One-year outcomes of a randomized trial of case management with seriously mentally ill offenders leaving jail

It was hypothesized that clients receiving case management services will improve to a moderate extent in terms of a variety of psychosocial and clinical outcomes compared with clients served by the usual system of care. It was further hypothesized that clients served by an Assertive Community Treatment (ACT) team will have significantly greater improvement than clients served by forensic case managers working individually. Two hundred seriously mentally ill inmates leaving jail were assigned to three conditions, and 94 remained in the study at 1 year. One-year outcomes were analyzed by service condition, using a hierarchical block discriminant function analysis. Contrary to the hypothesis, more clients in the experimental condition returned to jail within a year. No differences were found among the three conditions in social or clinical outcomes. Greater jail recidivism among clients receiving the more intensive service raises questions concerning tendencies to emphasize monitoring with this population. A significant number of individuals with serious mental illness are in-volved in the criminal justice system (Abramson 1972; Teplin 1983, 1991; Whitmer 1980). Jails, particularly, have a significant concentration of men-tally ill individuals as inmates. This is because jails, as differentiated from prisons that house sentenced offenders, are processing centers. As processing centers for arrested persons, jails may serve a number of functions through the time-limited seclusion of socially undesirable individuals. Consequently, there is a growing literature that indicates that arrest and jail may be used as a control mechanism for symptomatic behavior among persons with mental AUTHORS ’ NOTE: This research- was funded 6y NIMH Grant #R18MH46162. The authors wish to gratefully acknowledge the staffs of the Philadelphia Office ofMental Health, the Philadelphi