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Book Review   |    
Treatment of Offenders With Mental Disorders
Jeffrey Stovall, M.D.
Psychiatric Services 1999; doi:
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edited by Robert M. Wettstein, M.D.; New York City, Guilford Press, 1998, 438 pages, $45

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High-profile cases ranging from the assassination attempt on President Reagan in 1981 to the shootings at the U.S. Capitol in July 1998 raise public questions about the association between severe mental illness and criminal behavior. After such incidents, public discussion briefly focuses on legal and legislative remedies, with calls for stricter sentencing or mandatory treatment. The debate seldom focuses on the effectiveness or existence of treatment programs and the possibility of addressing public concerns through the implementation of effective treatment models.

Treatment of Offenders With Mental Disorders shifts the debate by providing a thorough guide to the provision of mental health services to criminal offenders. Edited by Robert Wettstein and featuring 19 authors reviewing eight subjects, the collection serves as a strong introduction for any reader working in or interested in the field. The chapters review studies of existing treatment programs and often reflect the direct work and study of the authors. They also have a practical focus. For example, a chapter on administration extensively discusses the value of pursuing accreditation by the Joint Commission on Accreditation of Healthcare Organizations, strategies for recruiting and retaining qualified staff, and the importance of allying with labor union representatives in implementing programs.

Other topics include the legal underpinnings of treatment and treatment programs based in hospitals, correctional facilities, and the community. Additional attention is given to three special populations: juvenile offenders, sex offenders, and offenders with mental retardation. The absence of the redundancy often seen in collections with multiple authors reveals a strong and clear editor's perspective. In general, the chapters are well written and organized, and they include extensive bibliographies.

An introduction or summary providing the editor's perspective on the importance of the topic would have enhanced the text. While an initiated reader may need little in the way of explanation or context of the issues raised here, a less-informed reader may wonder about the overall relevance of the treatment of offenders. The discussion of specific treatments for offenders with both mental illness and substance use disorders is underdeveloped throughout the text. In particular, a discussion of the role of dual diagnosis would have been a relevant addition to the chapter on community-based treatment. Reliance on literature of the 1980s provides a strong historical foundation for the authors' presentations; however, it may have prevented a more timely focus on current issues such as assertive community treatment, cost analysis, and the role of newer pharmacological agents.

The authors provide a thorough review of the development of treatment services for mentally ill offenders, and they also define the dual mandates of treating the individual and protecting society. Treatment of Offenders With Mental Disorders provides a comprehensive overview of services for offenders with mental disorders and will well serve any clinician or administrator working with this population.

Dr. Stovall is director of outpatient clinical services for Community Healthlink and assistant professor of clinical psychiatry at the University of Massachusetts Medical School in Worcester.

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