Mentally Ill Offenders Involved With the U.S. Criminal Justice System : A Synthesis

This study simultaneously assessed the inter-rater reliability of the Structured Clinical Interview for the Diagnostic and Statistical Manual of Mental Disorders Axis I (SCID I) and Axis II disorders (SCID II) in a mixed sample of n = 151 inpatients and outpatients, and non-patient controls. Audiotaped interviews were assessed by independent second raters blind for the first raters' scores and diagnoses. Categorical inter-rater reliability was assessed for 12 Axis I disorders of SCID I, while both categorical and dimensional inter-rater reliability was tested for all Axis II disorders. Results revealed moderate to excellent inter-rater agreement of the Axis I disorders, while most categorically and dimensionally measured personality disorders showed excellent inter-rater agreement. Copyright © 2010 John Wiley & Sons, Ltd.

Research on mental illness in relation to social problems such as crime, unemployment, and homelessness often ignores the broader social context in which mental illness is embedded. Policy, research, and practice will be improved if greater attention is given to social context. The authors critically analyze the approach used in much of the psychiatric services literature to infer links between mental illness and social problems. They compare these studies with studies that have been more validly conceptualized to account for social context. With this broader perspective, the impact of mental illness on crime, unemployment, and homelessness appears to be much smaller than that implied by much of the psychiatric services literature. Poverty moderates the relationship between serious mental illness and social problems. Factors related to poverty include lack of education, problems with employment, substance abuse, and a low likelihood of prosocial attachments. This relationship is often complicated and is not amenable to simple explanations. Research and policy that take this complexity into account may lead to greater effectiveness in interventions for persons with serious mental illness.