An Exploration of Networks Among People with Serious Mental Illnesses in the Criminal Justice System

Background/Purpose: Adults with serious mental illnesses (SMI) are over-represented in jails and prisons. While incarcerated, they are at higher risk of victimization, exacerbation of symptoms, spending more time in custody, and criminal recidivism compared to people without SMI. Mental health courts (MHC) are one of many interventions developed to divert people with SMI from jail and prison and into treatment. Despite the small body of effectiveness research, MHCs are growing nationally. Existing literature supports a reduction in recidivism and increase in service use among participants but there is no empirical support for what factors are promoting outcomes. Further, an understanding of how MHCs influence participants’ lives is nearly non-existent in the literature.

Using a mixed-methods approach, this paper explores MHC participants’ experiences and one possible factor associated with outcomes, networks. The qualitative component explores participants’ experience with networks while in the MHC. The quantitative component investigates the role network factors play in treatment engagement and recidivism. It is expected that network density will be positively related to engagement and negatively related to recidivism.

Method: Participants were recruited from two mid-western MHCs. All consumers in the MHC between two and 18 months were recruited. Ninety-two individuals met eligibility criteria; eighty individuals consented to participation. Study participants completed a structured interview involving survey questions and empirically-tested measures. Purposive sampling was used to recruit a subsample (n=26) of participants from the pool of eighty to complete 60-minute semi-structured interviews. Network factors were explored through empirically-tested measures, survey questions, and open-ended questions. 

Regression analysis is used to estimate the association between network factors and engagement and recidivism. Thematic analysis is used to analyze participants’ experiences.  

Results: Two salient themes from the qualitative analysis are presented. First, participants share that peers are critical components of their network in the context of treatment. Participants found that keeping involved in activities related to recovery (i.e., working at halfway house, taking a leadership role in AA) helped ensure that their networks were full of people with similar goals. Second, participants referenced the importance of perceiving that providers care and that they are working collaboratively toward shared goals.  The quantitative analysis supports the importance of network factors in recovery. Density, B = -9.82 ± 4.11, 15.53, p < 0.05, f ² = 0.64, and having friends and family who use drugs, B = -1.41 ± -2.49, -0.33, p < 0.05, f ² = 0.64, are significantly associated with treatment adherence.

Conclusions: The results of the current analysis have implications for practice and research. MHC providers should fully assess networks as part of treatment planning; providers need to explain the importance of this assessment to consumers to promote an understanding of how network factors can impact recovery.  Providers should encourage participation in peer-led activities and assist in linking consumers to peers in recovery. Research on adults with SMI involved in the justice system should include measures of network factors especially in effectiveness studies and intervention research. These factors influence outcomes and consumers’ ability to comply with probation requirements and treatment.