Comparing For-Profit and Nonprofit Mental Health Services in County Jails

Jail-Based For-Profit Mental Health Providers and Treatment Engagement After Release

OBJECTIVE

This study compared mental health treatment engagement among people with serious mental illness after release from jails that had either a for-profit (N=3 jails) or a nonprofit mental health provider (N=7 jails).

METHODS

Across the 10 jails, data were collected in 2019 for 1,238 individuals with serious mental illness. Data included demographic characteristics (age, race-ethnicity, gender, geography, and jail type) and behavioral health variables (previous mental health treatment, psychotropic medication use, substance use, and receipt of jail-based mental health services). Logistic regression was used to predict treatment engagement during the year after release, stratified by type of jail-based mental health provider, in analyses controlled for demographic and behavioral health variables.

RESULTS

Almost half (46%, N=573) of the individuals had stayed in jails with a for-profit mental health provider; the other half (54%, N=665) had stayed in jails with a nonprofit provider. In the year after release, 37% (N=458) of all individuals engaged in mental health treatment, and 63% (N=780) did not. Those who had stayed in a jail with a for-profit provider were significantly less likely to engage in mental health treatment during the year after release (AOR=0.59, 95% CI=0.42-0.83, p<0.01), compared with those in jails having a nonprofit provider.

CONCLUSIONS

Staying in a jail with a for-profit mental health provider was associated with reduced postrelease engagement with community service providers. Less engagement with services during a pivotal time after release may increase behavioral health crises that erode individuals' well-being and may raise downstream costs due to further criminal legal involvement and emergency care use.

"You can get a couple of ramen noodle packs for a BusparⓇ": A qualitative examination of medication access, policy, and procedures in southern jails

BACKGROUND

Jails in the United States are required to provide health care to the over 10 million people entering jails each year, a significant portion of whom need medications. Yet little is known about the processes by which medications are prescribed, obtained, and administered to incarcerated persons in jails.

OBJECTIVE

To describe medication access, policy, and procedures in jails.

METHODS

Semi-structured interviews were conducted with administrators and health workers from 34 jails (of 125 contacted) across 5 states in the southeastern United States. The interview guide covered all aspects of healthcare in jails from entry to release; however, the present study focused on responses relating to medications. Interviews were thematically coded using a combination of deductive and inductive coding guided by the research objective.

RESULTS

Four processes described medication use chronologically from intake to release: jail entry and health screening, pharmacy and medication protocols, protocols specific to medication dispensing and administration, and medications at release. Many jails had procedures for using medications brought from home, though some declined to use these medications. Medication decision-making in jails was primarily performed by contracted healthcare providers, and most medications were obtained from contract pharmacies. Almost all jails banned narcotics; however, other medication restrictions varied by jail. Most jails charged a copay for medications. Participants discussed various privacy practices related to medication distribution, as well as approaches to diversion prevention including "crushing and floating" medications. Finally, the pre-release medication management process included transition planning that ranged from no planning to sending additional prescriptions to the patient's pharmacy.

CONCLUSIONS

Medication access, protocols, and procedures in jails varies considerably, and there is a need for further adoption of existing standards and guidelines for the use of medications in jails, such as the Assess, Plan, Identify, and Coordinate (APIC) model of community re-entry.