Jennifer Skeem on Sentencing and Mental Health

Yesterday morning I heard a provocative and informative talk at the Texas Judicial Advisory Council's biennial sentencing conference from Dr. Jennifer Skeem, who is a member of the MacArthur Research Network on Mandated Community Treatment, and Centers for Psychology and Law and Evidence-Based Corrections, on the subject of "Mental Health and Sentencing." Here are some of the highlights from her comments. (All statistics were sourced in her presentation.)

Skeem's big picture thesis: For most mentally ill offenders, especially repeaters, treatment and medication alone usually isn't enough to stop recidivism. Instead, research shows that people with severe mental illness tend to have more criminogenic (crime-causing) risk factors - bad neighborhoods, destructive peer groups, antisocial personality or cognition, etc. - and those correlate much more strongly to recidivism than does mental illness.

Generally stating the problem, said Skeem, people with mental illness are significantly overrepresented in the system. Rates of mental illness among offenders are 3 times the average for men, twice the average for women (who have higher rates generally). Overall, 14% of male defendants and 30% of women suffer from severe mental illness, she said, and 72% of those have a co-occurring substance abuse disorder. Most are supervised in the community on probation and they often "fail." People with severe mental illness are twice as likely to have their probation revoked for technical violations, she said.

In most jurisdictions (73% according to a national survey), sentencing of mentally ill offenders by judges is usually "non-specific," often amounting to checking an additional box on a form - usually labeled "mental health" - that would then authorize whatever treatment package the prison or probation department wants to apply.

There is an "implicit" model in current sentencing practices regarding the mentally ill that Skeem believes is misdirected. Mental illness is seen as the root of offender criminality, so the offender is sentenced to treatment. Once their symptoms are reduced, by this logic, supposedly criminality will decline.

In practice, she said, increased mental-health services often do not result in fewer arrests or recidivism gains, even if they successfully reduce symptoms in the patient. Improved symptoms and functioning typically don't reduce crime, she said (with the notable exception of those whose offenses involve domestic violence). Even "Cadillac" mental health treatment programs don't translate into improved public safety outcomes.

That's because only about one in ten offenses by people with severe mental illness result directly from their mental health condition, she said, citing what she described as "elegant" cutting-edge research. Substance abuse is statistically a bigger contributing factor, but even it doesn't fully explain the data. The real problem, said Skeem, is that mentally ill offenders tend to have more overall risk factors than their counterparts. She emphasized that this insight should not be used as an excuse to avoid treating mental illness and that offenders who needed it should absolutely receive treatment. But mental health treatment shouldn't be seen as a primary way of changing offender behavior, which most frequently stems from other causes.

Skeem encouraged judges not to treat mental illness as some sort of "master status," but instead to target "criminogenic needs" just like the evidence-based practices models designed for regular probation caseloads. In the Q&A afterward, I asked what that position implied for mental health courts and specialized probation caseloads focused on the mentally ill. But Skeem declined to criticize such programs, saying they were important but that their focus should shift.

Indeed, Skeem said that where specialty mental health programming by courts and probation departments had been successful, it was primarily because they're more likely to studiously apply evidence-based practices and problem solving approaches than in regular probation.

In particular, she said, use of "authoritarian" approaches by probation officers tend to produce worse outcomes for all probationers, but particularly those with severe mental illness. Use of threats and punishments by POs measurably affect whether outcomes improve, she said. Negative pressure on probationers predicts failure. So in some instances specialized caseloads have demonstrated success not because they treat mental health needs but because they're more likely to adopt these evidence-based probation approaches.

Skeem said that "stigma" associated with mental illness along with "paternalism" by those in the system led to worse outcomes for probationers with mental illness. Though the public views the mentally ill as scary people, statistically they're no more likely to be arrested than the rest of us, she said. However, once on probation, people with mental illness are much more likely to be revoked on technical violations. Surveys of probation officers show some don't like having the mentally ill on their caseloads and may revoke them or seek to shift them to other programs so they won't have to deal with them.

From the standpoint of reducing crime, the best approach for probationers with mental illness, she said, is to focus on screening and assessment aimed at identifying criminogenic factors generally, then using those specific assessments to inform sentencing, tailoring which evidence-based practices are used based on individual circumstances.

For probation officers, said Skeem, offender visits should become less about "monitoring" and more about discussion of criminogenic needs and risk mitigation. Research by Jim Bonta has shown that just as negative pressure predicts failure, time spent on problem solving and navigating criminogenic factors "correlates powerfully" with reducing recidivism.

If accurate - and Judge David Crain who runs Travis County's mental health court told me most of the presentation jibed with his experience - Skeem's insight about the causes of crime among mentally ill offenders suggest helpful ways to reduce crime overall. "What works" for the mentally ill appears to be pretty much what works with regular probationers, it's just that probation departments don't regularly apply evidence-based practices outside of these specialty caseloads. If those techniques were implemented more widely, it follows, the approach should reduce recidivism among both groups.

RELATED: Go here for links to Skeem's research.