Societal Reentry of Prison Inmates With Mental Illness: Obstacles, Programs, and Best Practices

Exploring Reentry Concerns of Incarcerated Individuals with Severe Mental Illness

Little is known about the factors and circumstances that relate to how incarcerated individuals with serious mental illness (SMI) view their own needs upon reentry and their ability to meet them. In this study, 101 imprisoned adults with SMI rated their level of concern over meeting their basic needs and obtaining services following incarceration. Greater reentry concern was predicted by anticipated barriers to psychological care and increased psychological distress. When participants were asked what factors concerned them most, 51% identified housing, 41% financial concerns, and 39% obtaining services. The extent level of concern related to recidivism (rearrest during the 6-month follow-up post-release) was also examined; no significant relationship was observed. Findings align with prior research, suggesting that there should be less emphasis on convincing individuals of the value of mental health care and a greater focus on how to help them meet other demands that may prevent them from seeking such services.

Inequities in Mental Health Services: A 16-Year Longitudinal Study of Youth in the Justice System

OBJECTIVE

To examine: (1) if youth who have mental health disorders receive needed services after they leave detention-and as they age; and (2) inequities in service use, focusing on demographic characteristics and type of disorder.

METHOD

We used data from the Northwestern Juvenile Project, a longitudinal study of 1,829 youth randomly sampled from detention in Chicago, Illinois in 1995. Participants were re-interviewed up to 13 times through 2015. Interviewers assessed disorders using structured diagnostic interviews and assessed service use using the Child and Adolescent Service Assessment and the Services Assessment for Children and Adolescents.

RESULTS

Less than 20% of youth who needed services received them, up to median age 32 years. Female participants with any disorder had nearly twice the odds of receiving services compared with male participants (OR: 1.82; 95% CI: 1.41, 2.35). Compared with Black participants with any disorder, non-Hispanic White and Hispanic participants had 2.14 (95% CI: 1.57, 2.90) and 1.50 (95% CI: 1.04, 2.15) times the odds of receiving services. People with a disorder were more likely to receive services during childhood (< age 18) than during adulthood (OR: 2.29; 95% CI: 1.32, 3.95). Disorder mattered: participants with an internalizing disorder had 2.26 times and 2.43 times the odds of receiving services compared with those with a substance use disorder (respectively, 95% CI: 1.26, 4.04; 95% CI: 1.49, 3.97).

CONCLUSION

Few youth who need services receive them as they age; inequities persist over time. We must implement evidence-based strategies to reduce barriers to services.

The Impact of Relationship Quality on Couples With an Incarcerated Partner With Co-Occurring Mental Health and Substance Use Issues

Objective

In 2020, approximately 1.7 million people were incarcerated in the United States, with nearly half of the general population being related to, or romantically involved with, an incarcerated individual. Over 70% of these incarcerated individuals met the criteria for a co-occurring mental health and substance use diagnoses. Individuals with co-occurring disorders often experience high rates of recidivism, which negatively impacts their non-incarcerated partners. This study aimed to examine the impact of incarcerated individuals with co-occurring ADHD and depression on their relationship quality, focusing on the roles of substance use, substance use treatment, and self-efficacy.

Methods

The study analyzed the effects of substance use, substance use treatment, and self-efficacy on the relationship quality of couples where one partner was incarcerated and diagnosed with co-occurring ADHD and depression. The direct and indirect influences of these factors on relationship quality were assessed.

Results

The findings indicated that higher levels of substance use and depressive symptoms, along with lower levels of self-efficacy and substance use treatment, were associated with lower relationship quality. ADHD indirectly affected relationship quality via substance use (β = -.015, 95% CI [-0.023, -0.008]) and self-efficacy (β = -.027, 95% CI [-0.039, -0.016]). Depression had both direct effects on relationship quality (β = -.180, 95% CI [-0.224, -0.138]) and indirect effects via substance use (β = -.023, 95% CI [-0.033, -0.015]), self-efficacy (β = -.040, 95% CI [-0.056, -0.025]), and through substance use and substance treatment (β = -.002, 95% CI [0.001, 0.005]).

Conclusion

These findings highlight the need for further research to explore combined substance use and mental health treatment programs. Such interventions could potentially reduce recidivism rates, and promote the quality and maintenance of relationships among incarcerated individuals and their partners.

Adapting and Implementing an Evidence-Based Reentry Intervention for Incarcerated Transgender Women: Lessons Learned

Incarceration is a significant public health issue that disproportionately impacts transgender (trans) women, particularly those of color. The cycle of incarceration interacts with high levels of substance use, mental illness, and HIV to produce a high disease burden among trans women, but, to date, there are no published studies of trans-specific reentry support interventions. Informed by the Model of Gender Affirmation, we systematically adapted and pilot tested the evidence-based Project START intervention to create Girlfriends Connect (GC), a reentry support intervention for trans women incarcerated in a county jail. Qualitative interviews with trans women (10 prerelease and 6 postrelease) and community social service providers and jail staff (n = 7) who serve justice-involved transgender women, as well as input from a community advisory board, informed our adaptation. We then conducted a pilot randomized controlled trial (n = 14) and a service implementation project (n = 16) of GC to examine its feasibility and acceptability. Lessons learned include the importance of peer facilitators, facilitated referral to gender-affirming community resources, and obtaining programmatic buy-in from jail staff and administration. Results indicate that GC is feasible and acceptable, and holds promise in improving the health of transgender women reentering the community after a period of incarceration.

Health Care During Incarceration: A Policy Position Paper From the American College of Physicians

The American College of Physicians (ACP) has a long-standing commitment to improving the health of all Americans and opposes any form of discrimination in the delivery of health care services. ACP is committed to working toward fully understanding and supporting the unique needs of the incarcerated population and eliminating health disparities for these persons. In this position paper, ACP offers recommendations to policymakers and administrators to improve the health and well-being of persons incarcerated in adult correctional facilities.