Mental illness, criminality, and citizenship revisited.

In a 2000 editorial in The Journal, Rowe and Baranoski introduced the concept of citizenship as a theoretical framework for developing programatic and policy initiatives aimed at the community integration of persons with mental illness and criminal justice histories. Rowe and colleagues defined citizenship as a strong connection to the rights, responsibilities, roles, resources, and relationships—the five Rs—that society offers to its members through public and social institutions and associational community life. The earlier editorial helped focus understanding of citizenship in regard to the target group and its potential application in practice, thus providing a partial template for the work. Thus, the authors of this editorial would like to review the key elements of this research over the past decade, and also contemplate future efforts. Rowe first identified citizenship in the 1990s as a way of thinking about community integration in regard to people who are homeless with mental illnesses. Soon, though, it became clear to Rowe and Baranoski that citizenship, with its five Rs, had a special relevance to persons with mental illness and criminal justice charges or previous incarceration, for three overarching reasons. First, programs including but not limited to jail diversion that help to redirect people from criminal to mental health systems provide a much-needed service to such persons and are important elements of comprehensive mental health systems of care. They are not, however, intended to be, nor do they function as, mechanisms to support the community integration of those persons. Second, people with mental illness often run afoul of the law, not out of mens rea, but because of behavior related to symptoms of their mental illness, their lack of social skills, or the exigencies of poverty including homelessness. Many times, their “criminal conduct” involves an element of trying to make contact with their fellow citizens, or reflects an understanding that doing so is a social expectation they share with others. One example used in the 2000 editorial is of a man lecturing, loudly and in your face, on Jungian psychology at a bus stop, in an overreach at making contact with his fellow citizens. Another is that of a woman, homeless and with a mental illness, who is arrested for trespassing on private property in the act of working (collecting redeemable bottles left in the trash) and improving the environment (by recycling). The point of these examples was and is not to gainsay the impact of psychiatric disorders on these and other persons. It is also not to say that acting like a good citizen is preeminent in such individuals’ minds at the time of their actions, anymore than it is for most people when they pay their taxes or mow their lawns, even though these acts can be said, severally, to involve neighborliness, conformity to community norms, and support for maintenance of the social contract. In addition, the authors of this editorial do not see a need to argue what is already Dr. Rowe is Associate Professor, Department of Psychiatry, Yale School of Medicine, New Haven, CT. Dr. Pelletier is Adjunct Professor-Researcher, Department of Psychiatry, Fernand-Seguin Research Center, University of Montréal, Montréal, Québec, Canada, and Visiting Assistant Professor, Department of Psychiatry, Yale School of Medicine, New Haven, CT. Address correspondence to: Michael Rowe, PhD, Program for Recovery and Community Health, 319 Peck Street, Building 1, New Haven, CT 06513. E-mail: [email protected].