An Integrated Theory for the Accumulation of Mentally Ill Offenders and the Effect of Realignment in California

High mental illness prevalence in California state prisons has drawn much attention of scholars and policymakers in the past three decades. The problem with a high concentration of mentally ill prisoners culminated when the California Department of Corrections and Rehabilitation (CDCR) was sued for the violation of inmates’ rights under the Eighth Amendment in early 1990s. Consequently, CDCR’s health care was placed under Federal receivership to reform prison health care. The State government also introduce the Realignment policy in 2011 to reduce the prison population in order to make room for prison health care reform. Our study aims to understand the pathways through which the mentally ill individuals end up and remain in prisons and identify the high impact leverage points to sustainably reduce the mental illness prevalence in prisons. We develop a model to integrate theories from the criminology, criminal justice, and public health to advance our thinking about the problem. The Realignment policy, with the focus of diverting the inflow of first-time or reoffending prisoners is a drastic intervention to the system at the population level. Even so, the sustainability of the policy is contingent upon efficient planning at the institutional level. At the system-level, a system-wide goal ensure the actors in the criminal justice system and community work toward the goal to reduce the population with criminal history. At the institutional-level, it is essential that sufficient budgets are allocated to prison health care and community services. Particularly, the emphasis on community service capacity needs to be constant in order to shift the system from punishment-oriented to rehabilitation-oriented.