Predictors of Accessing Substance Abuse Services Among Individuals With Mental Disorders Released From Correctional Custody.

OBJECTIVE: In the context of an increasing correctional population and corresponding rates of mental illness and substance abuse among this population, this study focuses on describing the predictors of substance abuse service utilization for ex-inmates with dual disorders. Our aim is to assess the likelihood and characteristics of ex-inmates with mental disorders who access substance abuse treatment services within two years of correctional release. METHODS: Using merged administrative data on all ex-inmates with open mental health cases released from Massachusetts Department of Corrections and two County Houses of Corrections from 2007 to 2009 (N=2,280) and substance abuse treatment outcome data through 2011, we analyze the influence of demographics, behavioral and mental disorders, and criminal justice variables on entry into substance abuse treatment within 24 months post release. We also describe primary drug use and services utilized for all the ex-inmates who accessed substance abuse services (N=1,383). Regression techniques were used to analyze the probability of utilizing substance abuse treatment services by various demographic, behavioral, and criminal involvement characteristics. RESULTS: The prevalence of a history of substance use disorders is high in this population (69%; n = 1,285). Subsequently, at 24 months post release 61% (n = 1,383) of ex-inmates with open mental health cases utilized substance abuse treatment services. This group was disproportionately female, with a preincarceration history of substance abuse, an increased number of previous incarcerations, and more likely released under correctional supervision. CONCLUSIONS: Substance abuse is a chronic relapsing disorder and dual diagnosis is common among individuals with mental disorders involved with the criminal justice system. Their service needs and contacts across substance abuse, mental health, and criminal justice systems highlight individuals caught up in the institutional circuit. Study results point to the need for expanded and targeted dual diagnosis treatment approaches and relapse prevention for ex-inmates with mental disorders post correctional release.

Boston Offender Needs Delivery Project.

To bridge a gap in access to community services for releasing state inmates, the Boston Offender Needs Delivery (BOND) project was developed as a longitudinal study (2014-2016) of adult inmates with a history of substance use and co-occurring mental health disorders returning to the community following detention in one of Massachusetts' State correctional facilities. Pre-release inmates who were wrapping up their sentence (i.e., no community supervision) and presented with mental illness and/or substance use disorder were recruited. Participants were provided substance abuse treatment immediately post-release, as well as a variety of recovery supports for a follow-up period of 6 months. This first manuscript is intended to describe the rationale behind the BOND project, as well as the methods and procedure used to collect the data.

Feasibility and Acceptability of Mindfulness for Survivors of Homicide and Their Providers.

PURPOSE: This study uses participatory research methods with survivors of homicide and their service providers to explore the feasibility and acceptability of a culturally adapted mindfulness intervention for stress reduction and resilience in homicide survivors. PROCEDURES: Our mixed methods approach included: (a) previewing a Mindfulness-Based Stress Reduction program with providers and survivors; (b) using their iterative feedback during focus groups to revise the curriculum; and (c) studying the acceptability of the adapted curriculum for survivors through focus group and standardized data collection. FINDINGS: We learned that providers use mindfulness for self-care and both providers and survivors view the approach for survivors as promising. Based on attendance, participation, and focus group data, the adapted curriculum was both feasible and acceptable. Survivors' reports suggested most experienced improved emotion regulation, feelings of empowerment, and better coping. CONCLUSIONS: Culturally adapted mindfulness programs may support healing for homicide survivors and possibly other low-income people of color with significant trauma backgrounds. Further investigation is needed to rigorously assess outcomes and specific effects, both positive and negative, of mindfulness in this and other more diversified populations.

Female Veterans in Jail Diversion Programs: Differences From and Similarities to Their Male Peers.

OBJECTIVE: This study compared the demographic, behavioral health, criminal justice, and military characteristics and experiences of female and male veterans participating in criminal justice diversion programs funded under the Substance Abuse and Mental Health Services Administration Jail Diversion and Trauma Recovery program. METHODS: Data on program participants were collected as part of a national cross-site evaluation. Baseline interview data from 1,025 program participants were analyzed. RESULTS: For the most part, there were few statistically significant differences between female and male veterans with criminal justice involvement. However, females reported significantly more sexual trauma, more females had PTSD, and females had more severe PTSD symptoms. In contrast, males reported earlier criminal justice involvement, more males served in military combat, and males had higher rates of substance use. CONCLUSIONS: Although male and female veterans involved in jail diversion programs share many characteristics, the differences in types of trauma exposure and rates of substance use suggest that programs should include attention to gender in planning program services.

Intensity of Offending Following State Prison Release Among Persons Treated for Mental Health Problems While Incarcerated.

OBJECTIVE: This study examined a range of demographic, clinical, and criminal history factors as they relate to the intensity of offending for up to two years postrelease. METHODS: This study drew on data from 1,438 individuals released from Massachusetts state prisons between 2007 and 2009 who, while incarcerated, received treatment from the prisons' mental health services and were followed for 24 months postrelease. These data were used to explore predictive factors related to the intensity of criminal justice involvement, defined as number of arrests in the two-year follow-up period. RESULTS: Predictors of subsequent arrests included number of previous incarcerations and black race. Protective factors included older age, supervision by parole, and a drug-related or person-related governing offense on previous arrest. Clinical symptoms were not related to incidence of postrelease arrests. CONCLUSIONS: This study identified factors related to criminal history, such as type of charge, that were associated with the intensity of subsequent criminal justice involvement. These findings have not been reported in previous studies, perhaps because intensity of offending as opposed to a different dependent variable was used to measure criminal justice involvement. Further investigation should focus on whether the type of previous offense is related to postrelease risk factors for recidivism.

Comparison of offenders with mental illness only and offenders with dual diagnoses.

OBJECTIVE: The study compared offenders who had severe mental illness only and offenders who had severe mental illness and substance abuse problems-dual diagnoses-to determine whether these groups differed. Offenders with dual diagnoses who were involved with the criminal justice system at different levels were compared to explore their profiles and experiences after release. METHODS: Secondary data collected on offenders who had diagnoses of severe mental illness and of substance abuse in Massachusetts were used to examine sociodemographic, clinical characteristics, and criminal justice characteristics, service needs, and community reentry experiences in the first three months postrelease of 265 offenders with major mental illness and 436 with dual diagnoses. RESULTS: Offenders with dual diagnoses were more likely to be female and to have a history of being on probation and of using mental health services. On release from correctional custody, they had more immediate service needs than offenders with mental illness alone, including a need for housing and sex offender treatment, and they were more likely to require an assessment for dangerousness. They were also more likely to return to correctional custody. CONCLUSIONS: The data do not suggest that offenders with dual diagnoses have a distinct clinical background, but rather that substance abuse is an important feature that affects their real or perceived level of functioning, engagement with the criminal justice system, and dependence on social service institutions in the community.

Short-term outcomes for offenders with mental illness released from incarceration.

Using data on 247 offenders with mental illness, this analysis seeks to identify characteristics that distinguish those who are returned to prison or a psychiatric hospital with those who remain in the community. Sociodemographic, mental health, criminal history, and service variables are compared across a range of outcome categories with a focus on those reinstitutionalized and those reincarcerated. Those returning to institutions have somewhat different mental health service and criminal justice histories than the engaged/community group. In particular, the group that is reincarcerated is more likely released from misdemeanor sentences, and the group being released from felony sentences is more likely to be found in a psychiatric hospital after release from correctional custody. These findings have implications regarding the cumulative effects of engagement with the criminal justice system and the process through which persons with mental illness and a criminal history cycle through institutions.

Harmonizing databases? Developing a quasi-experimental design to evaluate a public mental health re-entry program.

Our study is the first-ever initiative to merge administrative databases in Massachusetts to evaluate an important public mental health program. It examines post-incarceration outcomes of adults with serious mental illness (SMI) enrolled in the Massachusetts Department of Mental Health (DMH) Forensic Transition Team (FTT) program. The program began in 1998 with the goal of transitioning offenders with SMI released from state and local correctional facilities utilizing a core set of transition activities. In this study we evaluate the program's effectiveness using merged administrative data from various state agencies for the years 2007-2011, comparing FTT clients to released prisoners who, despite having serious mental health disorders, did not meet the criterion for DMH services. By systematically describing our original study design and the barriers we encountered, this report will inform future efforts to evaluate public programs using merged administrative databases and electronic health records.

Emerging adults with psychiatric disabilities involved with the criminal justice system.

Experiencing serious psychiatric problems during the transition from adolescence to adulthood intensifies the perils emerging adults confront. Emerging adults whose childhood and adolescent experiences include significant contact with the public mental health or criminal justice systems have numerous additional hurdles to overcome. Disruptions in education, few opportunities for involvement with nonpsychiatrically involved peers, and limited life experiences reflect difficulties developing normative social control, skills, and networks. This article examines the impact of age and multiple stigmatized statuses by comparing an emerging adult and older cohort of psychiatrically disabled offenders. It explores whether there are features (demographic, clinical, and criminal ) that distinguish emerging adults that should be considered in creating appropriate community services for treatment and prevention and subsequent desistance from continued criminal involvement.

The impact of regionalization on reentry service outcomes for individuals with severe mental illness.

OBJECTIVE: The belief that public mental health services should be regionalized has guided their delivery for the past four decades. But there have been few opportunities to observe and evaluate a service entity's shift from a centralized to a regionalized delivery system. This brief report focuses on the regionalization of the Massachusetts Department of Mental Health's forensic transition team, a service that manages community reentry from correctional settings for persons with severe mental illness. METHODS: Pre-and postregionalization episodes (N=957) were compared to examine the consequences of regionalizing the forensic transition team. RESULTS: Overall, engagement in services, a key forensic transition team outcome measure, improved postregionalization. Unexpectedly, the rate of loss to follow-up significantly increased among former county house of correction inmates. CONCLUSIONS: Overall, regionalizing reentry services increased the forensic transition team's capability and expertise in managing reentry for persons with mental illness. However, follow-up of individuals exiting county houses of correction remains a challenge.

Understanding community re-entry of former prisoners with mental illness: a conceptual model to guide new research.

Criminal justice, mental health, and social service professionals face a myriad of role expectations in working with prisoners with mental illness to facilitate community re-entry. These expectations include those related to law enforcement, social welfare, and administrative efficiency. The challenge for front line workers and the multiple systems that employ them is to integrate all these expectations effectively on behalf of the individual as well as the community. Current models of re-entry for individuals leaving prison with mental illness focus on the management and interaction of service systems. This paper presents a model of prisoner re-entry that incorporates a larger social context, illustrating dynamics related to both individuals with mental illness leaving prison and their interaction with the community setting. This model was generated through an interdisciplinary team effort. It was refined through a focus group process that included advocates, community members and other informants from mental health and criminal justice systems in five states. The model is designed to generate new questions for research that address both individual and community level issues.

Deviance over the life course: the case of homeless substance abusers.

Characteristics of the homeless population highlight current and emerging social problems in America. It is estimated there are two to three million homeless people in the United States and that between 20% and 80% have substance abuse problems. In this paper I apply Hirschi's social bond theory to a qualitative study of 31 male homeless substance users from New Haven, Connecticut. I interviewed each man once in 1992 and a second time during 1993. The interview data provide evidence of non-normative attachments to families, friends, and institutions where there is little commitment to conventional goals. I conclude that for these men, being homeless and abusing substances is normative to their lives.