Expanding the focus of intervention and the metrics of success

The approaches discussed above take an important step in rethinking the relationship between mental illness and crime—namely, they demonstrate that for most people with mental illness, criminal justice involvement is not explained simply by a lack of mental health treatment. In so doing, they broaden the types of risks that put a person with serious mental illness at greater likelihood of running afoul of the criminal justice system. They are also valuable for their practice recommendations. For example, the treatment plan described in Changing Lives and Changing Outcomes addresses key risk factors for both illness recurrence and recidivism such as addiction, medication adherence, stress, trauma, and housing, education, and employment needs.23

So far, however, there has been little analysis of how to design interventions at the intersection of criminal justice and behavioral health systems that both decrease recidivism and expand life opportunities for participants. This area calls for greater focus from practitioners, researchers, and policymakers. The intense attention to reducing recidivism is understandable given the heavy social and economic costs of incarceration. But the fact that research on outcomes is rarely framed by an orientation to recovery—one that looks at opportunities for people with mental illness coming out of incarceration to renew possibilities, to regain competencies, or to reconnect socially— means that existing evaluation research tells us little about how an intervention succeeds in rebuilding lives.24

What follows, then, is an attempt to think more broadly about the desirable outcomes of interventions for people involved in the mental health and criminal justice systems. The ultimate goals—desistance from crime and recovery from mental illness—can be slow processes. To show promise, emerging practices and programs must recognize this fact and help to change the life course of people seeking to stop criminal behavior and achieve mental health.25 The ideas introduced here can help to lay the groundwork for further inquiry into what kinds of intervention can halt the progression from the need for mental health services to involvement in the criminal justice system, and what it will take to effect this result.