders. However, as with all qualitative methods, generalization was not the goal of this study. Instead, the major aim of this study was to identify potential patterns that could be tested in future studies utilizing more representative and larger samples. Another limitation is the reliance on recall data that can be compromised by faulty memory or mental health problems. However, everyone in this sample was on medication at the time and fully competent to take part in this interview, and many of them were forthcoming about their past offending behaviors. In addition, there may be some inaccuracies in the respondents’ reports concerning the onset of their offending and mental illness, as this information is dependent on the respondent’s recollection. Thus, this study is unable to confirm the temporal ordering of mental illness onset in relation to offending onset. However, the respondent’s establishment of whether they were experiencing any psychiatric symptoms around the time they were engaging in criminal activity as well as their assertion of whether or not they believe these symptoms had an impact on their offending behavior can still provide some insight into what is motivating them to engage in illegal activities.

Conclusion

The majority of the research examining the relationship of mental illness and offending has focused on offending behavior that takes place after mental illness onset and involvement in the criminal justice system (Bonta et al., 2014; Link, Cullen, Agnew, & Link, 2015; Peterson et al., 2014; Skeem et al., 2016). This focus has guided most of the policy discussions surrounding what should be done to reduce recidivism among offenders with mental health problems. However, it is equally important to go back to the very beginning to assess why offenders with mental illness started engaging in illegal activities. Knowing why they started offending can help determine if anything could have been done to prevent them from entering the adult criminal justice system. The findings from this current study suggest that mental illness played only a small role in the offending onset and subsequent offending behavior in this sample of mentally ill offenders. Furthermore, the majority of the respondents started offending prior to the age of 18, highlighting the need to devote more resources toward delivering evidence-based interventions (e.g., nurse–home visitation programs and TFCO) to youth at risk of becoming involved in a criminal lifestyle as one strategy for reducing the number of mentally ill who become involved in the adult criminal justice system.

Footnotes

Acknowledgements

The author thanks Susan Turner, Elliott Currie, David Farabee, and the two anonymous reviewers for their helpful comments on earlier drafts of this article. She is also grateful for the research support provided by Robert Veliz and Diana Zaragoza as well as Kris Langabeer for editorial review. Finally, she thanks the participants who volunteered to be interviewed and share their life experiences with her.

Author’s Note

The contents are solely the responsibility of the author and do not necessarily represent the views of the National Institute of Justice.

Declaration of Conflicting Interests

The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Funding

The author(s) disclosed receipt of the following financial support for the research, authorship, and/or publication of this article: The telepsychiatry study was funded by the National Institute of Justice (2010-DJ-BX-2002).

Notes

Author Biography

Stacy Calhoun is a doctoral candidate in the Department of Criminology, Law and Society at the University of California, Irvine. She has directed several studies funded by the National Institute on Drug Abuse, the National Institute of Justice and the California Endowment. Her work focuses on finding ways to improve the mental health, substance abuse, and offending outcomes of those involved in the criminal justice system.

References

Abramson

(1972). The criminalization of mentally disordered behavior: Possible side-effect of a new mental health law. Psychiatric Services, 23, 101-105.

Aderibigbe

Y. A.

(1997). Deinstitutionalization and criminalization: Tinkering in the interstices. Forensic Science International, 85, 127-134.

American Psychiatric Association. (1994). Diagnostic and statistical manual of mental disorders (4th ed.). Washington, DC: Author.

American Psychiatric Association. (2004). Mental illness and the criminal justice system: Redirecting resources toward treatment, not containment. Arlington, VA: Resource Document.

Baillargeon

Binswanger

I. A.

Penn

J. V.

Williams

B. A.

Murray

O. J.

(2009). Psychiatric disorders and repeat incarcerations: The revolving prison door. American Journal of Psychiatry, 166, 103-109.

Baillargeon

Penn

J. V.

Knight

Harzke

A. J.

Baillargeon

Becker

E. A.

(2010). Risk of reincarceration among prisoners with co-occurring severe mental illness and substance use disorders. Administration and Policy in Mental Health and Mental Health Services Research, 37, 367-374.

Battin

S. R.

Hill

K. G.

Abbott

R. D.

Catalano

R. F.

(1998). Contribution of gang membership to delinquency beyond delinquent friends. Criminology, 36, 93-116.

Boeije

(2002). A purposeful approach to the constant comparative method in the analysis of qualitative interviews. Quality and Quantity, 36, 391-409.

Bonta

Blais

Wilson

H. A.

(2014). A theoretically informed meta-analysis of the risk for general and violent recidivism for mentally disordered offenders. Aggression and Violent Behavior, 19, 278-287.

10.

Bonta

Law

Hanson

(1998). The prediction of criminal and violent recidivism among mentally disordered offenders: A meta-analysis. Psychological Bulletin, 123, 123-142.

11.

Borduin

C. M.

Mann

B. J.

Cone

L. T.

Henggeler

S. W.

Fucci

B. R.

Blaske

D. M.

Williams

R. A.

(1995). Multisystemic treatment of serious juvenile offenders: Long-term prevention of criminality and violence. Journal of Consulting and Clinical Psychology, 63, 569-578.

12.

Byron

(2014). Criminals need mental health care. Scientific American Mind, 25(2), 20-23.

13.

Calhoun

Conner

Miller

Messina

(2015). Improving the outcomes of children affected by parental substance abuse: A review of randomized controlled trials. Substance Abuse and Rehabilitation, 15, 1-10.

14.

Carr

W. A.

Rosenfeld

Magyar

Rotter

(2009). An exploration of criminal thinking styles among civil psychiatric patients. Criminal Behaviour and Mental Health, 19, 334-346.

15.

Chamberlain

Leve

L. D.

DeGarmo

D. S.

(2007). Multidimensional treatment foster care for girls in the juvenile justice system: 2-year follow-up of a randomized clinical trial. Journal of Consulting and Clinical Psychology, 75, 187-193.

16.

Cloyes

K. G.

Wong

Latimer

Abarca

(2010). Time to prison return for offenders with serious mental illness released from prison: A survival analysis. Criminal Justice and Behavior, 37, 175-187.

17.

Corbin

Strauss

(2014). Basics of qualitative research: Techniques and procedures for developing grounded theory. Thousand Oaks, CA: Sage.

18.

Eddy

J. M.

Whaley

R. B.

Chamberlain

(2004). The prevention of violent behavior by chronic and serious male juvenile offenders: A 2-year follow-up of a randomized clinical trial. Journal of Emotional and Behavioral Disorders, 12, 2-8.

19.

Epperson

M. W.

Wolff

Morgan

R. D.

Fisher

W. H.

Frueh

B. C.

Huening

(2014). Envisioning the next generation of behavioral health and criminal justice interventions. International Journal of Law and Psychiatry, 37, 427-438.

20.

Farabee

Calhoun

Veliz

(2016). An experimental comparison of telepsychiatry and conventional psychiatry for parolees. Psychiatric Services. Advance online publication. doi:10.1176/appi.ps.201500025

21.

Farrington

D. P.

Ttofi

M. M.

Coid

J. W.

(2009). Development of adolescence-limited, late-onset, and persistent offenders from age 8 to age 48. Aggressive Behavior, 35, 150-163.

22.

Fazel

(2011). Psychotic disorders and repeat offending: Systematic review and meta-analysis. Schizophrenia Bulletin, 37, 800-810.

23.

Fisher

W. H.

Packer

I. K.

Simon

L. J.

Smith

(2000). Community mental health services and the prevalence of severe mental illness in local jails: Are they related? Administration and Policy in Mental Health and Mental Health Services Research, 27, 371-382.

24.

Gronfein

(1985). Psychotropic drugs and the origins of deinstitutionalization. Social Problems, 32, 437-454.

25.

Henggeler

S. W.

Melton

G. B.

Smith

L. A.

Schoenwald

S. K.

Hanley

J. H.

(1993). Family preservation using multisystemic treatment: Long-term follow-up to a clinical trial with serious juvenile offenders. Journal of Child and Family Studies, 2, 283-293.

26.

Junginger

Claypoole

Laygo

Crisanti

(2006). Effects of serious mental illness and substance abuse on criminal offenses. Psychiatric Services, 57, 879-882.

27.

Kooyman

Walsh

Stevens

Burns

Tyrer

Tattan

Dean

(2012). Criminal offending before and after the onset of psychosis: Examination of an offender typology. Schizophrenia Research, 140, 198-203.

28.

Lamb

H. R.

(1984). Deinstitutionalization and the homeless mentally ill. Psychiatric Services, 35, 899-907.

29.

Lamb

H. R.

Bachrach

L. L.

(2001). Some perspectives on deinstitutionalization. Psychiatric Services, 52, 1039-1045.

30.

Lamb

H. R.

Weinberger

L. E.

(2005). The shift of psychiatric inpatient care from hospitals to jails and prisons. The Journal of the American Academy of Psychiatry and the Law, 33, 529-534.

31.

Lamb

H. R.

Weinberger

L. E.

(2013). Some perspectives on criminalization. The Journal of the American Academy of Psychiatry and the Law, 41, 287-293.

32.

Link

N. W.

Cullen

F. T.

Agnew

Link

B. G.

(2015). Can general strain theory help us understand violent behaviors among people with mental illnesses? Justice Quarterly. Advance online publication. doi:10.1080/07418825.2015.1005656

33.

Markowitz

F. E.

(2006). Psychiatric hospital capacity, homelessness, and crime and arrest rates. Criminology, 44, 45-72.

34.

Mathieu

Côté

(2009). A modelization of differences between early- and late-starter French-Canadian offenders. International Journal of Forensic Mental Health, 8, 25-32.

35.

Maxfield

Widom

(1996). The cycle of violence: Revisited 6 years later. Archives of Pediatrics & Adolescent Medicine, 150, 390-395.

36.

Maxson

(2011). Street gangs. In Wilson

J. Q.

Petersilia

(Eds.), Crime and public policy (pp. 158-182). New York, NY: Oxford University Press.

37.

Mersky

Reynolds

(2007). Child maltreatment and violent delinquency: Disentangling main effects and subgroup effects. Child Maltreatment, 12, 246-258.

38.

Messina

Grella

(2006). Childhood trauma and women’s health outcomes in a California prison population. American Journal of Public Health, 96, 1842-1848.

39.

Messina

Grella

Burdon

Prendergast

(2007). Childhood adverse events and current traumatic distress: A comparison of men and women drug-dependent prisoners. Criminal Justice and Behavior, 34, 1385-1401.

40.

Mihalic

S. F.

Elliott

D. S.

(2015). Evidence-based programs registry: Blueprints for Healthy Youth Development. Evaluation and Program Planning, 48, 124-131.

41.

Moffitt

T. E.

(1993). Adolescence-limited and life-course-persistent antisocial behavior: A developmental taxonomy. Psychological Review, 100, 674-701.

42.

Nagin

D. S.

Farrington

D. P.

(1992). The onset and persistence of offending. Criminology, 30, 501-524.

43.

Olds

D. L.

Henderson

C. R.

Cole

Eckenrode

Kitzman

Luckey

. . . Powers

(1998). Long-term effects of nurse home visitation on children’s criminal and antisocial behavior: 15-year follow-up of a randomized controlled trial. Journal of the American Medical Association, 280, 1238-1244.

44.

Peterson

J. K.

Skeem

Kennealy

Bray

Zvonkovic

(2014). How often and how consistently do symptoms directly precede criminal behavior among offenders with mental illness? Law and Human Behavior, 38, 439-449.

45.

Peterson

J. K.

Skeem

J. L.

Hart

Vidal

Keith

(2010). Analyzing offense patterns as a function of mental illness to test the criminalization hypothesis. Psychiatric Services, 61, 1217-1222.

46.

Piquero

A. R.

Farrington

D. P.

Blumstein

(2007). Key issues in criminal career research: New analyses of the Cambridge Study in Delinquent Development. New York, NY: Cambridge University Press.

47.

Piquero

A. R.

Farrington

D. P.

Welsh

B. C.

Tremblay

Jennings

W. G.

(2009). Effects of early family/parent training programs on antisocial behavior and delinquency. Journal of Experimental Criminology, 5, 83-120.

48.

Prins

S. J.

(2011). Does transinstitutionalization explain the overrepresentation of people with serious mental illnesses in the criminal justice system? Community Mental Health Journal, 47, 716-722.

49.

Raphael

Stoll

M. A.

(2013). Assessing the contribution of the deinstitutionalization of the mentally ill to growth in the U.S. incarceration rate. The Journal of Legal Studies, 42, 187-222.

50.

Rosenberg

S. D.

Mueser

K. T.

Jankowski

M. K.

Cournos

(2007). Correlates of adverse childhood events among adults with schizophrenia spectrum disorders. Psychiatric Services, 58, 245-253.

51.

Schilling

E. A.

Aseltine

R. H.

Gore

(2007). Adverse childhood experiences and mental health in young adults: A longitudinal survey. BMC Public Health, 7(1), 30-40.

52.

Simpson

A. I.

Grimbos

Chan

Penney

S. R.

(2015). Developmental typologies of serious mental illness and violence: Evidence from a forensic psychiatric setting. Australian & New Zealand Journal of Psychiatry.49, 1048-1059.

53.

Sinclair

Parry

Biehal

Fresen

Kay

Scott

Green

(2015). Multi-dimensional Treatment Foster Care in England: Differential effects by level of initial antisocial behaviour. European Child & Adolescent Psychiatry. Advance online publication. doi:10.1007/s00787-015-0799-9

54.

Skeem

Kennealy

Monahan

Peterson

Appelbaum

(2016). Psychosis uncommonly and inconsistently precedes violence among high-risk individuals. Clinical Psychological Science, 4, 40-49. doi:10.1177/2167702615575879

55.

Skeem

J. L.

Manchak

Peterson

J. K.

(2011). Correctional policy for offenders with mental illness: Creating a new paradigm for recidivism reduction. Law and Human Behavior, 35, 110-126.

56.

Teplin

(1984). Managing disorder: Police handling of the mentally ill. In Teplin

(Ed.), Mental health and criminal justice (pp. 157-175). Beverly Hills, CA: Sage.

57.

Thornberry

T. P.

Krohn

M. D.

Lizotte

A. J.

Chard-Wierschem

(1993). The role of juvenile gangs in facilitating delinquent behavior. Journal of Research in Crime & Delinquency, 30, 55-87.

58.

Torrey

E. F.

Zdanowicz

M. T.

Kennard

A. D.

Lamb

H. R.

Eslinger

D. F.

Biasotti

M. C.

Fuller

D. A.

(2014). The treatment of persons with mental illness in prisons and jails: A state survey. Arlington, VA: Treatment Advocacy Center.

59.

van Dongen

J. D. M.

Buck

N. M. L.

van Marle

H. J. C.

(2014). First offenders with psychosis: Justification of a third type within the early/late start offender typology. Crime & Delinquency, 60, 126-142.

60.

Vigil

J. D.

(2007). The projects: Gang and non-gang families in East Los Angeles. Austin: University of Texas Press.

61.

Wells

Rankin

(1991). Families and delinquency: A meta-analysis of the impact of broken homes. Social Problems, 38, 71-93.

62.

Wright

K. A.

Bouffard

L. A.

(2016). Capturing crime: The qualitative analysis of individual cases for advancing criminological knowledge. International Journal of Offender Therapy and Comparative Criminology, 60, 123-145.