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Racial justice movements sparked by police killings of Black and Brown persons have led to a reassessment of the role of policing in America. This has promoted important conversations about how best to improve public safety and design law enforcement practices that are equitable and just across communities. A component of this conversation is addressing stress and trauma faced by police as a routine part of their duties, as it can affect the quality of policing. Job-related stress and trauma experienced by police officers are an international phenomenon, yet underexplored areas in social work research and practice. Police officers experience high levels of stress from routine exposure to traumatic situations, leading to high rates of post-traumatic stress disorder, substance use, and depression. Officers who are actively experiencing symptoms of stress and trauma are more likely to engage in misconduct, including the unnecessary use of force. This study explores the stress and trauma-related experiences of police officers. We conducted one-on-one, semi-structured interviews with 23 officers from an urban police department in St Louis, Missouri. Analysis of interviews addressed three areas: (1) stress and trauma experiences associated with police work, (2) negative effects of stress and trauma on officers, and (3) factors impacting officer access to treatment. We conclude that social work can contribute to improved policing outcomes by helping officers address their job-related stress and trauma through engaged research and practice. [ABSTRACT FROM AUTHOR]

Women police officers may experience discrimination and work–life balance challenges that can impede their entry into and advancement and retention within police organizations. This study used in-depth interviews with 14 women police officers in the St. Louis, MO, metropolitan region to examine workplace stressors, experiences within policing, and perceptions of whether and how gender influenced those stressors and experiences. Participants expressed that they experienced discrimination based on gender, including direct discrimination, such as denial of specialized training, denial of lateral changes in duty assignments, and barriers to career advancement, and indirect discrimination in the form of teasing, harassment, and higher expectations. Many participants also reported they deployed coping strategies to insulate themselves from those experiences, isolated themselves from situations that might result in discrimination or harassment, or sought ways to mitigate the harm of those experiences. Police departments must create environments that support not just gender representation but gender equity. [ABSTRACT FROM AUTHOR]

Mental health courts are one potential means to mitigate violence against family members by people with mental illness. This study identified the rate at which cases of family violence come before a mental health court and the success of defendants charged with assaulting family members. In a sample of 1,456 defendants eligible to participate in a mental health court, descriptive statistics were used to report rates of admission of defendants charged with assaulting family members and their characteristics; a static group design was used to compare post-program rearrests among defendants who assaulted family members who successfully completed the program, who did not complete the program, and who did not participate despite being eligible; and logistic regression was used to determine the effect of participation on rearrest when controlling for demographic and clinical factors. The study found that family violence occurred in 24.7% of admitted cases. Most eligible defendants who assaulted family members (75.8%) participated in the court program, and among those who did, 72.2% successfully completed the program. Defendants who assaulted family members and had a positive program termination had a much lower rate of rearrest post-program completion compared with those who did not complete the program or did not participate despite being eligible, a finding that held when controlling for other factors. This study suggests that mental health courts can be an effective option for mitigating family violence committed by people with mental illness. [ABSTRACT FROM AUTHOR]

This study empirically examines the associations between legal representation and four key outcomes in mental health courts. The outcomes include whether eligible defendants chose to participate in a municipal mental health court (MMHC); if defendants chose to participate, whether the MMHC resolved their criminal charges without court supervision; whether eligible defendants attended the initial MMHC court hearings; and whether defendants successfully completed the MMHC program. The study included 1012 defendants who were accepted into a MMHC in a state where municipal court defendants do not have to be represented by a defense attorney. We conducted bivariate and logistic regression analyses to identify differences in each of the four outcomes between MMHC defendants who did or did not have a defense attorney. The results of the bivariate and logistic regression analyses found defendants represented by defense attorneys were more likely to choose not to participate in the MMHC, to resolve their criminal charges without court supervision, to participate in initial court hearings, and to successfully complete the MMHC program. All four regression models were statistically significant, although the amount of variance explained was relatively low, ranging from 6% to 13%. [ABSTRACT FROM AUTHOR]

Understanding trends in substance use by gender among jail‐based treatment program participants can inform policies and programs tailored to this population. Preprogram assessment data from 3509 individuals entering a jail‐based substance use disorder treatment program in Missouri between 1998 and 2016 were analyzed. Primary outcome was program participants' strongly preferred substances. Demographic covariates and drug preferences were compared between males and females. Average yearly trends in preferred substances were calculated. While 25.8% of the sample preferred heroin, it was more strongly preferred by women (36.4%) than men (22.0%, p < 0.0001). Alcohol and marijuana were preferred more by males. Overall, preferences for heroin and methamphetamine increased over time while alcohol, marijuana, and other stimulants decreased. Women being more likely to prefer heroin and the increasing preference for heroin over time are consistent with national trends. Offering evidence‐based treatment like pharmacotherapy and gender‐sensitive approaches can help address the needs of this vulnerable population. [ABSTRACT FROM AUTHOR]

This study examines potential gender differences among defendants referred by criminal courts for psychiatric evaluations by analyzing demographic, clinical, and criminal history variables and evaluation findings. This study offers a large sample size of 718 females, as well as 3,627 males. Bivariate logistic regression and heterogeneity analyses were utilized to assess potential differences. Females were older; diagnosed more with mood, anxiety, and borderline personality disorders; less likely to have prior felony convictions; and more likely to be in the community than jail at the time of the evaluation. In addition, when controlling for other factors, females were more likely to be evaluated as having a mental disease or defect, to need hospitalization pending trial, and to be incompetent to stand trial. [ABSTRACT FROM AUTHOR]

This study compared the characteristics and court-ordered evaluation questions and responses among 4,430 defendants to determine if differences existed between those represented by public defenders and private attorneys when receiving trial competency or responsibility psychiatric evaluations from a state department of mental health. Defendants represented by public defenders were more likely to be younger, to have less education, to have psychotic disorders, to have a history of inpatient psychiatric treatment, to live in urban or rural counties, and to be jailed at the time of the evaluation. In addition, defendants represented by public defenders were less likely to have a request for a criminal responsibility evaluation and more likely to be evaluated as having a mental illness, to be incompetent to stand trial, and to need hospitalization pending trial. Consideration of whether defendants with public defenders receiving less requests for responsibility evaluations was indicative of a therapeutic jurisprudence approach is discussed. Implications for research on types of legal representation of defendants with mental illness are discussed. [ABSTRACT FROM AUTHOR]

Mental health courts (MHCs) have emerged as one option to address the needs of people with severe mental illness who enter the criminal justice system. Little is known about defendants having multiple referrals to MHCs or the outcomes of subsequent admissions. This study included a sample of 1,084 defendants referred to municipal MHC. During the 13-year study period, 14.3% of defendants had a second admission, with an estimated probability of readmission of 17.4%. Key factors associated with readmission included being eligible to participate in the court but choosing not to do so, being rearrested during court supervision, and having a negative termination from supervision. Defendants who had a second admission during the study period had poorer outcomes than those with one admission. When defendants are referred for readmission to MHCs, careful assessment is required to ensure that these courts are the best alternative for them. [ABSTRACT FROM AUTHOR]

The current study examines whether racial differences exist for defendants referred by criminal courts for pretrial psychiatric evaluations across demographic, clinical, and criminal history variables. Compared to Caucasian defendants, African Americans were younger, less educated, diagnosed more frequently with schizophrenia, but less with mood disorders, more likely to have prior felony convictions, and more likely to be in jail at the time of the evaluation. In addition, when controlling for other factors, African American defendants were more likely to be evaluated by forensic examiners as having a mental disease or defect, but racial differences did not exist for opinions regarding the need for inpatient hospitalization, incompetency to stand trial, or responsibility at the time of the crime. Practice recommendations are discussed. [ABSTRACT FROM AUTHOR]

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Mental health courts are one means to address the involvement of persons with mental illness in the criminal justice system. Using a sample of 811 participants of a municipal mental health court, this study found that 23.2% of participants were rearrested during court supervision. This study also identified factors associated with these rearrests, as well as the effect of rearrests during supervision on program completion and rearrests in the 1-year period following program completion. This study concludes with implications for mental health court supervision. [ABSTRACT FROM PUBLISHER]

The article examines the development, outcomes and future challenges of mental health courts in the U.S. Topics discussed include percentage of prison inmates diagnosed with mental illness, deinstitutionalization of mental health services to reduce state psychiatric hospital population and addressing criminogenic factors that leads to arrest and recidivism such as substance abuse.

This study evaluated a statewide demonstration project to implement a group-based intervention called Procovery in selected inpatient and community mental health centers. Procovery is a facilitated mutual support group designed to build hope and a sense of social inclusion by raising consciousness and helping people develop an understanding of the ways one can move toward recovery in their own lives. This evaluation sought to determine both consumer outcomes and perceptions of the program and implementation efforts held by consumers and the facilitators of the intervention. A multidimensional approach was used, including a quasi-experimental design with consumers, questionnaires and focus groups with the intervention facilitators, and individual interviews with administrators. The Procovery model was shown to have a positive impact on consumers' recoveries and was viewed favorably by consumers, facilitators, and administrators. Several barriers to effective implementation were identified. These findings and their implications for future practice and research are discussed. [ABSTRACT FROM AUTHOR]

As higher numbers of individuals are released from prison and rejoin society, reentry programs can help former offenders reintegrate into society without continuing to engage in crime. This quasi-experimental study examined whether participation in reentry programming was associated with reduced recidivism among offenders who were no longer under criminal justice supervision. Offenders who completed their sentences in prison were invited to participate in Project Re-Connect (PRC), a six-month, voluntary prisoner reentry program. Following participants' release from prison, PRC provided case management and direct monetary support to participants for up to six months. Survival analysis was used to compare recidivism rates between 122 PRC participants and 158 eligible non- participants. Cox regression coefficients indicated that program participation and having a high school diploma or its equivalent were associated with reduced likelihood of new convictions, whereas substance abuse was associated with higher risk of subsequent convictions. The implications for social work policy and practice are discussed. [ABSTRACT FROM AUTHOR]

Mental health courts have recently emerged as one means to reduce the number of persons with mental illness in the criminal justice system. Using a post-test only comparison group design, this study examined rearrest rates for 1 year post discharge among three groups meeting admission criteria for a municipal mental health court. The rearrest rate of defendants who successfully completed the program ( N = 351) was 14.5%, compared to 38% among defendants negatively terminated from the program ( N = 137), and 25.8% among defendants who chose not to participate ( N = 89). This positive result held even when controlling for a range of variables in a Cox regression survival analysis. Factors associated with rearrest are identified for each of the three groups. [ABSTRACT FROM AUTHOR]

This study examines 122 ex-offenders who participated in Project Re-Connect, a 6-month, voluntary, prisoner-reentry program for inmates who served their maximum prison sentence. The needs most frequently self-identified by program participants prior to their return into the community included transportation, clothing, food, housing, and employment or vocational training. To help address these needs, program participants had access to US$3,000. These funds were largely directed toward the self-identified needs, with the greatest portion of expenditures applied to housing. Social outcomes, including employment, housing, and substance abuse, are examined for program participants. The study found that many ex-offenders will seek assistance through reentry programs, even when participation is voluntary, and that they are capable of self-identifying their service needs. [ABSTRACT FROM AUTHOR]

Mental health courts developed in the USA in the late 1990s as one means to reduce the involvement of people with mental illness in the criminal justice system. In response to the growth in number of mental health courts, the Council of State Governments led an initiative to identify essential elements of mental health courts to guide their development and implementation. This paper applies these essential elements to a municipal mental health court in a multijurisdictional, suburban county. While this court met most essential elements, they faced a number of challenges. The primary ones included not being able to advance from hearing municipal cases only to state misdemeanor and felonies, not having the resources to expand program capacity for municipal cases, and participants not being able to always access needed mental health treatment, rehabilitation, and support services. The paper concludes with implications for behavioral health administrators and direct service staff in implementing the essential elements of mental health courts. [ABSTRACT FROM AUTHOR]

Harm reduction is a conceptual framework and set of practices that focus on the minimization of the physical, social, and legal harms substance users do to themselves and to society as a whole. Its application to community mental health settings is relatively new, and can create controversies and ethical dilemmas if not properly designed, implemented, and evaluated. Building on the harm reduction literature, the community mental health literature, and the authors' experiences with a community mental health program that uses a harm reduction approach, the authors offer five guidelines for its successful implementation. The authors conclude that when properly integrated with other recovery-based services, and when appropriately applied to the individual client's stage of change, harm reduction can effectively be used, and should be used, in community mental health settings with clients with co-occurring substance use and psychiatric disorders. [ABSTRACT FROM AUTHOR]

This article reports on a process evaluation of the efforts of a collaborative team organized to develop a comprehensive plan for children of prisoners in the state of Missouri over an 18-month period. Direct observation of planning team meetings, content analysis of work products, surveys of team members, and interviews of staff were used to evaluate work done, needs addressed, voices heard and valued, and organization of the planning process. Evaluation findings suggest six lessons for collaborating across diverse groups including state and local governmental agencies and not-for-profit agencies. Lessons include recognizing the importance of setting realistic goals, having a clear purpose, establishing a system to track progress toward these goals, establishing a structure appropriate to the task with clarity of roles within that structure, developing creative means to ensure attendance of key parties, and evaluating subjective and objective outcomes of the planning process in addition to the achievement of stated goals. With training and careful planning to address the issues identified, collaborative planning can make a substantial contribution to social service delivery. [ABSTRACT FROM AUTHOR]

Development of policies and procedures to contend with the risks presented by elopement, aggression, and suicidal behaviors are long-standing challenges for mental health administrators. Guidance in making such judgments can be obtained through the use of a multivariate statistical technique known as logistic regression. This procedure can be used to develop a predictive equation that is mathematically formulated to use the best combination of predictors, rather than considering just one factor at a time. This paper presents an overview of logistic regression and its utility in mental health administrative decision making. A case example of its application is presented using data on elopements from Missouri's long-term state psychiatric hospitals. Ultimately, the use of statistical prediction analyses tempered with differential qualitative weighting of classification errors can augment decision-making processes in a manner that provides guidance and flexibility while wrestling with the complex problem of risk assessment and decision making. [ABSTRACT FROM AUTHOR]

Conditional release, monitoring, and revocation are important components of insanity acquittee systems because they help to balance public safety with the treatment needs of insanity acquittees. We describe a state conditional release system within the United States that uses existing personnel to assess risk and make release decisions as another model for how to design and implement an insanity acquittee conditional release system. The State of Missouri's system had low costs per client associated with monitoring insanity acquittees in the community. However, substantial time commitments by actors in the mental health and criminal justice systems were required to ensure a high level of public safety in the release process. In addition, hospitalization was used extensively to protect public safety, which in part has resulted in insanity acquittees occupying approximately 50% of the state's long-term public psychiatric hospital beds. It is possible that other jurisdictions may be able to design insanity acquittee conditional release systems that still provide an acceptable degree of public safety yet do not incur some of the substantial costs associated with lengthy hospitalization and indefinite community oversight found in Missouri's insanity acquittee system. [ABSTRACT FROM AUTHOR]

In recent years communities across the United States have instituted specialized criminal courts for defendants with substance abuse disorders and mental illness. These specialized courts seek to prevent incarceration and facilitate community-based treatment for offenders, while at the same time protecting public safety. The authors describe two types of specialized courts: drug courts and mental health courts. They critically examine the strengths and weaknesses of these courts and conclude with implications for social work education, practice, research, and advocacy. [ABSTRACT FROM AUTHOR]

Almost 1.5 million children in the United States have parents who are incarcerated in prisons. These children are at-risk for juvenile delinquency, failure in school, and residential instability. Efforts to locate and provide services to these children require cooperation from a range of social institutions that historically have not worked together. This article describes two collaboratives organized to identify and address the needs of these children. One collaborative has largely succeeded, while the other did not meet all of its goals. Drawing upon models of interorganizational and interdiscriplinary collaboration, this article analyzes their successes and failures and offers lessons for interorganizational collboratives. [ABSTRACT FROM AUTHOR]

This qualitative study assessed clients' participation in organizational decision making in a public long-term psychiatric hospital. Numerous examples were found in which clients meaningfully participated in the decision-making process and achieved favorable policy changes. Three means of involving clients were found to be especially useful: (1) using a consumer council, (2) involving clients in the formal policy review process, and (3) including clients in the hospital's performance improvement system. The authors offer guidelines for mental health organizations wishing to promote client participation in organizational decision making. Implications for social work are discussed. [ABSTRACT FROM AUTHOR]

Forensic patients are occupying an increasingly large number of beds in state psychiatric hospitals. The presence of these mentally ill offenders has raised concerns about the risk they present to nonforensic patients. This study compared the rate of assaults and factors associated with assaultive behavior among 308 nonforensic patients and two groups of forensic patients including 469 patients found not guilty by reason of insanity and 76 pretrial patients. Consistent with other studies, nonforensic patients had higher rates of assaults than either group of forensic patients. However, being a forensic patient did not affect the odds of assault when controlling for the effects of demographic and clinical variables in a multivariate logistic regression analysis. Factors associated with assaults in each of the three patient groups were identified using multivariate analyses. Implications are presented for treatment of assaultive behavior, mixing of forensic and nonforensic patients within state hospitals, forensic release policies, and future research. [ABSTRACT FROM AUTHOR]

Persons with developmental disabilities who enter the criminal justice system face injustices throughout the process. For example, their disability often goes undetected, they are more likely to incriminate themselves because they do not understand their Miranda rights, they are more likely to be imprisoned rather than receive probation, and they typically serve longer prison sentences. Based upon a review of the literature and the experiences of one program, this article provides strategies for practicing social justice with this population, which require intervention at the individual, organizational, and social policy levels. [ABSTRACT FROM AUTHOR]

This article examines the practice of social justice with persons with mental illness residing in public psychiatric hospitals by involving them in decision making. Ten guidelines for involving clients in decision making are offered, which were derived from the professional literature and a study of client decision making at a long-term public psychiatric hospital. Guidelines include making an organizational commitment to involve clients in decision making, treating the mental illness, providing clients with decision making skills, offering clients options, giving clients information to make informed choices, developing structures and processes for client participation in decision making, properly implementing decision making processes, acting upon clients' preferences, and publicizing clients' participation in decision making. The article concludes by discussing the roles played by clinical and administrative staff in promoting social justice by involving clients in decision making in public psychiatric hospitals. [ABSTRACT FROM AUTHOR]

We contend that people with severe mental illness can be empowered though participation in decision making when certain conditions are met. Applying the work of Joel Handler, we identify seven conditions that must be present for meaningful participation to occur. Some conditions are internal to the person, such as having controlled psychiatric symptoms and decision-making skills, while others are a function of the mental health system. We apply the conditions to an analysis of empowerment at a public psychiatric hospital. We conclude with the roles of mental health clinicians, administrators, and policy makers in creating conditions for empowerment. [ABSTRACT FROM AUTHOR]

Persons with developmental disabilities who enter the criminal justice system face injustices throughout the process. For example, their disability often goes undetected, they are more likely to incriminate themselves because they do not understand their Miranda rights, they are more likely to be imprisoned rather than receive probation, and they typically serve longer prison sentences. Based upon a review of the literature and the experiences of one program, this article provides strategies for practicing social justice with this population, which require intervention at the individual, organizational, and social policy levels. [ABSTRACT FROM PUBLISHER]

This article examines the practice of social justice with persons with mental illness residing in public psychiatric hospitals by involving them in decision making. Ten guidelines for involving clients in decision making are offered, which were derived from the professional literature and a study of client decision making at a long‐term public psychiatric hospital. Guidelines include making an organizational commitment to involve clients in decision making, treating the mental illness, providing clients with decision making skills, offering clients options, giving clients information to make informed choices, developing structures and processes for client participation in decision making, properly implementing decision making processes, acting upon clients’ preferences, and publicizing clients’ participation in decision making. The article concludes by discussing the roles played by clinical and administrative staff in promoting social justice by involving clients in decision making in public psychiatric hospitals. [ABSTRACT FROM PUBLISHER]

This article presents a study which reviewed documents and conducted focus groups with clients and staff of a public psychiatric hospital to identify barriers to empowerment and the conditions that must be present for client empowerment to occur through treatment planning. Participation in treatment planning can be one means of empowering clients. However, the significant barriers exist to empowering people with severe mental illness through treatment planning. The conditions for empowerment were based on both psychological and organizational factors. For empowerment to occur, clients need psychiatric stability and decision-making skills. Organizations promote empowerment by ensuring that clinical staff have the time to involve clients in treatment planning. It is also enhanced by promoting staff attitudes that are respectful of client's ability to participate in treatment planning, providing clients with a range of treatment options, designing programs that have a strong philosophical commitment to client empowerment, and implementing programs properly. Empowerment has been defined in many ways but typically emphasizes client choice and control. Benefits clients derive from empowerment include increased self-confidence and self-responsibility.

This article argues for the increased involvement of people with severe mental illness and consumers of other health and mental health services in evaluation and performance improvement in the organizations from which they receive services. Among other reasons, consumers can bring a different perspective to the selection of areas to evaluate, such involvement is consistent with some models of program evaluation, and the process of participation itself can be empowering to consumers. Based on a review of the literature and the experiences of a public psychiatric hospital in involving consumers in evaluation and performance improvement, the authors exemplify how mental health consumers can participate in each stage of the evaluation process, ranging from the initial stage of posing evaluation questions to the final stage of acting on evaluation findings. Next, challenges to consumer involvement are described. Guidelines are then offered for involving consumers of health and mental health services in evaluation and performance improvement. [ABSTRACT FROM AUTHOR]

Federalism is a system of government that divides power between two or more levels of government. During the current conservative political climate in the United States, power has shifted increasingly from the federal government to states, a move that has implications for the achievement of social justice. Consequently, it is now necessary for social workers to engage in political activity at the state and local levels, in addition to the federal level, to promote social justice. Implications for social work policy practice, research, and education for advancing social justice within the federal system of government are explored. [ABSTRACT FROM AUTHOR]

Over the last 15 years, social scientists increasingly have used focus groups as a method for collecting qualitative data. With focus groups, a moderator uses the group process with a small number of participants to stimulate discussion and obtain information on the beliefs, attitudes, or motivations of participants on a specific topic. Based upon a review of a sample of social work articles, researchers used focus groups to study a wide range of topics, with diverse and vulnerable populations, and in combination with other qualitative or quantitative methods. Although focus groups have limitations, they have the potential to be an important qualitative data collection method to capture information about the variety of issues and populations dealt with by the social work profession. In addition, social work researchers have the potential to further develop focus groups as a qualitative research method. [ABSTRACT FROM AUTHOR]

Therapeutic communities (TCs) are emerging as one of the primary approaches for the treatment of substance abuse for criminal offenders. However, the achievement of positive TC outcomes is predicated on their successful implementation. This study examines the effect of two situational influences on the implementation of a TC program in a state prison the enactment of a smoking ban and a change in treatment providers. Results suggest that the smoking ban led to a loss of inmates' focus on treatment goals and strained inmate-custody staff relationships, whereas the change in treatment providers resulted in an immediate turnover of one third of the counselors and a disruption of relationships between custody and treatment staff. [ABSTRACT FROM AUTHOR]

This article describes a consumer group within a public psychiatric hospital that serves primarily a forensic population. Some barriers to participation included the severity of some clients' mental illness, an organizational culture that does not fully support participation, the lack of clients' awareness of problems or alternative actions, and inherent power imbalances between clients and staff. Despite these barriers, the consumer group has made improvements for facility clients. Some factors associated with this success included strong administrative support, the allocation of a highly qualified staff liaison to work with the group, and the integration of the group into the facility's formal decision-making structure. Lessons are offered for the development of similar groups within public psychiatric hospitals and community-based mental health agencies. [ABSTRACT FROM AUTHOR]

The study discussed in this article describes the characteristics of 188 patients who were residing in a state psychiatric hospital on July 1,1995, and identifies the patient-related factors associated with the 74 patients who were discharged within four years of the survey date. Because of different criteria for discharge between patients admitted by their legal guardians and those committed by the criminal courts, separate analyses were conducted on the two groups. Overall, court-committed patients who were discharged demonstrated higher levels of psychiatric stability and nondangerous behaviors than guardianship patients who were discharged. [ABSTRACT FROM AUTHOR]

This article presents information on the treatment of forensic patients. This article explores the increased role of state-operated public psychiatric hospitals in treating forensic patients. Patients with a forensic legal status have a mental illness and are involved with the criminal justice system. Using data from Missouri's forensic system, the article compares the characteristics of voluntary hospital patients with those of the largest hospitalized group of forensic patients-those found not guilty by reason of insanity (NGRI). Overall, NGRI patients tended to he higher functioning, less likely to have committed assault acts and more likely to have substance abuse and personality disorder diagnoses. The article explores the treatment needs of forensic patients who reside in public psychiatric hospitals and discusses the effect of the strong presence of forensic patients in public psychiatric hospitals on social work practice, including clinical work with forensic patients, social work administration and social work advocacy. The role of state-operated public psychiatric hospitals has changed in the era of the de-institutionalization of mental health services. No longer are these hospitals the hub of psychiatric services in most states. Instead, their function is being redefined, and they are becoming providers of primarily long-term psychiatric hospitalization.

Mental illness among criminal offenders has been the subject of special attention for centuries. There is a belief that persons who commit crimes as a result of mental illness should not be held criminally responsible because they lack the criminal intent to commit the acts. This belief forms the care of the insanity defense in the U.S. The insanity defense is a plea option in which the defendant seeks acquittal for the alleged criminal offense by reason of insanity. The insanity defense has not been without its detractors. Despite its long, established legal history, its use has increasingly come under attack by the general public, by politicians, and by members of the criminal justice and mental health systems. Two alternatives to the insanity defense that have gained political popularity include its abolishment and the addition of the guilty but mentally ill verdict. The criminal justice system seeks to protect public safety, while the primary goal of the mental health system is to treat and rehabilitate persons with mental illness.

Even though state departments of mental health have primary responsibility for the care, custody, and treatment of insanity acquittees, the impact of insanity acquittees on the public mental health system is generally lacking in policy discussions and as a topic for policy research. This issue has received increased attention in Missouri, where insanity acquittees now occupy half of the long-term public psychiatric hospital beds. This article examines the presence of Missouri's insanity acquittees on the state's public mental health system and includes the impact on goals, fiscal costs, inpatient and community psychiatric services, and inpatient treatment staff. As states consider managed care and other cost containment measures, it remains to be seen if the high costs associated with extensive use of hospitalization of insanity acquittees to promote public safety will influence policy changes to more community-based insanity acquittee systems. [ABSTRACT FROM AUTHOR]

Explores the extent to which insanity acquittee legislation can structure the implementation of mental health policy. Description of Missouri's insanity acquittee system; Types of legislative structuring; Emphasis on the need for mental health policy maker and enforcers to be involved in the political process.

Focuses on the implementation of psychosocial rehabilitation (PSR) in long-term inpatient psychiatric facilities. Establishment of a PSR philosophical base Staff training in PSR values; Technological issues; Use of community resources; Program evaluation system; Benefits to clients residing in long-term, public psychiatric facilities.