In reply: We agree with Dr. Parker that it is important to know what program service elements are effective in reducing reincarceration of probationers and parolees involved in the mental health system. However, this was not the objective of the study reported in the article, which examined the impact of the usual community mental health services delivered by a variety of agencies on reincarceration of probationers and parolees. Our study did not examine the type of specialized program for forensic clients that Dr. Parker describes.
The practical implications of the study's results are similar to those of our previous research (1,2,3): providers who do not have the clinical skills to work with difficult forensic clients frequently resort to monitoring clients' behaviors and using the leverage gained from violations of stipulations to reincarcerate forensic clients rather than providing therapeutic treatment. In Dr. Parker's program, a team serving 250 clients may not have the time for intensive observation.
The finding of a higher reincarceration rate hearkens back to the findings of aftercare studies conducted in the 1970s. In some of those studies, patients in aftercare programs had higher rates of rehospitalization. The programs provided greater opportunities to observe clients' behaviors, which resulted in rehospitalization when clients became symptomatic. Even though the intent of intensive supervision programs is not to incarcerate probationers and parolees, studies have found that participants in these programs have higher rates of incarceration than those who receive usual supervision because others have greater opportunities to observe any criminal violations (4).
Care must be taken to ensure that service providers offer forensic clients meaningful rehabilitation and that they do not merely view themselves as extensions of probation and parole officers, whose job it is to monitor compliance with stipulations of community placement.