Transitioning Between Systems of Care: Missed Opportunities for Engaging Adults with Serious Mental Illness and Criminal Justice Involvement

Abstract

Individuals with serious mental illness are overrepresented in the criminal justice system and face difficulties accessing mental health services both during incarceration and upon re-entry into the community. This study examines how such individuals describe their experiences receiving care both during and after their time in custody and explores the perspectives of mental health service providers who treat this population upon re-entry. Semi-structured interviews were conducted with 43 individuals identified as having a history of serious mental illness and criminal justice involvement, as well as with 25 providers who have worked with this population. Clients noted the stress of transitioning to criminal justice settings, the uneven availability of services within jail and prison, and the significant challenges faced upon re-entry. Providers reported barriers to working with this population, including minimal coordination with the criminal justice system and challenging behaviors and attitudes on the part of both clients and providers. Findings identify potential target areas for improved care coordination as well as for additional provider education regarding the unique needs of this population.

Do timely mental health services reduce re‐incarceration among prison releasees with severe mental illness?

“…In addition to mental health service use, other needs must be addressed to avoid repeated criminal justice involvement. Safe housing, substance abuse support for those with dual diagnoses, job support, and education can support successful reentry . As availability of these services varies between contexts, the apparent association between mental health service use and criminal justice outcomes may also vary.…”

STI/HIV Sexual Risk Behavior and Prevalent STI Among Incarcerated African American Men in Committed Partnerships: The Significance of Poverty, Mood Disorders, and Substance Use

“…Addressing the co-morbidities of mood disorders and addictions has long been known to constitute an important priority for correctional health programming that has implications for reduced rates of reentry (67), and addressing these factors is considered to be important for reduced STI/HIV risk (44, 55). There remains a need to strengthen substance use treatment in corrections (55) while mental health services and discharge planning within correctional facilities currently are inconsistent and inadequate (68, 69). When addressing substance use in the context of STI/HIV prevention among inmates, programming should be tailored for older versus younger inmates given the dramatic cohort differences in drug use observed.…”

Perspectives of Treatment Providers and Clients with Serious Mental Illness Regarding Effective Therapeutic Relationships

“…[1][2][3][4] Studies have identified many predictors of treatment disengagement including demographic factors (e.g., younger age, male gender), clinical factors (e.g., co-occurring substance abuse, poor awareness of symptoms), and service use (e.g., prior history of treatment discontinuation). 1,3 Treatment providers are challenged to establish effective therapeutic relationships with clients with serious mental illness because of common complicating factors including impaired awareness of symptoms, 5 co-occurring substance abuse, 6 housing instability, 7 criminal justice involvement, 8,9 unemployment, 10 and stigma. 11,12 Despite and perhaps because of these challenges, effective therapeutic relationships are key predictors of symptom, functional, and service use outcomes in this population.…”