Early Mental Health Services Linked to Reduced Reincarceration

Access to mental health services soon after release from prison is associated with a lower risk of re-incarceration, the data indicates.

In a British Columbia cohort study that included more than 1,000 people released from prison, access to mental health services was associated with a 39% decreased risk of re-incarceration over a median follow-up period of approximately 8 months.

“Expanding timely access to mental health services after release is critical,” write study author Amanda Slaunwhite, PhD, assistant professor of public health at the University of British Columbia in Vancouver, and colleagues. “This must be done with attention to the service needs of people who have co-occurring substance use disorders and people with the most serious mental disorder diagnoses, who face the highest risk of re-incarceration.”

The study was published online December 15 at JAMA Open Network.

timely treatment

Overdoses, recidivism, and death frequently occur in the days and weeks after release from prison, and those recently released from prison face significant barriers to accessing housing, employment, and health services. In British Columbia, the the overall re-incarceration rate is 50% in the first 2 years after launch.

The study is unusual in that it looks at the availability of mental health services soon after release, whereas previous studies have often looked at longer periods. The researchers also noted that longer intervals between release and availability of services were associated with higher incarceration rates.

The researchers randomly sampled 20 percent of 1,089,677 adults in the British Columbia Provincial Overdose Cohort, which collects health data from participants who experience an overdose. They identified 4,171 prison releases among 1,664 participants in this sample. Around 85% of the launches were for men and 70.7% for people under 40 years of age. The mean follow-up time was 0.68 years per release.

Approximately 46% of released inmates transitioned to Mental Health Services Access (MHSA), and 40.6% did not. Overall, 59.3% of those released to the MHSA were re-incarcerated during follow-up. Release to the MHSA was associated with a reduced risk of reincarceration (hazard ratio [HR], 0.61). Each additional month that passed between release and the MHSA was associated with increased risk of incarceration (HR, 1.04).

Men were more likely than women to be re-incarcerated whether the MHSA was available (HR, 1.25) or not (HR, 1.37). Substance use disorder was associated with increased risk of reincarceration whether the MHSA was available (HR, 1.32) or not (HR, 1.53).

Coordinated discharge planning

commenting on the study Medscape Medical News, Rusty Reeves, MD, director of psychiatry at Rutgers University Correctional Healthcare in Trenton, NJ, said it “substantiates the efforts of many correctional systems over the past few years to improve their discharge planning for the release of inmates.” [from] to make sure they have the medications they need and have follow-up appointments they need.” Reeves, who was not involved in this research, previously conducted a study which found that substance use disorder was a stronger predictor of reincarceration than mental illness alone.

Reeves noted that the study doesn’t prove cause and effect. “But the results support the hypothesis that post-incarceration mental health treatment reduces the risk of subsequent incarceration,” she added.

Recently released inmates often have key unmet needs for mental health services and needs such as food, transportation, housing and employment, according to Nathaniel Morris, MD, assistant professor of clinical psychiatry at the University of California, San Francisco. “This study draws attention to the need for coordinated discharge planning and readmission services for incarcerated people, including ways that support services might help prevent readmission,” said Morris, who was not involved in the study. .

“Over the past two decades, and particularly also with the litigation that has forced correctional systems to reform, the mental health care provider in correctional systems is approaching and perhaps sometimes exceeding the standards that they have in the community. Reeves said. “In the community, you’re hospitalized and you’re on medication, you’ll get an appointment with someone who can prescribe the medication, and probably a therapist as well. And those standards now exist in correctional facilities. This study suggests there are benefits.”

Many inmates have mental illness, and some are being held for psychiatric symptoms rather than criminal intent, according to Christine Montross, MD, associate professor of psychiatry and human behavior at Brown University Warren Alpert School of Medicine in Providence, Rhode Island. “We’re arresting people because we don’t give them adequate care, and the consequences can be disastrous. If people with psychiatric illnesses don’t get necessary mental health treatment in detention or aren’t prepared for mental health care when they leave, then the cycle repeats itself over and over again,” said Montross, who was not involved in the study.

“One of the data points from the study, that people with psychotic disorders are at the highest risk of reincarceration, speaks directly to this issue. It’s the conclusion I found most compelling and damning for us as a society,” Montross said. . The dysregulated behavior of psychosis is treatable, he added. When left untreated, the patient’s behavior sometimes violates social and legal norms, even when it poses little danger.

“When people with psychotic illnesses come into contact with the police and spend time in correctional facilities, it is often compelling evidence of nothing more than woefully poor access to mental health treatment in our communities. Cut funding for prison programs , prisons and posts “Detention services have been a persistent and relentless trend. This study shows that if our goal is to reduce recidivism, it is also a trend that runs counter to our goals,” Montross said.

The study was supported by grants from the Canadian Institutes for Health Research, Health Research BC and the University of British Columbia. Slaunwhite has received grants from the Canadian Institutes for Health Research, the Public Health Agency of Canada, Health Canada and the Michael Smith Foundation for Health and is a member of the board of directors of Unlocking the Gates, a non-profit service society. profit. Reeves, Morris and Montross have disclosed no relevant financial relationships.

JAMA Network Open. Published online on December 15, 2022. Text complete

Jim Kling is a science writer and physician in Bellingham, Washington.

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