First-Episode Incarceration: Creating a Recovery-Informed Framework for Integrated Mental Health and Criminal Justice Responses

The number of people diagnosed with serious mental illness in the U.S. criminal justice system has reached unprecedented levels. Increasingly, people recognize that the justice system is no substitute for a well-functioning community mental health system. Although a range of targeted interventions have emerged over the past two decades, existing approaches have done little to reduce the overall number of incarcerated people with serious mental illness. This report, modeled on promising approaches in the mental health field to people experiencing a first episode of psychosis, outlines a new integrated framework that encourages the mental health and criminal justice fields to collaborate on developing programs based on early intervention, an understanding of the social determinants that underlie ill health and criminal justice involvement, and recovery-oriented treatment. The analysis, observations, and recommendations in this report are based on an extensive review of the literature in both the mental health and criminal justice fields, as well as on interviews with 11 national and local practitioners, policymakers, academics, and others involved in responses to people with mental illness who are at risk of running afoul of the criminal justice system.a The authors examined peer-reviewed journals, white papers, and reports from government, professional organizations, and nonprofits. After compiling information on national practices, they interviewed 11 stakeholders chosen for their leadership capacity at a variety of organizations that serve people with behavioral health needs affected by the justice system. Although the interviewees' specialties differed, they all answered questions about:emerging practices or programs that merit more evaluation and attention;opportunities for applying mental health service models to clients in criminal justice settings;promising programs using peer counseling;the potential application of mental health recovery frameworks to people in the criminal justice system; andthe promise of interventions attuned to environment-based and place-based frameworks