Critical Time Intervention for MEN with Mental Illness Leaving Prison

BACKGROUND AND PURPOSE: Thirty years of mass incarceration policies in the US continue to produce a large population of vulnerable people entering and leaving prisons, including people with serious mental illnesses. Despite clear evidence that the period following prison release is associated with a high risk of morbidity, mortality and adverse social outcomes, few theory-driven evidence-based models exist for providing support to this population during this period. Critical Time Intervention (CTI) is an established EBP that has been shown to enhance continuity of support for persons with severe mental illnesses following discharge from hospitals and shelters. The current study posits that the time-limited, phased, focused transitional nature of CTI could be effectively applied with men with mental illnesses leaving prison. Using a conceptual framework built around enhancing social ties, the study hypotheses are that CTI will be more effective than basic prison-based release planning in achieving effective engagement with mental health services. This, in turn, would lead to improved mental health and community stability outcomes, including reduced risk of re-incarceration.   METHODS: An NIMH-funded field-based RCT is currently underway, in which 216 men with mental illness recruited from the mental health services of a state prison system were randomized to either CTI or a comparison condition called Enhanced Reentry Planning (ERP). Participants assigned to both groups were followed for up to 18 months after release from prison. Outcomes reported here are initial engagement with CTI case managers and community based practitioner services after release from prison. These were assessed via in-person interviews at 30 and 90 days after release. Measures included assessments of practitioner engagement and support (the CONNECT measure), social support, social capital, reciprocity, distress from psychiatric sympoms and quality of life.  RESULTS: Compared with assignment to ERP, CTI was robustly associated with stronger engagement with community care practitioners 90 days after release. In a model that explained 56% of the variance in practitioner responsiveness, F (df = 12, 81) = 8.47 (p < 001). CTI had the strongest effect among the variables in the model (B = .557, SE = 114, p < .001). Other effects were found for greater anxiety, less hostility, less social support, less social capital, greater family contact, and less social contact, all at p < .05 probability level or lower. CONCLUSIONS and IMPLICATIONS: Effectively transitioning vulnerable populations from prison to community remains a challenging venture, even with highly resourced interventions. The accessibility and capacity of services in the community settings are a key element of this challenge. Further work will test the complete meditational outcome model towards varied outcomes relating to health, social integration, and criminal justice involvement. It appears that social isolation and limited network resources are more essential elements of the challenge than access to psychiatric care alone.