To the Editor: As a clinician and researcher in forensic psychiatric rehabilitation, I was delighted to see the special section on mentally ill offenders in the December 1999 issue. The articles gave me a very useful update on the current development of treatment and rehabilitation for this neglected group. Dr. Roskes' comment (1) that mental health professionals are reluctant to go into jails and serve the needs of this population seems applicable all over the world.
I was particularly interested in Dr. Roskes' and Mr. Feldman's description (2) of the collaborative community-based treatment program for offenders with mental illness. Despite the comprehensive range of interventions included in the program, intervention with families was neglected both in the program description and in the special section.
A research update on the psychosocial treatment of schizophrenia and other severe mental illnesses included family intervention as one of the four standard treatment modalities (3). The importance of family intervention in relieving the burdens and stresses of families of persons with mental illness is not doubted in the field of psychiatric rehabilitation. Both clinical experience and the literature suggest that families who are looking after a family member with a criminal history and a psychiatric disability have even more burdens and stresses than other families with a mentally ill relative. Their loved ones are doubly stigmatized because they are perceived by the public as both mad and bad (4). Extra stress also may arise from the family's need to deal with the police, the courts, the judicial system, and other parties in legal proceedings.
Efforts to assess the burdens and needs of families of offenders with mental illness have been surprisingly limited. In a recent review of studies in this area in Australia and the United Kingdom, I found that most were unsophisticated in design. In the most systematic effort, McCann (5) sent questionnaires to participants in relatives' support groups in a hospital in the United Kingdom. Questionnaires returned by 17 relatives indicated that most of the stresses were associated with legal proceedings and the need to cope with the media.
I am currently conducting a study in a forensic psychiatric hospital in Hong Kong to formulate intervention strategies to help families cope with relatives who are mentally ill and are returning to the community. Perhaps clinicians and researchers in the United States can also pay some attention to families in the course of providing community treatment and rehabilitation for offenders with mental illness.
Dr. Tsang is assistant professor in the department of rehabilitation sciences at Hong Kong Polytechnic University.