Program Profile: Mentally Ill Offender Community Transition Program (Washington)

The program is targeted at individuals whose mental illnesses are seen as instrumental in their offenses, and who are likely to qualify for and benefit from publicly supported treatment in the community. The overall goal is to reduce recidivism . The program is rated Effective. Participants in the program were less likely to be convicted of any new offense and convicted of felony offenses, compared with the matched comparison group. The difference was statistically significant.

An Effective rating implies that implementing the program is likely to result in the intended outcome(s).

This program's rating is based on evidence that includes at least one high-quality randomized controlled trial.

Program Goals/Target Population

The Mentally Ill Offender Community Transition Program (MIOCTP) was established by the Washington State legislature in 1998. The program is targeted at individuals whose mental illnesses are seen as instrumental in their offenses, and who are likely to qualify for and benefit from publicly supported treatment in the community. The overall goal is to reduce recidivism for these individuals.

Target Population/Eligibility

Candidates for MIOCTP are referred by the Department of Corrections (DOC) mental health-risk-management specialists. The follow selection criteria are applied to possible program participants: 1) the candidate has a major mental illness that influenced previous criminal activity; 2) the candidate is judged by DOC staff as less likely to reoffend if provided ongoing mental health treatment; 3) the candidate is unlikely to obtain housing and/or treatment from other sources; 4) the candidate has time left on his or her sentence for prerelease services (generally a minimum of 3 months); 5) the candidate cannot be a Level 3 sex offender (the highest-risk rating assigned to those leaving prison, based on criminal history and treatment record); and 6) the candidate is a willing participant in services.

Program Components/Key Personnel

There are five main components of the MIOCTP. First, there is coordinated prerelease planning, which involves assessment, treatment planning, and entitlement application up to 3 months prior to a participant’s release. Second, there are intensive, postrelease case-management services, which coordinate individual and group treatment services with a multidisciplinary staff (who include a mental health case manager, psychiatrist, nurse practitioner, registered nurse, substance abuse counselor, community corrections officer [CCO], and residential house manager). The program includes structured programming, daily contact (if needed), bimonthly home visits, individual crisis response planning (available 24 hours a day), and a treatment philosophy of authoritative, structured goals focused on avoiding further criminal activity.

In addition, there is close coordination with CCOs, by making them an important part of the community treatment team. Residential support is also available, which includes a housing subsidy, and onsite housing management and monitored living for the primary initial housing option. Finally, co-occurring disorders treatment (i.e., treatment for mental health and substance abuse issues) is carried out by staff who are cross-trained in substance abuse treatment and supported by community corrections programs that are directed at substance abuse. Treatment addresses availability of substance and desire for use in transition to the community following release from prison, and operates under a harm reduction model (Marlatt 1998).

Study 1

Theurer and colleagues (2008) used a retrospective matched control study design to determine the impact of the Mentally Ill Offender Community Transition Program (MIOCTP) on recidivism measures. The study population consisted of inmates in four King County, Washington, prison sites who had major mental illnesses. Level 3 sex offenders (the highest-risk persons leaving prison) were excluded from the study. Candidates for MIOCTP were referred by the Department of Corrections (DOC) mental health-risk-management specialists. The following selection criteria were applied to possible study participants: 1) the candidate has a major mental illness that influenced previous criminal activity; 2) the candidate is judged by DOC staff as less likely to reoffend if provided ongoing mental health treatment; 3) the candidate is unlikely to obtain housing and/or treatment from other sources; and 4) the candidate has time left on his or her sentence for prerelease services (generally a minimum of 3 months). 

Treatment and comparison groups (n = 64 in each group) were generated using propensity score, one-to-one matching. Members of the comparison group had been released between 1996 and 2000, while treatment group members had been released between 1998 and 2003. After matching, the groups were tested for pre-existing differences on the following characteristics: past felonies, past misdemeanors, status as a person convicted of a sex offense, infraction rate, mental health residential time, age of release, gender, and ethnicity. No statistically significant differences were found. Of the 64 treatment group participants, 56 percent were male, and 51 percent were white. Thirty percent of the sample was African American, and 19 percent were Native American/Asian/Pacific Islander. The primary diagnosis for the majority (56 percent) was psychotic disorder, 20 percent reported depression, 20 percent reported bipolar, and 3 percent reported other. The study does not provide demographic characteristics for the comparison group.

To evaluate recidivism outcomes, the authors used administrative data from several state-level government organizations to determine the proportion in each group who were convicted of a new offense and who were convicted of a felony offense over the 2-year follow-up period. Logistic regression techniques were used. A subgroup analysis was conducted for participants who entered the program after the first year to account for preliminary implementation challenges.

Subgroup Analysis

A subgroup (N = 39) analysis for participants entering the program after the first year was conducted. Theurer and Lovell (2008) found that 28 percent of Mentally Ill Offenders Community Transition Program (MIOCTP) participants who entered the program after the first year were convicted of any new offense (misdemeanor or felony), compared with 59 percent of the matched comparison group. This was a statistically significant difference. The results also showed that 15 percent of participants in the MIOCTP who entered after the first year were convicted of a new felony offense, compared with 38 percent of the matched comparison group (also a statistically significant difference). In addition, 2 years after the MIOCTP was established, another program in Washington State called the Dangerous Mentally Ill Offender (DMIO) Program, now called the Offender Reentry Community Safety (ORCS) Program, was established and targeted individuals with a mental illness and history of violence who were believed to post special risks after their release. The program is also featured on CrimeSolutions: https://crimesolutions.ojp.gov/ratedprograms/438

These sources were used in the development of the program profile:

These sources were used in the development of the program profile:

Following are CrimeSolutions-rated programs that are related to this practice:

Adult Reentry Programs

This practice involves correctional programs that focus on the transition of individuals from prison into the community. Reentry programs involve treatment or services that have been initiated while the individual is in custody and a follow-up component after the individual is released. The practice is rated Promising for reducing recidivism.

Evidence Ratings for Outcomes

Crime & Delinquency - Multiple crime/offense types

Rehabilitation Programs for Adults Convicted of a Crime

This practice includes programs that are designed to reduce recidivism among adults by improving their behaviors, skills, mental health, social functioning, and access to education and employment. They may become participants in rehabilitation programs during multiple points in their involvement with the criminal justice system. This practice is rated Promising for reducing recidivism among adults who have been convicted of an offense.

Evidence Ratings for Outcomes

Crime & Delinquency - Multiple crime/offense types

Why might a practice's outcome ratings differ from the ratings of specific programs encompassed by that practice?