Prevalence and Correlates of Criminal Victimization Among New Admissions to Outpatient Mental Health Services in Hawaii

Adults with serious mental illness (SMI) experience criminal victimization at rates higher than the general population whether they reside in the community or correctional settings. This study examines the past-six month prevalence and correlates of criminal victimization among a large community sample (N = 2,209) of consumers with SMI newly admitted to outpatient mental health services during 2005 through 2008. A cross-sectional design was used with self-report and clinical data collected from administrative records. Victimization was determined by responses to direct questions about experiences in the previous 6 months with respect to victimization of a non-violent and/or violent crime. Socio-demographic, clinical and criminal correlates of victimization were abstracted from a quality of life survey and clinical assessment interview conducted at admission. Overall, 25.4 % of consumers reported being a victim of any crime (violent or non-violent) in the past 6 months, with 20.3 % reporting non-violent and 12.3 % violent victimization. The risk of victimization was elevated for those who were female, White, not taking atypical psychotropic medication, not feeling safe in their living arrangement, and were arrested or homeless in the six-months prior to engaging in mental health outpatient treatment. Policy and practice implications of these findings are discussed.     

Perpetration of violence, violent victimization, and severe mental illness: balancing public health concerns

OBJECTIVE: This review examined U.S. empirical studies published since 1990 of the perpetration of violence and of violent victimization among persons with severe mental illness and their relative importance as public health concerns. METHODS: MEDLINE, PsycINFO, and Web of Science were searched for published empirical investigations of recent prevalence or incidence of perpetration or victimization among persons with severe mental illness. Studies of special populations were included if separate rates were reported for persons with and without severe mental illness. RESULTS: The search yielded 31 studies of violence perpetration and ten studies of violent victimization. Few examined perpetration and victimization in the same sample. Prevalence rates varied by sample type and time frame (recall period). Half of the studies of perpetration examined inpatients; of these, about half sampled only committed inpatients, whose rates of perpetration (17%-50%) were higher than those of other samples. Among outpatients, 2% to 13% had perpetrated violence in the past six months to three years, compared with 20% to 34% who had been violently victimized. Studies combining outpatients and inpatients reported that 12% to 22% had perpetrated violence in the past six to 18 months, compared with 35% who had been a victim in the past year. CONCLUSIONS: Perpetration of violence and violent victimization are more common among persons with severe mental illness than in the general population. Victimization is a greater public health concern than perpetration. Ironically, the discipline's focus on perpetration among inpatients may contribute to negative stereotypes.     

Criminal offending and distinguishing features of offenders among persons experiencing a first episode of psychosis

Aims: Persons with severe mental illness (SMI) are at increased risk of criminal offending, particularly violent offending, as compared with the general population. Most offenders with SMI acquire convictions prior to contact with mental health services. This study examined offending among 301 individuals experiencing their first episode of psychosis. Methods: Patients provided information on sociodemographic and clinical variables and completed a neurological soft sign examination and neuropsychological tests. Additional information was extracted from clinical files and official criminal records. Results: The results show that 33.9% of the men and 10.0% of the women had a record of criminal convictions, and 19.9% of the men and 4.6% of the women had been convicted of at least one violent crime. Proportionately more male and female patients than men and women in the general UK population had prior convictions for violent crimes. In a multivariate model including background and clinical variables, only one variable distinguished the male offenders. African‐Caribbean ethnicity was associated with a threefold increase in the odds of offending (odds ratio = 3.84, 95% confidence interval 1.03–14.37). Offenders, as compared with non‐offenders, obtained significantly lower premorbid and current intelligence quotient scores and similar scores on tests of neurological soft signs, working memory and executive functions. Conclusions: At contact with mental health services for a first episode of psychosis, significant numbers of patients have records of criminal convictions and thereby a high risk for future violent behaviour. These patients require specific interventions, in addition to medication, to reduce offending and aggressive behaviour.     

Crime victims and criminal offenders among adults with serious mental illness

OBJECTIVE: This study compared crime victimization rates with rates of criminal offending among adults with serious mental illness. METHODS: Statistical estimation determined caseload overlap between anonymous extracts from public mental health and criminal justice databases for 13 rural Vermont counties. Participants included 2,610 adults who received community-based services during the study year (July 2005 through June 2006). RESULTS: Among the 2,610 adults 6.6% were identified by police as criminal offenders and 7.1% were identified as crime victims. Compared with the general population, however, their elevated risk of being identified as a victim (2.4) was lower than their elevated risk of being identified as an offender (2.6). These categories are not mutually exclusive. CONCLUSIONS: To better understand involvement in the criminal justice system among adults with serious mental illness, research should consider rates of criminal offending and victimization and compare these with rates for the general population.     

Characteristics of recent violence among entrants to acute mental health and substance abuse services

OBJECTIVE: The aim of this study was to describe the characteristics of recent interpersonal violence perpetrated and experienced by individuals recruited from acute crisis mental health and substance abuse treatment settings and to examine differences among incidents involving individuals with mental disorders only (MDO), substance use disorders only (SDO), and co-occurring mental and substance use disorders (COD). METHOD: Participants (N = 419) were interviewed about their involvement in specific acts of violence in the past 30 days. Participants were also asked about where each incident took place, who was involved, whether individuals were injured, and whether alcohol or drugs were used before the incident. We examined distributions of violence characteristics for the full sample and used logistic regression analyses to test differences among incidents involving participants with MDO, SDO, and COD. RESULTS: Approximately 41% (n = 171) of the sample was involved in at least one incident of violence as a perpetrator or a victim, generating a total of 379 incidents. Far more incidents of violence involved victimization (62%) than perpetration (38%). Most incidents were isolated and involved only perpetration or only victimization. However, a total of 98 (26%) incidents occurred with another incident and constituted 49 episodes of violence that included incidents of perpetration and victimization. Characteristics of perpetration and victimization incidents were similar, except that victimization incidents involved more serious types of violence. The majority of incidents took place outdoors and did not result in injuries. Participants used drugs or alcohol prior to over 40% of incidents. Most incidents of perpetration (70%) targeted someone known to the participant. Diagnostic group was the strongest predictor of type of injury, location of incident, and use of alcohol and drugs before the incident. Individuals with substance use disorders, either alone or co-occurring with mental disorders, were more likely to report that violent incidents took place outdoors. Individuals with mental disorders, either alone or co-occurring with substance use disorders, were less likely to report alcohol and drug use prior to involvement in violence. CONCLUSIONS: Violence is common among individuals entering acute crisis mental health and substance abuse treatment. We found that such persons are more likely to report being victims of violence than perpetrators of violence. In contrast to prior studies, we found that most incidents took place outdoors. Although individuals in different diagnostic groups were no more or less likely to perpetrate or experience violence, they perpetrated and experienced violence under different circumstances. Implications and directions for future research and practice are discussed.     

Psychotic-like experiences and interpersonal violence in the general population

BACKGROUND: Research on the association of psychopathology and violence has mainly focused on severe but rare mental disorders, especially psychotic disorders. However, evidence is growing that psychotic disorders are continuous with common psychotic-like experiences in the general population. This study aimed to examine the association of psychotic-like experiences with violence in a general population sample. METHODS: In 38,132 adult participants of the 2001 US National Household Survey on Drug Abuse, the association of psychotic-like experiences with violent behavior were examined. RESULTS: Psychotic-like experiences were reported by 5.1% (N = 2,584) of adults in the community. These experiences were associated with increased risk of attacking someone with the intent of hurting that person (Odds Ratio [OR] = 5.72), intimate partner violence (OR = 4.97), arrests for aggravated assault (OR = 5.12), and arrests for other assault (OR = 3.65). The risk of violence increased with the number of psychotic-like experiences. Unusual perceptual experiences and paranoid ideations were more consistently associated with violence. CONCLUSIONS: The link between psychopathology and interpersonal violence appears to expand beyond the limits of severe mental disorders and to include more common psychotic-like experiences in the general population.     

Police-registered offenses and psychiatric disorders among young males

OBJECTIVE: To study associations between crime and psychiatric disorders among adolescent males in a representative population-based cohort study. METHOD: The sample includes 2,712 Finnish boys born in 1981. Information on criminality consists of offenses registered in the Finnish National Police Register 1998-2001. Crime was classified according to frequency and type (drug, violent, property, traffic, and drunk driving offenses). Information on psychiatric diagnoses between 1999 and 2004 was collected from the Finnish National Military Register. RESULTS: Of the 2,712 boys, 22% had a crime registration during the 4-year period, and 10% had at least one psychiatric disorder according to the Military Register. Those with psychiatric disorders accounted for 49% of all crimes. Of those with more than five crimes (n = 98), 59% had psychiatric diagnoses. After adjusting for other crime types and childhood socio-economic status, property crime was independently associated with several diagnoses: antisocial personality (APD), substance use (SUD), psychotic, anxiety, and adjustment disorders. Drug offending was independently associated with APD, SUD, and psychotic disorder, and traffic offenses with APD. CONCLUSIONS: Youth crime is predominantly associated with antisocial personality and substance use disorders. Crime prevention efforts should focus on boys showing a risk for antisocial and substance use problems. In particular, property, drug, and repeat offenders need mental health and substance use assessment. There is a need to develop integrated mental health and substance use treatment services for young offenders within or alongside the criminal justice system.     

The Associations of Area-Level Violent Crime Rates and Self-Reported Violent Crime Exposure with Adolescent Behavioral Health

The effects of witnessing and experiencing crime have seldom been disaggregated. Little research has assessed the effect of multiple exposures to crime. We assess independent contributions of self-reported crime and area-level crime to adolescent behavioral health outcomes. Cross sectional data on 5519 adolescents from the Comprehensive Community Mental Health Services for Children and their Families Program was linked to FBI crime rate data to assess associations of mutually exclusive categories of self-reported crime exposure and area-level crime rates with mental health and substance abuse. Self-reported crime exposure was significantly associated with poorer behavioral health. Violent victimization had the largest association with all outcomes except internalizing scores. All self-reported crime variables were significantly associated with three of the outcomes. Area-level crime rates were associated with one mental health outcome. Providers should assess direct and indirect crime exposure rather than only focusing on violent victimization.     

Impact of traumatic and violent victimization experiences in individuals with schizophrenia and schizoaffective disorder

Individuals with schizophrenia or schizoaffective disorder (SZ) experience more violent victimization and noninterpersonal traumatic experiences than the general population. Earlier studies, however, have generally excluded one or grouped together victimization and trauma experiences into single outcome variables, which may obscure their contributory role to SZ symptoms. This issue is important because there is some evidence that intentionally induced violence produces higher rates of psychopathology than nonintentional traumatic experiences. We examined the independent contribution of both types of victimization experiences on SZ patients' symptomatology. We were also interested in determining whether SZ patients' pattern of acute symptom presentation could discriminate between SZ patients with and without posttraumatic stress disorder (PTSD) comorbidity. SZ inpatients (n = 70) were assessed for the presence of comorbid PTSD diagnosis, violent victimization, and noninterpersonal traumatic experiences. Patients were also rated on SZ symptom severity and general psychopathology measures. Past violent victimization experiences predicted severity of dysphoria and anxiety in SZ. Past traumatic experiences, however, predicted severity of psychosis. Victimization predicted severity of patients' autistic/cognitive symptoms. SZ patients with comorbid PTSD presented with significantly more anxiety and dysphoria symptoms and SZ illness chronicity than their non-PTSD counterparts. Discriminant function analysis revealed that the severity of positive, dysphoric, autistic/cognitive, and anxiety symptoms differentiated comorbid PTSD patients from their non-PTSD counterparts, with an overall 72.9% classification rate. Past traumatic and victimization experiences are significantly associated with SZ patients' symptom severity and illness course in partially overlapping domains. Use of common assessment strategies may be employed to increase detection of PTSD in SZ patients presenting for acute treatment.     

Risks for individuals with schizophrenia who are living in the community

OBJECTIVE: This study examined the incidence and predictors of police contact, criminal charges, and victimization among noninstitutionalized individuals with schizophrenia living in the community. METHODS: A total of 172 individuals with schizophrenia or schizoaffective disorder were recruited from community-based programs in urban Los Angeles between 1989 and 1991 and were monitored for three years. At baseline, all participants were housed and did not have co-occurring substance use disorders. Face-to-face interviews were conducted every six months. RESULTS: Eighty-three individuals (48 percent) had contact with the police during the study period. A small percentage of the contacts involved aggressive behavior against property or persons. Being younger, having had more address changes at baseline, and having a history of arrest and assault were significant predictors of police contact. Thirty-seven individuals (22 percent) reported that charges had been filed against them. Poorer social functioning, more address changes, fewer days of taking medication at baseline, and a history of arrest and assault were significant predictors of criminal charges. Sixty-five participants (38 percent of the sample) reported having been the victim of a crime during the three years, 91 percent of which was violent. Having more severe clinical symptoms and more substance use at baseline were significant predictors of victimization. CONCLUSIONS: Individuals in this sample were at least 14 times more likely to be victims of a violent crime than to be arrested for one. In general, the risk associated with being in the community was higher than the risk these individuals posed to the community     

Violence and violent victimization in people with severe mental illness in a rural low-income country setting: A comparative cross-sectional community study

BackgroundViolence perpetrated by and against people with severe mental illness (SMI) is important but rarely investigated in low- and middle income countries.ObjectiveTo compare the prevalence of perpetrated violence and violent victimization, and associated factors, in people with and without SMI in rural Ethiopia.MethodA random sub-sample of people with a standardized, clinician diagnosis of SMI (n = 201) was recruited from an existing population-based study and compared to a group of unaffected individuals from the same neighborhood (n = 200). The lifetime and 12-month prevalence of violence and violent victimization was measured using an adapted version of the McArthur Violence Interview.ResultLifetime and 12-month prevalence of perpetrated violence in people with SMI (28.4% and 17.4%, respectively) was significantly higher than in the non-mentally ill comparison group (15.0% and 8.5%, respectively). Male gender, being literate and violent victimization were associated independently with violence in both groups. In people with SMI, violence was associated additionally with being unmarried, exposure to stressful life events and non-response to medication. The prevalence of violent victimization was also significantly higher in people with SMI than those without SMI (60.7% vs. 41.5%). In people with SMI, violent victimization was associated with unemployment, non-adherence to treatment and being a perpetrator of violence.ConclusionsOur finding of high levels of violence and violent victimization in people with SMI underscores the need to improve access to mental health services in this setting, as well as the urgent need to raise awareness about victimization of people with SMI.     

Cognitive-behavioral treatment for PTSD among people with severe mental illness: a proposed treatment model

The lifetime prevalence of posttraumatic stress disorder (PTSD) is about 8%-14% in the general population, and trauma victimization (51%-98%) and PTSD (up to 42%) are even more prevalent among persons treated within public-sector mental health clinics. Despite this, individuals with PTSD and severe mental illness (SMI) who are treated within the public sector tend to receive inadequate mental health services. In addition, treatments for PTSD for this population remain undeveloped, with virtually no available empirical treatment outcome data to guide clinicians. We propose a model for a comprehensive, multicomponent cognitive-behavioral treatment program for this target population that includes elements of consumer education, anxiety management training, social skills training, exposure therapy, "homework" assignments, and long-term follow-up care. Special considerations for public-sector consumers with PTSD and SMI are addressed, as are directions for future research.     

Income differences in persons seeking outpatient treatment for mental disorders: a comparison of the United States with Ontario and The Netherlands

BACKGROUND: Variations in the relationships among income, use of mental health services, and sector of care are examined by comparing data from 3 countries that differ in the organization and financing of mental health services. METHODS: Data come from the 1990-1992 National Comorbidity Survey (n = 5,384), the 1990-1991 Mental Health Supplement to the Ontario Health Survey (n = 6,321), and the 1996 Netherlands Mental Health Survey and Incidence Study (n = 6031). Analysis of the association between income and use of mental health services was carried out for the population that was between ages 18 and 54 years. Differential use of mental health treatment was examined in 3 sectors: the general medical sector, the specialty sector, and the human services sector. RESULTS: No significant association between income and probability of any mental health treatment was observed for persons with psychiatric disorders in any of the 3 countries. However, there were significant differences among countries in the association between income and sector of mental health care treatment. In the United States, income is positively related to treatment being received in the specialty sector and negatively related to treatment being received in the human services sector. In the Netherlands, patients in the middle-income bracket are less likely to receive specialty care, while those in the high-income bracket are less likely to be seen in the human service sector. Income is unrelated to the sector of care for patients in Ontario. CONCLUSIONS: Future research should examine whether differential access to the specialty sector for low-income people in the United States is associated with worse mental health outcomes.     

Victimization of patients with schizophrenia and related disorders

BACKGROUND: Previous research has predominately focused on patients with mental illness as the instigators, rather than the victims, of violence and criminal activity. However, patients with schizophrenia appear to experience a higher degree of victimization compared to general community samples. We aimed to establish the 1-month prevalence of violent and non-violent victimization in a sample of patients with schizophrenia spectrum disorders and to investigate the determinants of victimization. METHOD: Reports of violent and non-violent victimization were recorded in 348 patients in Dandenong, an outer metropolitan suburb of Melbourne, Australia along with the subjective perception of patients as to their degree of protection from being robbed or attacked. Patients reporting victimization were compared with those who did not, across a range of clinical and psychosocial variables. RESULTS: 11.2% of the sample reported being the victim of non-violent crime and 4.3% the victim of violent crime in the 1-month period. 23.2% reported dissatisfaction with their protection against being attacked or robbed. The major determinant of victimization was the lack of any meaningful daily activity. CONCLUSIONS: Patients with schizophrenia spectrum disorders are at increased risk of victimization, both of the violent and non-violent type. Further research is required to understand the pathways through which victimization occurs and to understand whether psychosocial interventions can reduce victimization in this patient population.     

Twelve-month and lifetime prevalences of mental disorders and treatment contact among Pacific people in Te Rau Hinengaro: the New Zealand Mental Health Survey

OBJECTIVE: To show the 12 month and lifetime prevalences of mental disorders and 12 month treatment contact of Pacific people in Te Rau Hinengaro: The New Zealand Mental Health Survey. METHOD: Te Rau Hinengaro: The New Zealand Mental Health Survey, undertaken in 2003 and 2004, was a nationally representative face-to-face household survey of 12,992 New Zealand adults aged 16 years and over including Māori (n = 2457), Pacific people (n = 2236), people of mixed Pacific and Māori ethnicity (n = 138), and 'Others' (a composite group of predominantly European descent) (n = 8161). Ethnicity was measured by self-identified ethnicity using the New Zealand 2001 Census of Population and Dwellings question. A fully structured diagnostic interview, the World Health Organization World Mental Health Survey Initiative version of the Composite International Diagnostic Interview (CIDI 3.0), was used to measure disorders. The overall response rate was 73.3%. RESULTS: Pacific people have high rates of mental illness: the unadjusted 12 month prevalence for Pacific people was 25.0% compared with 20.7% for the total New Zealand population. There were also higher 12 month prevalences of suicidal ideation (4.5%) and suicide attempts (1.2%). Only 25.0% of Pacific people who had experienced a serious mental disorder had visited any health service for their mental health reason compared with 58.0% of the total New Zealand population. The prevalence of mental disorder was lower among Pacific people born in the Islands than among New Zealand-born Pacific people. CONCLUSION: Pacific people experience high prevalence of mental disorder and New Zealand-born Pacific people experience significantly higher prevalence than Island-born Pacific people.     

A cross-sectional study of psychosocial and criminal factors associated with arrest in mentally ill female detainees

In this study, the relationship was examined among clinical, criminal, and sociodemographic characteristics and the severity of the criminal charge of mentally ill female detainees admitted to the women's psychiatric unit at a large urban jail. In a cross-sectional study, 96 randomly selected female detainees were interviewed by one of two trained interviewers using the Structured Clinical Interview for DSM (SCID)-IV, the Addiction Severity Index, the Global Assessment of Functioning Scale (GAF), and the Medical Outcomes Study 36-Item Short-Form Health Survey. Criminal offense categories were based on the Federal Bureau of Investigation's Uniform Crime Reporting Program. Altogether, 48 percent of the detainees had been charged with committing at least one Part I crime; 27 percent were charged with committing a violent crime against persons. Lower GAF score and previous conviction(s) for a serious crime were associated with current arrest for a Part I crime. The data also suggest that a lower GAF score may be associated with a current charge of committing a violent crime, and placement on probation or parole before the current arrest may be protective against this charge. Mentally ill women who are more functionally impaired may be at higher risk of being arrested and charged with committing more serious and more violent crimes than those with lesser impairment.     

Recent physical and sexual violence against adults with severe mental illness: a systematic review and meta-analysis

Abstract

People with severe mental illness (SMI) have high prevalence of lifetime victimization, but little is known about the extent and risk of recent domestic/sexual violence. The objective was to synthesize evidence on prevalence, odds, and risk factors for recent violence against people with SMI, with a focus on domestic and sexual violence. Relevant studies were identified through literature searches in Medline, Psychinf, Embase (for studies published in 2010–2015), and through existing systematic reviews (for studies published in 2000–2014). The review included 30 studies (with 16 140 SMI participants), including six on domestic violence and 11 on sexual violence. Prevalence of recent domestic violence ranged from 15–22% among women and from 4–10% among men/mixed samples; with little evidence on risk compared with the general population. Median prevalence of sexual violence was 9.9% (IQR?=?5.9–18.1%) in women and 3.1% (IQR?=?2.5–6.7%) in men; with 6-fold higher odds of victimization compared with the general population. There was little evidence on risk factors for domestic or sexual violence. In conclusion, people with SMI have a high prevalence of recent domestic and sexual violence, but little is known about risk factors for these violence types, or extent of domestic violence victimization compared to the general population.     

Homelessness in the state and federal prison population

AIMS: This study sought to investigate the rates and correlates of homelessness (i.e. living on the street or in a homeless shelter), including mental illness, among US adult state and federal prison inmates (ASFPIs). METHOD: Data from a national survey of ASFPIs based on a random sampling survey (N = 17,565) were used to compare the homelessness rate among AFSPIs with that in the general population. Logistic regression was then used to examine the association of homelessness among ASFPIs with factors including symptoms, treatment of mental illness, previous criminal justice involvement, specific crimes, and demographic characteristics. RESULTS: Nine percent of ASFPIs reported an episode of homelessness in the year prior to arrest, 4-6 times the estimated rate in the general US adult population after allowing for age, race/ethnicity, and gender. In comparison to other inmates, these homeless inmates were more likely to be currently incarcerated for a property crime, but also to have had previous criminal justice system involvement for both property and violent crimes, to suffer from mental health and/or substance abuse problems, and to be more likely to have been unemployed and with a low income. CONCLUSIONS: Recent homelessness is far more common among ASFPIs than the general population. Prior incarceration, mental illness, substance abuse and disadvantageous socio-demographic characteristics were all found to be associated with homelessness among prison inmates, suggesting that there are several important factors in addition to efforts to survive with limited resources through criminal acts that influence the rates of homelessness among incarcerated individuals.     

Violent Crime in Asperger Syndrome: The Role of Psychiatric Comorbidity

Although several studies have suggested an association between violent crime and Asperger syndrome (AS), few have examined the underlying reasons. The aim of this review is to determine to what extent psychiatric factors contribute to offending behavior in this population. Online databases were used to identify relevant articles which were then cross-referenced with keyword searches for “violence,” “crime,” “murder,” “assault,” “rape,” and “sex offenses.” Most of the 17 publications which met the inclusion criteria were single case reports. Of the 37 cases described in these publications, 11 cases (29.7%) cases had a definite psychiatric disorder and 20 cases (54%) had a probable psychiatric disorder at the time of committing the crime. These findings underscore the role of psychiatric disorders in the occurrence of violent crime in persons with Asperger syndrome and highlight the need for their early diagnosis and treatment.     

Jail incarceration, homelessness, and mental health: a national study

OBJECTIVE: This study sought to investigate the rates and correlates of homelessness, especially mental illness, among adult jail inmates. METHODS: Data from a national survey of jail inmates (N=6,953) were used to compare the proportion of jail inmates who had been homeless in the previous year with the proportion of persons in the general population who had been homeless in the previous year, after standardization to the age, race and ethnicity, and gender distribution of the jail sample. Logistic regression was then used to examine the extent to which homelessness among jail inmates was associated with factors such as symptoms or treatment of mental illness, previous criminal justice involvement, specific recent crimes, and demographic characteristics. RESULTS: Inmates who had been homeless (that is, those who reported an episode of homelessness anytime in the year before incarceration) made up 15.3% of the U.S. jail population, or 7.5 to 11.3 times the standardized estimate of 1.36% to 2.03% in the general U.S. adult population. In comparison with other inmates, those who had been homeless were more likely to be currently incarcerated for a property crime, but they were also more likely to have past criminal justice system involvement for both nonviolent and violent offenses, to have mental health and substance abuse problems, to be less educated, and to be unemployed. CONCLUSIONS: Recent homelessness was 7.5 to 11.3 times more common among jail inmates than in the general population. Homelessness and incarceration appear to increase the risk of each other, and these factors seem to be mediated by mental illness and substance abuse, as well as by disadvantageous sociodemographic characteristics.