Successful systems integration strategies: the access program for persons who are homeless and mentally ill.

In 1993, the Access to Community Care and Effective Services and Supports (ACCESS) federal demonstration program was initiated. Using a quasi-experimental design, the 5-year demonstration program sought to assess the impact of integrated systems of care on outcomes for homeless persons with mental illness. The authors report on which integration strategies were chosen and how their implementation is quantified. Data collected primarily through annual site visits revealed that only two strategies were used by all nine systems. The systems integration strategies employed remained relatively stable over the 5 years. Successful implementation appears to be related to the strategies selected.

The impact of federal systems integration initiatives on services for mentally ill homeless persons.

Nearly everyone writing on homelessness over the past 15 years has called for comprehensive integrated systems of care to address the multiple and complex needs of people who become homeless, especially those with mental illness. What is often overlooked is that calls for systems integration are far from new. Although the names have changed over the years, the underlying concepts have not. The purposes of this paper are fourfold: (1) to clarify the distinction between services integration and systems integration; (2) to map the evolution of federal programs to demonstrate that most of these really have been focused on services integration rather than systems integration; (3) to assess the extent that data from these programs supports the idea of systems integration; and (4) to show how the current ACCESS demonstration for persons who are homeless and mentally ill is likely to provide answers that prior programs have not. Without these new data, systems integration, as one solution to the problems of homelessness, remains a theory without empirical evidence; albeit a theory with persuasive conceptual underpinnings.

Comparing outcomes for diverted and nondiverted jail detainees with mental illnesses.

Jail diversion programs have been proposed for use with persons with mental illnesses. While much support exists for these programs in theory, little is known about their characteristics, the individuals they divert, or their effectiveness. The current study focuses on identifying the characteristics of persons diverted through a court-based program in one midwestern city and their outcomes during the first 2 months after diversion. Information on participants (n = 80) was gathered through detainee interviews, staff interviews, and record abstracts. Two factors appear to be important in diversion: (1) community risk and (2) availability of specialized programs for diverted offenders. Demographic, clinical, and social context variables appear to influence diversion decisions. Overall, the diverted and nondiverted groups did approximately the same upon release, but one third of the nondiverted group never got released during the follow-up.

A national survey of hospital -and community-based approaches to pretrial mental health evaluations.

To document the scope of recent trends in performing pretrial mental health evaluations, telephone interviews were conducted with 157 authorities in 50 states and the District of Columbia. These authorities included forensic mental health program directors and forensic clinical professionals. In all states, evaluations were made on an outpatient basis to some extent, and 45 states used inpatient evaluations. However, only ten states relied primarily on inpatient pretrial evaluations, generally in facilities with statewide catchment areas. A total of 32 states relied primarily on outpatient evaluations, generally conducted by providers with regional or local catchment areas.

Public perceptions of the criminally insane.

The authors interviewed 413 residents of New York State in a study of public perceptions of the criminally insane. They found that the criminally insane are generally considered dangerous, harmful, and violent, and as a class they are feared and rejected by society far more than are than are the mentally ill. However, none of the individuals identified by study respondents as criminally insane were legally classified as such. The authors believe the public confusion about who is criminally insane arises from the media's emphasis on prior history of mental treatment of individuals committing violent and bizarre crimes, and from misunderstanding of the role of mental health professionals in criminal proceedings.

Explaining the increased arrest rate among mental patients: the changing clientele of state hospitals.

The arrest rates of nearly 2,000 psychiatric patients released from psychiatric centers in 1968 and those of nearly 2,000 patients released in 1975 were compared with the arrest rates of a group of 5,000 patients studied 25 years earlier. In general, arrest rates among the two recent samples were considerably higher than general population rates, primarily because of the large proportion of patients previously arrested. Other characteristics related to subsequent arrest were age and admitting diagnosis. One additional finding was that the number of patients with prior arrests had increased markedly over the years.

Changing students' constructs of mental patients by means of educative seminars.

Demonstrated that through a brief, didactic, demythologizing approach, college students' attitudes toward mental illness can be changed in a psychosocial or non-medical model direction. Furthermore, results indicate that such an approach effectively can change students' somewhat negative constructs of mental patients in a positive direction.

From maximum security to secure treatment: organizational constraints.

This study focuses on an organization at the interface of the criminal justice and mental health systems. The institution examined was a maximum security mental hospital, primarily for incompetent felony defendants, as it was attempting to change from a custodial to a treatment orientation. Interest centered on whether structural factors in this type of organization place significant constraints on the ability of the organization to change in the intended direction. Data were collected at five points in time over a two-year period to test the impact of three substantial modifications in the organizational setting on the level of treatment. The latter was measured by patient/inmate responses on Prisonization and Favorableness Scales. Supporting the research hypotheses, there were some initial fluctuations in scle scores, but during the two periods of organizational stability no significant changes in either scale were evident. These findings are discussed in the context of technological constraints facing organizations, especially those providing mental health services in the criminal justice system, with the dual goals of custody and treatment.