Center for Behavioral Health Services & Criminal Justice Research Rutgers, The State University of New Jersey, New Brunswick, NJ, United States.
Int J Law Psychiatry. 2013 Jan-Feb;36(1):1-10. doi: 10.1016/j.ijlp.2012.11.001. Epub 2012 Nov 22.
Specialized interventions, such as police and jail diversion, mental health courts, specialized probation, forensic assertive community treatment, designed to engage justice-involved persons with serious mental illnesses, have expanded over the past two decades. Some of these "first generation" interventions have demonstrated efficacy and several have earned recognition as evidence-based practices. Yet, overall, they have not appreciably reduced the prevalence of persons with serious mental illnesses involved in the criminal justice system. To understand how to make the next generation of interventions more effective, a survey of a national sample of community-based programs serving these clients was conducted. Surveys were completed on-line by direct service staff affiliated with 85 programs and collected data on the characteristics and needs of the client base; characteristics and challenges associated with difficult-to-engage clients; service needs and obstacles; and recommendations for improving program effectiveness. A sample of the survey participants (19 programs from 18 states) attended a day-long workshop to discuss the survey findings and ways to improve treatment adherence and client services. Respondents reported that their clients have a constellation of problems with different origins, etiologies, and symptoms, often crossing over the boundaries of mental illness, addictions, and antisocial pathologies. According to the practitioners working with justice-involved clients with mental illnesses, responding effectively requires knowledge of many different problems, expertise to respond to them, and an understanding of how these problems interact when they co-occur. The poly-problems of these clients suggest the need for an integrated and comprehensive approach, which is challenged by the fragmented and diverse ideologies of the behavioral health, criminal justice, and social service systems.
专业化干预措施，如警察和监狱转介、心理健康法庭、专门缓刑、法医坚定社区治疗，旨在让涉及严重精神疾病的司法人员参与其中，在过去二十年中得到了扩展。其中一些“第一代”干预措施已经证明了其效果，并且有几个已经被公认为基于证据的实践。然而，总体而言，它们并没有显著减少涉及刑事司法系统的严重精神疾病患者的比例。为了了解如何使下一代干预措施更有效，对服务于这些客户的全国社区项目样本进行了调查。 85 个项目的直接服务人员在线完成了调查，收集了客户群体的特征和需求、难以接触客户的特点和挑战、服务需求和障碍以及提高项目效果的建议等数据。调查参与者的样本（来自 18 个州的 19 个项目）参加了为期一天的研讨会，讨论调查结果以及提高治疗依从性和客户服务的方法。受访者报告称，他们的客户存在一系列问题，这些问题具有不同的起源、病因和症状，常常跨越精神疾病、成瘾和反社会病理学的界限。根据与涉及精神疾病的司法人员合作的从业者的说法，有效应对需要了解许多不同的问题、应对这些问题的专业知识，以及了解这些问题在同时发生时如何相互作用。这些客户的多种问题表明需要采取综合和全面的方法，但行为健康、刑事司法和社会服务系统的分散和多样化意识形态对此提出了挑战。
