The voices of Urban Institute's researchers and staff
July 14, 2015

Exploring a new opportunity to help mentally ill individuals in the criminal justice system

July 13, 2015

About 7 million people are under the purview of adult correctional systems in the United States, including jail, prison, and community-based supervision. Many suffer from cognitive impairments and mental illness, which can affect their judgment, memory, and even their ability to manage day-to-day tasks. In fact, many of these individuals got into trouble with the law because of a mismanaged condition or neglected care, and not necessarily because they set out to do harm.

As documented in a recent, comprehensive review by the Urban Institute, there is mounting evidence that criminal justice-involved individuals with mental illness are more likely than those without such issues to experience adverse outcomes, such as misconduct and accidents in prisons, as well as recidivism. Because of these challenges, helping these folks stay out of trouble would not only benefit the individual, but also hold high promise for saving significant costs in criminal justice spending and reducing associated victimization costs.  

How can we help criminal justice-involved individuals with psychotic disorders?

A range of treatment options is available to help someone with a disorder like schizophrenia maintain a normal, law-abiding life, but they require consistency. Daily oral medications are common in the treatment of schizophrenia, but unless administered in a highly controlled environment, like prison, such treatment may often lead to non-compliance because these individuals can easily forget to take the medication. Missed medication can increase the risk of psychotic relapse, and for some, could potentially lead to more trouble with the law.

This challenge is not unique to offender populations and has been documented in the medical field as well. In the 1960s, it led to the development of long-acting injectable antipsychotics that circumvent the need for daily administration. Though there can be several side effects, these drugs hold promise for individuals with schizophrenia in the criminal justice system because a single shot could help them stay focused and minimize symptoms for a month or longer.

The schizophrenia drug market is quickly becoming genericized, and, as forecasted three years ago, new injectable schizophrenia drugs are expected to expand the market considerably. There is a potentially lucrative market for injectable schizophrenia drugs in the criminal justice system, which may also hold promise for public safety and better outcomes for those living with the condition. It seems worth exploring how to leverage this opportunity presented by motivated pharmaceutical companies to help criminal justice-involved individuals with mental illness.

There’s still no silver-bullet solution

It is important to remember that a direct link between a psychotic relapse and behavioral or criminal justice system outcomes is not well understood. Moreover, injectable antipsychotics may require a longer time to achieve a steady state level, which may be a critical limitation for use with offender populations.

Though there is a lot more to learn, this is an exciting time for the field and for the understanding of treatment options for criminal justice-involved individuals. Future policy should consider pilot programs to understand the short- and long-term effects of this and other advances in medicine on criminal justice-involved individuals with mental illness. With the results of such efforts, the idea of helping these individuals—rather than institutionalizing them—may gain further traction.

The author conducted earlier research on mental illness and the criminal justice system that was funded by Janssen Pharmaceuticals. Funders do not determine research findings or influence scholars' conclusions. The views expressed are those of the author and should not be attributed to the Urban Institute, its trustees, or its funders.

Photo by Cathleen Allison/AP

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