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Community Ment Health J (2011) 47:716722
DOI 10.1007/s10597-011-9420-y
BRIEF REPORT
Does Transinstitutionalization Explain the Overrepresentation of People with Serious Mental Illnesses in the Criminal Justice System?
Seth J. Prins
Received: 15 March 2010 / Accepted: 25 May 2011 / Published online: 8 June 2011 Springer Science+Business Media, LLC 2011
Abstract Although there is broad consensus that people with serious mental illnesses (SMI) are overrepresented in correctional settings, there is less agreement about the policy trends that may have created this situation. Some researchers and policymakers posit a direct link between deinstitutionalization and increased rates of SMI in jails and prisons, a phenomenon described as transinstitutionalization. Others offer evidence that challenges this hypothesis and suggest that it may be a reductionist explanation. This paper reviews claims from both sides of the debate, and concludes that merely increasing access to state psychiatric hospital beds would likely not reduce the number of people with SMI in jails and prisons. A more nuanced approach is recommended for explaining why people with SMI become involved in the criminal justice system and why developing effective strategies to divert them out of jails and prisons and into community-based treatment is needed to improve both their mental health and criminal justice outcomes.
Keywords Deinstitutionalization Mentally ill offenders
Incarceration Correctional institutions Community
mental health services Jail Prison
Introduction
The popular account of why people with serious mental illnesses (SMI) are overrepresented in jails and prisons is usually structured as follows: deinstitutionalization, combined with inadequate funding of community-based treatment for individuals in need of mental health services, has led to the criminalization of mental illness and attendant increases in incarceration rates (Earley 2006). This represents a return to the conditions that psychiatric institutions were originally designed to alleviate (Earley 2006). Indeed, the mainstream assumption that the state psychiatric hospital and criminal justice systems are functionally interdependent (Steadman et al. 1984)a phenomenon described as transinstitutionalizationis commonly accepted. The policy question one might reasonably derive from this account, however, is rarely posed: Would increasing the number of state psychiatric beds (i.e., rein-stitutionalization) reduce the number of people with SMI in jails and prisons?
The answer to this question depends on whether the transinstitutionalization hypothesis is an appropriate causal inference, and this matter is subject to disagreement. Many...