Necessary But Not Sufficient

Necessary But Not Sufficient

This article appeared in the Winter 2015 issue of SSA Magazine.

Today’s programs for people with serious mental illnesses in the criminal justice system are missing the full picture

Adults with serious mental illnesses have been overrepresented in the criminal justice system for years. Recognizing this fact—and with a belief that ignoring their needs in criminal proceedings leads to poor outcomes, both socially and clinically—a number of programs have been introduced around the country over the past two decades. These include jail diversion programs, mental health courts, specialized probation and parole caseloads, and services emphasizing psychiatric rehabilitation.

Unfortunately, research has shown that these interventions are not having the intended effect: They have shown limited effectiveness in improving both criminal justice and mental health outcomes for those who participate, and over the past 20 years there has been no significant decrease in the prevalence of people with serious mental illnesses in the criminal justice system.

“People have talked about the lack of efficacy of these interventions for a while, but we’re introducing the idea that their lack of potency is due to a primary focus on mental health treatment, which is necessary but not sufficient,” says Matthew Epperson, an assistant professor at SSA and lead author of “Envisioning the Next Generation of Behavioral Health and Criminal Justice Interventions,” a paper published in the September–October 2014 issue of International Journal of Law and Psychiatry.

As defined by Epperson and his colleagues, “first-generation” interventions are solely dedicated to treating symptoms of mental illness. What is missing, they argue, is recognition of research that shows that people with serious mental illness typically display a similar array of risk factors for criminal involvement as the broader criminal justice-involved population.

“Issues such as unemployment, trauma, substance abuse, criminal thinking—these need to be targets of treatment as well,” Epperson says. “This paper is intended to advance the conversation about where we need to go as a field. My research agenda seeks to identify and pilot what the second-generation of interventions for criminal behavior and mental health can be.”

— Carl Vogel