People with mental illness are significantly over-represented in the criminal justice system. Estimates suggest that people seriously affected by mental illness are three or four times more prevalent in prison populations than in the general community, and the vast majority of prisoners have had some type of mental health problem (eg, Fazel & Danesh 2002, Herrman et al 1991, Brinded et al 2001). There are many reasons for this higher prevalence, including people with mental illness coming to the attention of the police when they should be receiving treatment. Repeatedly throughout the consultations, consumers and carers reported incidents of not being able to get a mental health service response until the situation had escalated to the point where a police response was called in.

My parents finally call the police. It's like using a sledgehammer to crack a nut. — Consumer
Many of the crimes committed by people with mental illness are minor, and they should be diverted from the criminal justice system to the mental health system (Ogloff 2002). However, in some jurisdictions there are few alternatives to the criminal justice system for people with mental illness because of a lack of appropriate mental health services.

Not only are there many people with mental illness in the criminal justice system, but incarceration itself has serious negative impacts on people's mental health, as well as the sources of mental health and wellbeing, such as employment, accommodation and social relationships. Consequently, there is an urgent need for the issue of relapse prevention to be taken up in the criminal justice system.

There is a pressing need for the criminal justice workforce to have an understanding of mental health issues. This includes training for prison officers, community services officers, and probation and parole officers. Specialist mental health care needs to be provided within correctional institutions and corrective services, and strong links must be forged between mental health services, drug and alcohol services, and correctional services to ensure that the needs of people with this complex array of problems is met (Ogloff 2002).

Essential for relapse prevention are systems to help people to re-enter the community after incarceration. Currently, people are released from prison without medication or referral to mental health services, and even without such fundamental supports such as transport, housing and food (Borzycki 2005). People who have been incarcerated have trouble with finding and keeping appropriate accommodation, employment and re-establishing social relationships. The lack of these supports means that there are multiple and cumulative risks for mental health as a consequence of incarceration.
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There is an urgent need for pre-release preparation and post-release follow-up into the community. A major Australian report of interventions for returning prisoners to the community states that a "significant challenge in terms of prisoner reintegration is therefore likely to be the development of programs that can simultaneously address alcohol and other drug use, mental wellbeing, and chronic physical ill-health" (Borzycki 2005).

The problems of continuity of care and disadvantage that are documented elsewhere in this document are heightened for forensic populations and this is an area that is neglected in terms of relapse prevention.