Lamberti J Steven
Department of Psychiatry, University of Rochester Medical Center, 300 Crittenden Blvd., Rochester, NY 14642, USA.
Psychiatr Serv. 2007 Jun;58(6):773-81. doi: 10.1176/ps.2007.58.6.773.
The high prevalence of adults with psychotic disorders in the criminal justice system has received much attention recently, but our understanding of this problem is marked by diverging opinions. Mental health professionals point to deinstitutionalization and our fragmented mental health system as primary causes. Criminologists minimize the role of mental illness and contend that persons with and without mental illness are arrested for the same reasons. Meanwhile, practice guidelines offer little guidance to clinicians about how to address the problem. Drawing upon contemporary crime prevention principles as well as current knowledge of psychotic disorders and their treatment, this article presents a conceptual framework for understanding and preventing criminal recidivism. The framework highlights the importance of individual and service-system risk variables and emphasizes the central role of treatment nonadherence as a mediator between modifiable risk variables and recidivism. On the basis of the conceptual framework described in this article, three necessary elements of intervention are presented for preventing recidivism among adults with psychotic disorders: competent care, access to services, and legal leverage. Research is needed to further define and test these intervention elements as foundations for future service delivery efforts.
近期，刑事司法系统中患有精神疾病的成年人的高患病率备受关注，但我们对这一问题的理解存在不同观点。心理健康专业人士指出，非机构化和碎片化的心理健康系统是主要原因。犯罪学家则淡化精神疾病的作用，认为有精神疾病和无精神疾病的人被捕原因相同。与此同时，实践指南几乎没有为临床医生提供如何解决这一问题的指导。本文借鉴当代犯罪预防原则以及对精神疾病及其治疗的现有认识，提出了一个理解和预防犯罪再犯的概念框架。该框架强调了个体和服务系统风险变量的重要性，并强调治疗依从性作为可改变风险变量与再犯之间的中介的核心作用。基于本文所述的概念框架，提出了预防患有精神疾病的成年人再犯的三个必要干预要素：有效护理、服务可及性和法律手段。需要开展研究，进一步界定和测试这些干预要素，作为未来服务提供工作的基础。
