Research That Matters (January 17 - 20, 2008)

Purpose: People with mental illness involved in the criminal justice system are confronted with complex service needs when they leave jail. It is important to assess how these individuals define and prioritize their service needs and how these priorities shape the sequencing and trajectory of their help seeking activities after they are released from jail. Method: Ethnographic research techniques were used over 17 months to examine the activities of the case managers and clients of a reentry program for people with serious mental illness leaving jail. Data includes 500 hours of participant observation, 24 interviews with clients and staff, and 115 anonymous open-ended surveys that asked clients to identify and prioritize their service needs. Results: 63% of the clients indicated that housing was one of their two most important service needs and 35% indicated financial assistance. In contrast, only 7% of the clients identified that mental health services was one of their two most important service needs, and 4% indicated drug and alcohol treatment services. This ordering of service needs was reflected in the way that client's ordered their help seeking activities when they were first released from jail in that clients only attempted to access treatment services after they had found sustainable forms of housing and economic support. This ordering creates a service hierarchy that forced clients and staff to scavenge for temporary sources of food, clothing, and shelter, while trying to negotiate the time-consuming and arduous application processes associated with public benefit programs. These service priorities exacerbated gaps in mental health treatment post release because clients only attempted to access mental health services after they had secured their welfare benefits, which took between 2 to 4 weeks to complete in most situations. Implications: People leaving jail have to make decisions about how to prioritize their help seeking activities, and when forced to choose, treatment services take a back seat to more basic concerns with physical and economic survival. This service hierarchy creates an interdependence between the welfare and mental health systems' which suggests that mental health services can increase their relevance to people with mental illness leaving jail by adopting service priorities that are more closely aligned with the full range of service needs confronting these individuals at the point of release. These findings also suggest that including the service recipient's point of view in discussions about how to provide services and supports to people transitioning from jail to the community would strengthen the relevance of the resulting research and policies.