Research That Matters (January 17 - 20, 2008)

Background and Purpose: Individuals with mental illnesses (MI) are overrepresented in the criminal justice system. The U.S. Bureau of Justice Statistics documented that an estimated 64% of local jail inmates have mental health problems, and high rates of incarceration among individuals with MI is a priority issue in the President's New Freedom Commission on Mental Health report. Despite this emphasis, the criminal justice system continues to be overloaded with individuals with MI and has in many cases become the de facto mental healthcare system. Our research examined the processes by which individuals with MI are identified and provided care while in jail. We asked: 1) How are individuals with MI identified during jail intake? 2) What are the procedures for service provision to these inmates? 3)What are the procedures for communication with community-based service providers regarding these inmates? Methods: A committee of relevant stakeholders, including consumers, family members, providers, advocates, policy makers, and researchers, was convened to design the study. The group developed a semi-structured interview protocol, to be administered by telephone to all jail administrators in the state. Each administrator was contacted by letter and phone and asked to participate; of the 93 administrators 80 (87%) agreed to be interviewed. After interview completion, results were tabulated and analyzed using descriptive statistical methods. Results: Screening was inconsistent. 96% reported screening for MI, however none used an evidence-based instrument. Privacy was an issue. Only 41% of jails consistently conduct screenings in a private setting and only 8% dispensed medication in private. Individuals often wait for medications. In 50% of jails there was a wait of over three days and in 12% of jails of over two weeks. Inmates may not get their usual medication. Over 30% of jails had a formulary and another 20% reported making medication substitutions. Getting consumers mental health care while in jail is difficult. Less that 13% of jails had on-site mental health staff. Jails relied on their public mental health agency for care of inmates; over 30% reported having to take inmates out of the jail (in handcuffs and shackles) to receive care. Communication between jail and community care is erratic. 60% of jails reported contacting provider at admission, only 19% reported always contacting providers at release. Conclusions and Implications: Individuals with MI are inconsistently identified, and when identified may wait extended periods of time for care. Continuity of care between jails and community providers is weak. As a result, there is an elevated risk of disruption of mental health care and decompensation upon incarceration. Policies are needed to mandate use of evidence-based screening tools, better training for jail staff, and improved communication between community providers and jail staff. To date the impact of this research has been seen at a state level. Upon completion of this report, stakeholders disseminated results and recommendations widely. The report was ultimately reviewed by state legislators, and resultant draft legislation has been submitted mandating evidence-based screening, jail staff training, and coordination between public mental health agencies and local jails.