The Council of State Governments (CSG) Justice Center has released a guide designed to help policy makers, program administrators, and practitioners improve outcomes for people with mental illness who are under correctional supervision in the community. It summarizes current findings in three research areas—supervision strategies in community corrections, treatment approaches for people with mental illness, and integrated supervision and treatment strategies—with the goal of ensuring that interventions are informed by the latest evidence on what works, for whom, and under what circumstances.

The number of people under correctional supervision in the community has reached unprecedented levels—about one in 45 adults are on probation or parole. Community corrections officers, who face staggeringly large caseloads, are increasingly required to supervise people with serious mental illnesses, most of whom have co-occurring substance use disorders. Traditional probation and parole agencies are not set up to employ the supervision strategies required to meet the broad treatment and service needs of these individuals. Although some agencies have implemented special responses to this population, all too often these approaches are not backed by research and therefore may be less sustainable, politically potent, efficient, and successful than those that incorporate empirically sound interventions. Thus it is not surprising that people with mental illnesses are twice as likely as others under community supervision to have their community sentences revoked, which returns them to prison or jail and deepens their involvement in the justice system.

The 44-page publication, Improving Outcomes for People With Mental Illnesses Under Community Corrections Supervision: A Guide to Research-Informed Policy and Practice, uses a reader-friendly layout to organize the contents around policy makers' common questions about people with mental illnesses who are under correctional supervision and about the type and effectiveness of services and treatments for this population. Each question is followed by a brief response and a summary of research findings that support the response. The guide is divided into three sections. The first section provides information on the scope of the problem—how people with mental illness enter the justice system and typical outcomes for them there. It explains why traditional supervision strategies are less effective for this population.

The second section, which reviews findings from the three research areas, begins with a two-by-two matrix—high and low criminogenic risk and high and low functional impairment—for considering appropriate supervision and treatment approaches for people with mental illnesses. Interventions and strategies that have been shown to improve outcomes and reduce recidivism for the general population of persons on probation or parole are reviewed. They include adherence to the RNR model (risk-needs-responsivity), which matches the intensity of supervision to the level of risk of recidivism, targets changeable risk factors by addressing needs, and matches modes of service to a person's abilities and styles. Other evidence-based approaches in this area include cognitive-behavioral treatment, which addresses irrational thoughts that lead to anger and antisocial behavior, and drug treatment in the community. Research also supports certain strategies for use by corrections officers: "firm-but-fair" relationships, compliance strategies that favor problem solving over threats of incarceration, and boundary spanning, in which officers develop knowledge about mental health and community resources, maintain relationships with clinicians, and advocate for services. Boundary spanning has been shown to increase linkages to treatment, but not to reduce recidivism, for people with mental illnesses on probation.

Several evidence-based approaches and supporting research are described to answer the question "Which mental health treatment interventions improve clinical outcomes for people with mental illnesses?" Assertive community treatment (ACT), illness self-management and recovery, integrated mental health and substance use services, supported employment, psychopharmacology, and family psychoeducation are all briefly outlined. Supported housing and trauma interventions are included as promising practices.

A much smaller body of literature has examined the effectiveness of integrated community supervision strategies and mental health treatment strategies. They include specialized probation caseloads, forensic ACT, forensic intensive case management, parole outpatient clinics for people with mental illnesses, and the Partnership for Active Community Engagement (PACE). Specialized caseloads composed exclusively of people with mental illnesses are smaller than traditional caseloads; officers receive significant training in mental health issues and collaborate with community-based service providers. Research findings for forensic adaptations of ACT have been mixed; although hospital stays and recidivism are reduced for many participants, enhanced oversight sometimes leads to higher revocation rates. Forensic intensive case management, which is less resource intensive than forensic ACT, has been shown to reduce recidivism, but clinical outcomes do not appear to be affected. Parole outpatient clinics that aim to reduce symptoms of people with mental illnesses have been studied in California and have been found to reduce participants' return to prison. PACE, a collaborative project in Colorado operated by a multidisciplinary team and designed as an alternative to probation, has shown promise in reducing jail time.

Although promising approaches are being evaluated, important questions remain, and the guide's final section identifies priorities for a national research agenda in several areas, including screening and assessment, cross-agency collaboration, performance-based contracting and funding, and organizational culture and leadership. Development of the guide, which is part of a series designed to improve the justice system's response to people with mental illness, was supported by the John D. and Catherine T. MacArthur Foundation and the National Institute of Corrections of the U.S. Department of Justice. It is available on the CSG Web site at justicecenter.csg.org.