Saturday, November 21, 2009

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.


Anonymous said...

This is very important research and is consistent with what is know from many other areas of research related to decreasing recidivism. Evidence-based practices point to proactive strategies, tailored to the needs of offenders, that help them maintain a more stabile life, recognize the criminogenic factors that are likely to lead them back to prison/jail and help them navigate around these factors successfully.

These are the same principles that apply to the non-mentally ill as well as the mentally ill. When we provide a constructive, helping hand aimed at helping the formerly incarcerated rebuild stabile lives (treatment, health care, jobs, education, housing, and community based assistance programs) they are much less likely to reoffend and recidivate. This improves public safety and reduces costs for taxpayers.

A preventive perspective can be applied on the front end as well by focusing less on whom to punish and or more how to heal the harms caused by the offense. It is a paradigm shift to recognize that justice focused on traditional punishment is costly, ineffective and counterproductive.

About 80% of offending cases involve misdemeananors. Of the felonies about 80% are non-violent property crimes. So, alternative evidence based approaches could be applied much more broadly than they are on the front end as well on the back end with recidivism reduction.

Perhaps it is time to pass on ideological beliefs and look at the evidence.

Anonymous said...

Bad news for state employees. Today the Austin American Statesman anounced that ERS is cutting benefits to state employees by raising health insurance costs to employees - read the story for yourself.

JSN said...

Persons that are developmentally disabled or mentally ill pose special problems for the criminal justice system if they are accused of a crime. The problems can be very complex because there are different types of developmental disabilities and mental illnesses each having a wide range of severity. I think that at the low and medium levels it may be useful to consider them as aggravating rather than causative factors. At high levels of severity I think that is a distinction without a difference.

What seems to be happening is that the courts and the departments of corrections are in the process of educating themselves about developmental disabilities and mental illnesses. We also need to educate the police and the general public as well.

I would like to see MH/DD staff talking on a regular basis with court, corrections and law enforcement staff as well as holding joint forums to help educate the public.

Anonymous said...

criminogenic - did she coin that shit all by her little self or what? Most of these people are full of shit and nearly every goddamned one of them have some kind of mental disorder themselves.

Not only that, they are ALL full of shit. The little twerps, they get a little degree from some worthless university and suddenly start stringing together a bunch of mumbo jumbo crap and everyone sits up to pay attention.

This has been going on for centuries and the bottom line is no one gives a flying fuck because we all know that, basically, PEOPLE SUCK.

And it will all continue no matter how many little kids sit in prestigious lecture halls and turn out new fandagled theories about why PEOPLE SUCK.

YOU SUCK, I SUCK, WE ALL SUCK. That's just the way it is. Now die and go the fuck away.

Gritsforbreakfast said...

2:16 - people sucked 35 years ago, too, and Texas had fewer than 25,000 people in prison. If "people suck" no matter what, what's the point in paying to lock so many up?

Anti-intellectualism may be a fun hobby, but there's a reason most people who say such things don't sign their names - it's an embarrassingly stupid position to take that sends a much more derogatory message about you than those you're criticizing. Offer solutions, if you're so much wiser than Prof. Skeem.

Old Salty said...

Why even bother to reply to that guy? He was obviously baiting you and the rest of us who care about these things.

Anonymous said...

Anon 2:16 -- your comment is insulting and ignorant. It leads nowhere. It is destructive -- if you cannot participate in a thoughtful and constructive way don't participate at all.

TDCJ EX said...

Blogs such as Grits will always attract their fair share of wing nuts and extremists who do what they do for attention and other reasons known only to the poster I and others got drawn into it on another thread . Some of these wingnuts and distributed attention seekers need to be put in their place . Some are everything they claim to be against or worse . Some hold the ignorant belief that any one who has been though the “system” cannot in any way contribute to any discussion about criminal justice.

On the topic with mental illness being a major reason people are caught. up in our highly dysfunctional and corrupt criminal Justice system . It would be much less expensive to deal with psychological or psychiatric problems before they escalate to the point where cops ,court and prison become involved .

Wishful thinking though we tend to use our criminal (in) justice system to single every human problem and behavior regardless of what it is . Could that be the problem Maybe once the criminal (in) justice system takes up most of our tax dollars we might think about changing .
Apply evidence based research , first society has to figure out that that “tuff on crime “ and their wallets approach does not work .

Soon the "this is an excuse" crowd will be out to spout thier repetitive gibberish

Gritsforbreakfast said...

TDCJ EX, FWIW Skeem's argument is that it's incorrect to suppose that "It would be much less expensive to deal with psychological or psychiatric problems before they escalate to the point where cops, court and prison become involved." She's actually saying that mental health treatment in and of itself won't reduce criminality in 90% of cases and people with severe mental illness need the same kind of "criminogenic" risk mitigation as others on probation - they just tend to have more risk factors.

Salty, you're probably right I shouldn't feed the trolls. Good point.

TDCJ EX said...

Grits I agree on that . What I was trying to say was if we mitigate some of risks such as
“bad neighborhoods, destructive peer groups, antisocial personality or cognition, etc. “ Before they ever get to the level where the criminal justice system gets involved would also help

,I would disagree with Ms Skeem in part that removing these risk prior to escalation to where cops courts and prison get involved will help . Does not help to some degree . It would follow if those risk are there prior to a the mentally ill .

I have no doubts people who have psychological / psychiatric conditions need different supervision that hose who do not once the are in the system . Mitigating those risks once they are released should be based on solid data driven research .

Anonymous said...

"Evidence-based practices point to proactive strategies, tailored to the needs of offenders, that help them maintain a more stabile life, recognize the criminogenic factors ...and help them navigate around these factors successfully."

Yeah, we're going to apply proactive strategies to reduce criminogenic factors starting at easy places like Beirut and the Gaza Strip and then we will take on Houston, Dallas and San Antonio.

Oh yeah, we're going to remake the hood! Have you navigated the hood after dark recently?

Anonymous said...

We hired some of these professors to practice the art of origami and others to creatively string together words like recidivism, proactive, criminogenic and paradigm.

Both groups were found to contribute equally to the reduction of recidivism. I quess Grits missed the origami seminars.

Anonymous said...

This is an interesting little chicken vs egg discussion. Are they mentally ill because they use drugs and live in crappy neighborhoods? Or do they use drugs and live in crappy neighborhoods because they are mentally ill? In either event, I'm curious as to where this Utopia is that the good professor wants to send all these crazies to? My bet is that it's nowhere in her zip code--or Grits' either for that matter.

At any rate, until we answer these questions, the mentally ill are Exhibit A as to why Grits' wish for legalized drugs is probably not a good idea. This segment of our population already have a hard enough time with legalized alcohol. Could you imagine how many people would live beneath the underpasses if they could go into Krogers and buy weed, cocaine or meth?

Gritsforbreakfast said...

5:23 writes, "Grits' wish for legalized drugs is probably not a good idea"

Where did I ever express this wish?

As for 4:49, 3:54, etc., what I notice is that when smart people discuss evidence, a bunch of anonymous, whining naysayers who have nothing to contribute themselves just make stuff up and gripe about red herrings and things nobody ever said instead of reacting to the arguments at hand. That's certainly been the case on this string.

Anonymous said...

I find it amazing, this woman is an extremely highly regarded professor from UC Irvine. She is a faculty member in one of the most highly regarded forensic psychology programs in the world. Grits some of the people here are just idiots.

I think this is a great debate because essentially she is arguing that mental health problems generally do not excuse behavior as that the vast majority of crime committed by those with mental illnesses is not necessarily a result of the mental illness.

I would love to hear more on how the mentality of the mental health diversion courts should shift

Unknown said...

My recent misdemeanor arrest for assault was for an incredibly minor offense (though charged as class A). It was a direct result of my mental illness. Although I spent only little over a day in the Fort Bend jail, I learned a lesson. I never want to see the inside of a jail again. Although I plead to a reduced charge "Class C" I never should have been arrested. The situation could easily have been easily resolved, on the scene, by any reasonable and competent police officer or bystander. I have observed that the police and court system in general, care little about the mental condition of a defendant.
BTW I am the son of a retired Police Lieutenant.

Anon 2:16 said...

Grits - if I had a solution I'd be glad to offer it.

I don't think I'm anti-intellectualism. What I am is pissed off and anti-self-mental-masturbatorialism-for the sake of justifying bullshit. Is that a word? Can I coin it and get some jack off to quote me so I sound like I know what I'm talking about? Probably not.

So what is the difference between me throwing out some crap or some asswipe with a degree who trumps up some bullshit explanation that really changes nothing but her bank balance? It's all bullshit.

What about all the soldiers coming back with PTSD now and going on killing sprees or committing suicide while the Army and the (collective) mental health profession sits on its ass and rakes in the bucks, only to see those with the power to change it skew the issue with politics?

You don't have to be a fucking PH.D to see this, you just need a concscience.

Check out I am under a lot of pressure to not diagnose PTSD

Then look at the case of Nicholas Horner, a highly decorated Marine who did three tours in Iraq, but when he came home he "went off" and murdered two people inexplicably. He's not the only one, it's going on all over the country only you don't hear about it.

These people are not criminals, or deviants or psychopaths. They went through an experience most of us can't imagine and which broke them as functioning people.

The reason they can't get help is because the Department of Defense and the psychiatric profession won't stand up and do the right thing.

This is why PEOPLE SUCK.

And I'm including myself in that bunch because I don't know what to do about it either.

Nevertheless, thank you for this blog and letting me express myself.

Happy Holidays everyone :)

Anon 2:16 said...

And why doesn't anyone ever mention the case of Otty Sanchez who ate her freaking baby?

Besides Hannibal Lecter there can't be a more evil person in the whole world. But do you hear Jenny Seem or anyone else from the psyche community chiming in? Indeed, Susan Reed, that consumate bitch of a DA down in Bexar County can't decide what to do.

Why do you suppose this is? If it was a young father accused of "shaken baby syndrome" she'd be all over his ass from day one demanding 40 years, and if he had a mental illness she'd be telling the he was just "malingering".

Like I said, PEOPLE SUCK.

Anonymous said...

Anon 2:16, psychologists tried endlessly to get the Bush administration to pony up the money to fund the care for the mental health needs of those coming back from war. They didn't do it, for over 6 years. So the only people to blame for the lack of mental health care are those in the former Bush administration and congress.

It is interesting to read..."a highly decorated Marine who did three tours in Iraq, but when he came home he "went off" and murdered two people inexplicably.... He's not the only one, it's going on all over the country...These people are not criminals, or deviants or psychopaths. They went through an experience most of us can't imagine and which broke them as functioning people."

Very interesting that people who murder are not criminals, are you saying they are not responsible for their actions because they went through experiences?

that you think it is not

Anonymous said...

and the reason that no one mentions Otty Sanchez is that no one has ever heard of her...especially Dr. Skeem.