The criminalization of persons with serious mental illness living in rural areas.

In the context of restrictive admissions policies at public inpatient facilities, rates of arrest and incarceration of persons with serious mental illness (SMI) have been increasing, leading to the perception that SMI persons are being unduly "criminalized." This paper describes the characteristics of persons with SMI (N = 177) in Mississippi who have been (1) jailed without charges while awaiting a hospital bed and (2) jailed for a criminal offense. Seventy-five percent (N = 132) of the 177 subjects had been held in local jails awaiting state hospital admission at least once in their lives, most for more than five days. Fifteen percent (N = 26) had contact with the police for a criminal offense in the past year. Rural residence markedly increased the risk for waiting in jail (OR = 4.24) but was not related to committing a criminal offense. Protective factors for any type of criminal justice contact were female gender, caucasian ethnicity, better compliance with medication regimes, and nonrural residence. The phenomenon of rural criminalization, i.e., waiting in jail without criminal charges, differs qualitatively from the criminalization that occurs in urban areas and may require a different solution. To avoid criminalization of SMI persons in rural areas, public mental health systems must develop effective crisis interventions in the community or work with local law enforcement officials and medical and mental health facilities to create more immediate access to acute inpatient care.