Prison Reentry and Mental Illness: Engagement in a High-Risk Context

BACKGROUND AND PURPOSE: Reentry interventions for persons with serious mental illnesses have produced mixed outcomes related to psychiatric or criminal recidivism. Most research has focused on individual level characteristics contributing to recidivism and has not examined the environmental level characteristics that can contribute to recidivism. Furthermore, these processes have the potential to affect evidence-based interventions geared towards this population. This paper examines the role of the risk environment on the reentry process for persons with serious mental illnesses leaving prison, especially its effect on engagement with an evidence-based intervention, Critical Time Intervention (CTI), that seeks to link individuals with existing community supports. METHODS: In-depth and go-along interviews were conducted with consumers (N = 28) and staff members (N = 6). Consumers participated in at least one and up to six interviews in order to capture the different stages of reentry and to track the reentry process. In addition to the staff interviews, program data also included treatment team meetings and program records. Data were analyzed iteratively using a constructivist grounded theory approach. RESULTS: Public and social policies that limited or excluded resources to individuals based on their criminal history posed significant challenges for both consumers and staff in acquiring basic needs, including income and housing.  Criminal justice policies such as warrants issued for unpaid fees and fines and heightened surveillance by police in certain communities resulted in returns to jail for some, despite a desire to avoid further legal entanglement. Returns to jail interrupted attempts by staff to link individuals to health services, entitlement applications, or work. In these ways, the risk environment impinged on the ability of staff to link consumers to important resources. As the risk environment limited the amount of concrete or instrumental support staff could provide to some consumers, they often relied on the provision of emotional support as the main intervention modality. Staff developed a narrative of instilling hope and provided unconditional positive regard to consumers, which helped to maintain relationships and provide stability for consumers during transition to the community. CONCLUSIONS AND IMPLICATIONS: The risk environment has the potential to undermine interventions for persons with mental illness returning to the community from prison by limiting access to resources and promoting continued entanglements with the criminal justice system. Staff working in these conditions may need to be sensitive to the heightened role of emotional support in providing stability during this transition. Additionally, there are potentially punitive public policies that limit access to resources for persons with SMI leaving prison. Altering these policies can contribute to improving the effectiveness of reentry interventions.