Bridging Disciplinary Boundaries (January 11 - 14, 2007)

PURPOSE: Mental health and substance abuse professionals are beginning to develop collaborative relationships to address the needs of people with co-occurring disorders. However, people with co-occurring mental health and substance use disorders are often involved in the criminal justice system. The overlay of the criminal justice system creates demands and opportunities often overlooked by behavioral health professionals. This paper demonstrates unmet service needs of a criminal justice sample and illustrates opportunities for social work professionals in mental health and substance abuse treatment to include corrections staff in their efforts to improve service delivery and decrease recidivism. METHODS: This federally funded (NIDA) study of 198 women provides a profile of co-occurring problems and service use. The Computerized Diagnostic Interview Schedule (C-DIS) was used to ascertain the presence of a dual disorder using screens for depression, generalized anxiety disorder, post-traumatic stress disorder, alcohol and/or drug dependence. Demographics, legal history, employment history and treatment/service histories were collected during interviews in a full service, urban jail. RESULTS: The majority of women (70%) expected to be released back into the community and an additional 14% expected to enter a community-based treatment facility upon release. Substance use disorders and mental health disorders were prevalent. 187 (94%) met criteria for a current co-occurring substance use disorder and a mental illness; 155 (78%) met criteria for a lifetime co-occurring disorder. One hundred percent of the sample endorsed at least one traumatic event or violent lifetime event. Analysis of service histories showed that a majority (84%) had received alcohol and other drug treatment at some time in the past five years but that only slightly over half (53%) had received mental health services. 87 women (44%) reported receiving both AODA and MH services at some point in the past five years, but only 12% reported they had received services for both mental health and substance use disorders concurrently. Twelve step programs were the most frequently reported service; 129 women said they attended at least one Twelve Step meeting in the past 5 years. Approximately half (52%) of the sample had a high school diploma, vocational diploma or GED. 82 women (41%) didn't work at all in the 12 months before coming to jail. Only 49 women (25%) reported their primary income came from full or part time work; 25 (13%) reported their primary income source as government programs. The median number of jail incarcerations was 5. IMPLICATIONS: The data strongly indicate the need for social workers to collaborate with the criminal justice system in efforts to serve women with dual disorders and multiple social needs. Since most women expected to return to the community, there is a need for community based practitioners to collaborate with corrections staff to understand their clients' legal problems and to develop re-entry plans that will address both mental health and AODA needs. Vocational and educational planning are also important issues to support sobriety, recovery and to decrease recidivism rates. Opportunities and models of collaborative assessment, brief intervention/diversion, treatment and monitoring will be discussed.