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

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. Copyright © 2013 John Wiley & Sons, Ltd.     

Race differences in psychopathology and disparities in treatment seeking: Community and jail-based treatment seeking patterns

Whites in community samples utilize mental health services at a much higher rate than African Americans (Kessler, et al., 2005). Is this also the case among those in jails? In this study of jail inmates (229 African American, 185 White) there were no race difference in the overall need for mental health treatment (63% of participants had significant symptoms on the Personality Assessment Inventory) but race differences in the level and types of symptoms were evident. Additionally, while Whites were more likely to report pre-incarceration treatment there were no differences in treatment seeking or access to mental health programs while in jail, implying that if barriers to treatment in the community were removed (cost/insurance, location/transportation, time) racial disparities in treatment utilization may be reduced.     

Mental health attitudes among Middle Eastern/North African individuals in the United States

ABSTRACT

Middle Eastern/North African (MENA) individuals may have heightened risk for developing mental health problems due to unique cultural stressors. However, traditional cultural and religious practices and beliefs socialised within the family environment may reduce the likelihood of seeking mental health services. This qualitative study aimed to better understand the intersection of cultural, religious, and mental health attitudes among MENA individuals. Semi-structured telephone interviews were conducted with MENA adults who had received therapy services (N?=?13) and were analysed for emergent themes. Respondents reported lack of understanding of mental illness within their communities, and prominent levels of perceived and self-stigma. Families and religious practices/beliefs played an important role in responding to mental illness. Results suggest that incorporating psychoeducation and community awareness campaigns alongside religious services may help to reduce barriers to receiving mental health treatment.     

An analysis of post-booking jail diversion programming for persons with co-occurring disorders

For persons with co-occurring disorders, interaction with criminal justice systems is a frequent occurrence. As a result, a variety of diversionary programs have been developed nationwide. In this study, a total of 248 individuals with co-occurring disorders of serious mental illness and substance use disorders who had been arrested and booked on misdemeanor charges participated in a post-booking jail diversion program in two urban communities. A quasi-experimental design was used with individuals assigned to diversion or non-diversion status based upon the decision processes of the mental health-criminal justice systems. The effectiveness of the jail diversion program was evaluated from a variety of sources, including structured interviews, behavioral health service utilization patterns, and criminal justice recidivism patterns. Analyses revealed general main effects for time on many of the outcome variables, with few main effects or interaction effects detected on the basis of diversion status (diverted versus non-diverted). Across all measures assessing mental health and substance abuse, study participants displayed improvements over time, irrespective of their diversion status or program location. Participants generally displayed no significant changes in their rates of accessibility to, or frequency of use of, the various mental health, substance abuse, and other services, and few changes for diversion status were detected with regard to service utilization. Although a number of indicators of criminality and violence were reduced over time, these reductions were statistically insignificant, with changes for diversionary status or time identified at follow-up. These results are discussed in light of their implications for jail diversion programming and future research in this area.     

Connectedness to the criminal community and the community at large predicts 1‐year post‐release outcomes among felony offenders

Connectedness to one's community relates to positive psychological and behavioral outcomes. But what implications do connectedness to distinct communities—the criminal community and the community at large—have for inmates about to be released from jail? This study (N = 383) prospectively examined connectedness to the criminal community and community at large prior to release from jail and functioning at 1‐year post‐release. Connectedness to the community at large positively predicted community adjustment, whereas connectedness to the criminal community positively predicted recidivism. Targeting both types of community connectedness may enhance interventions intended to undermine recidivism and increase positive outcomes for inmates.     

Evaluation of a mental health treatment court with assertive community treatment

Without active engagement, many adults with serious mental illnesses remain untreated in the community and commit criminal offenses, resulting in their placement in the jails rather than mental health facilities. A mental health treatment court (MHTC) with an assertive community treatment (ACT) model of case management was developed through the cooperative efforts of the criminal justice and mental health systems. Participants were 235 adults with a serious mental illness who were booked into the county jail, and who volunteered for the study. An experimental design was used, with participants randomly assigned to MHTC or treatment as usual (TAU), consisting of adversarial criminal processing and less intensive mental health treatment. Results were reported for 6 and 12 month follow-up periods. Clients in both conditions improved in life satisfaction, distress, and independent living, while participants in the MHTC also showed reductions in substance abuse and new criminal activity. Outcomes are interpreted within the context of changes brought about in the community subsequent to implementation of the MHTC.     

Effects of diversion on adults with co-occurring mental illness and substance use: outcomes from a national multi-site study

This quasi-experimental non-equivalent comparison group study examines outcomes for participants in eight programs conducting criminal justice diversion for people with co-occurring serious mental illness and substance use disorders compared with jail detainees eligible for diversion, but who were processed through standard criminal justice methods without diversion. Nearly 2000 participants were interviewed at baseline, and 1500 at 3 month and 1300 at 12 month follow-up to baseline. In these interviews, outcome measures of re-arrest, mental health functioning, substance abuse, quality of life, and service utilization were obtained. Those diverted were more likely to have received mental health counseling, mental health medication, and mental health hospitalization than those not enrolled in a diversion program, but were equally likely to have received substance abuse counseling. Overall, the differences in proportions receiving services between the two groups were small, even when these differences were statistically significant. The effect associated with diversion differed somewhat across the individual sites. However, overall cross-site pooled analyses revealed no outcome differences between groups on measures of mental health symptoms, substance use, criminal justice recidivism, or quality of life. Although the immediate benefit of diversion as an access mechanism to community treatment is indicated in pooled cross-site results, such access was driven by more coercive (pre-booking and court) models and results suggest that effecting substantially greater access to services or services use did not occur. The findings also suggest that mental health, substance abuse, and criminal justice outcomes remain dependent on the treatment intervention received, perhaps moderated by type of diversion intervention, rather than on a generic and initial diversion event.     

Jail suicide and legal redress

Suicide is the leading cause of death in jails. Especially at risk are pretrial detainees. This paper provides clinicians who serve as consultants to jails with an overview of legal precedent concerning liability for jail suicide on the federal appellate, federal district, and state levels. Liability on the federal level is based upon actions involving deliberate indifference or gross negligence. A table is provided granting a summary view of appellate-level decisions on liability for jail suicide. Liability on the state level involves lesser standards of negligence. The paper concludes with several liability-generating scenarios.     

“I'm a police officer not a social worker or mental health nurse”: Online discourses of exclusion and resistance regarding mental health‐related police work

Despite estimates suggesting that around 15% of UK police incidents involve people with a mental health concern, officers receive very little mental health training. The police have faced high‐profile criticisms over their handling of mental health‐related incidents, whereas the underfunding and fragmentation of UK mental health services has led to concerns that police officers are being forced to undertake a primary role in mental health care. At a time of austerity and widespread cuts to public services, it is important to explore how particular groups work to justify the parameters of their professional duties. This article therefore explores the discourses surrounding mental health problems on an online police discussion forum, highlighting two distinct ways in which mental health‐related work is represented as being incompatible with policing. First, mental health problems are delegitimised and conflated with “scrounging,” positioning individuals as undeserving of police time; second, mental health problems are reified and associated with violence and extreme behaviour, justifying the use of force by police officers and deflecting responsibility onto mental health services. Findings are consistent with previous research suggesting that mental health work is not perceived to be a valid part of the police role.     

Counseling in Singapore

Singapore, a tiny island nation, rose from 3rd‐ to 1st‐world status in just 3 decades. Unlike in most developed countries, counseling in Singapore has a short history with faith‐based beginnings and currently faces challenges to remain culturally relevant. The authors trace the development of Singapore's counseling services, provide an update regarding counseling practices in the school and community, and describe counseling and its relation to psychology in the educational setting. The authors conclude by examining professional issues and future directions.     

Trauma‐Informed Care for Individuals with Serious Mental Illness: An Avenue for Community Psychology's Involvement in Community Mental Health

Individuals with serious mental illness are at particularly high risk for trauma; however, service environments with which they interact may not always be trauma‐informed. While community mental health and other human services settings are moving toward trauma‐informed care (TIC) service delivery, a variety of TIC frameworks exist without consensus regarding operationalization, thereby leading to challenges in implementation. TIC is principle‐driven and presents substantial overlap with community psychology values and competencies, including ecological frameworks, second‐order change, empowerment, and citizen participation. One way to address barriers to TIC implementation is to draw on the strengths of the field of community psychology. With a particular emphasis on the applicability of TIC to individuals with serious mental illness, this paper identifies key implementation issues and recommends future directions for community psychologists in clarifying the service framework, its adaptation to specific service contexts, and improving delivery through consultation and evaluation. Community psychologists may work with various disciplines involved in the TIC field to together promote a more conscious, actionable shift in service delivery.     

Socially Valued Roles,Self‐Determination,and Community Participation among Individuals Living with Serious Mental Illnesses

Decades after deinstitutionalization, individuals living with serious mental illnesses remain isolated, socially disengaged, and devalued members of communities. Burgeoning research and services need conceptual clarity to improve such social conditions. This qualitative inquiry used grounded theory and participatory approaches to conduct an in‐depth exploration of community participation for individuals living with serious mental illnesses based on key stakeholder perspectives (n = 45). Results revealed that community participation is a multifaceted construct with layers of meaning for individuals living with serious mental illnesses. Overarching themes are contextualized in Self‐Determination Theory and presented with deidentified illustrations. Implications for services, research, and policy are discussed.     

Global Mental Health: A Call for Increased Awareness and Action for Family Therapists

Global mental health (GMH) is an emerging field that focuses on the need for culturally sensitive mental health services in low‐ and middle‐income countries (LMICs). While many new initiatives have been established worldwide to understand GMH needs and to provide care in LMICs, family therapists have primarily worked with families in high‐income countries. The few existing family‐based initiatives in GMH focus on psychoeducation and are typically not based on general systems theory. However, emerging trends in family therapy may enable family therapists to impact mental health issues in LMICs. These trends, which are shared interests of both family therapy and GMH, include collaborative care, a growing emphasis on the importance of culture in understanding and treating mental health issues, recognition of the ability of families to support or impede recovery from mental illness, and the use of strength‐based and evidence‐based treatments. This paper describes ways for family therapists to become active in the GMH community.     

New Perspectives on the Child‐ and Youth‐Serving Workforce in Low‐Resource Communities: Fostering Best Practices and Professional Development

The professionals and paraprofessionals who work daily with youth in low‐resource, marginalized communities are integral to youth wellbeing; yet, their professional development, and the factors that promote it, are not well understood. In this introduction to the special issue, Understanding and Strengthening the Child‐ and Youth‐Serving Workforce in Low‐Resource Communities, we focus on understudied practitioners operating in an array of sectors and settings, such as home visitors, mental health paraprofessionals, early childhood assistant teachers, teachers in low‐income countries, school resource officers, juvenile justice staff, and after‐school and community‐based program workers. We put forward a conceptual model detailing the interactive, layered set of proximal‐to‐distal ecological factors that influence the practice and professional development of these workers, and show how papers in the current issue address these layers in their examination of workforce development. We conclude with a summary of the contributions and lessons from this work – including the value of a whole‐person approach, the importance of sharing process across research stages, and the need to build on the foundation provided by community psychology and implementation science – toward the twin goals of understanding and building the skills and strengths of the workforce, and ultimately, enhancing youth development.     

An Examination of Inmate Physical Assaults on Jail Correctional Staff: Exploring Inmate-Level and Jail-Level Conditions in the United States

The current study examines individual-level determinants of inmate-on correctional staff assaults, particularly the demographic characteristics of inmates, and the context of structural/environmental characteristics of specific jails. Findings from a series of negative binomial regression models indicate some significant relationships, with additional analyses highlighting the nonlinear nature of the relationship between racial representation and assaults. The findings give credence to both the “lone-wolf” and “gang mentality” perspectives, in that jails with an unbalanced racial composition have higher rates of inmate assaults on correctional staff when groups are both under- and over-represented as a proportion of the jail population.     

Community-based services and resources: The significance of choice and diversity

Conclusions We are reminded by the growth of consumer-run approaches of the value of diversity and individual choice in community support of persons with severe mental illness. These ideas are evident in the alternative approaches that have been developed to serve persons who have not been reached by more traditional services. The ACT program, described by Bond et al. (1990), is an example of a service approach designed to be responsive to individuals' day-to-day needs as they define them. Continued development of this type of alternative service should be encouraged.Persons coping with severe mental illness benefit from a variety of community supports and resources. Strategies that encourage consumer involvement, ownership, and control help to provide diversity of services and to empower the consumer. Our efforts, as professionals, to provide community services can be enhanced by (a) supporting diversity of service and resource options, both inside and outside of the professional mental health system; (b) developing services that are responsive to individuals needs as they define them; and (c) facilitating the process of consumer choice in selecting resources options.The author expresses thanks to Marc A. Zimmerman and Richard H. Price for comments on earlier drafts of this paper.     

Efficacy of a Mental Health Treatment Court with assertive community treatment

This study examined the efficacy of a Mental Health Treatment Court (MHTC) with diversion to treatment supported by an assertive community treatment (ACT) model of case management. A total of 235 participants were randomly assigned to either MHTC or treatment as usual (TAU) and assessed over a 2 year period. It was hypothesized that participants in the MHTC would decrease their criminal activity and improve their psychosocial functioning relative to participants receiving TAU. While there were offenders for whom neither treatment was effective, a majority in both groups decreased jail days and improved psychosocial functioning, with MHTC participants demonstrating greater gains in most areas. The impact of implementing the MHTC on community practices, and the value of integrating criminal justice and mental health systems, is discussed.     

Identification Reduces Stigma of Mental Ill‐Health: A Community‐Based Study

The stigma surrounding mental ill‐health is an important issue that affects likelihood of diagnosis and uptake of services, as those affected may work to avoid exposure, judgment, or any perceived loss in status associated with their mental ill‐health. In this study, we drew upon social identity theory to examine how social group membership might influence the stigma surrounding mental ill‐health. Participants from two urban centers in Ireland (N = 626) completed a survey measuring stigma of mental health, perceived social support as well as identification with two different social groups (community and religion). Mediation analysis showed that subjective identification with religious and community groups led to greater perceived social support and consequently lower perceived stigma of mental ill‐health. Furthermore, findings indicated that high identification with more than one social group can lead to enhanced social resources, and that identification with a religious group was associated with greater community identification. This study thus extends the evidence base of group identification by demonstrating its relationship with stigma of mental ill‐health, while also reinforcing how multiple identities can interact to enhance social resources crucial for well‐being.