Examining the Relationship Between Mental Illness, Substance Use,Treatment Services, and Criminal Recidivism
People with serious mental illness (SMI) involved in the criminal justice system face high rates of co-occurring chronic health conditions, including substance use disorders. The receipt of mental health services has been found to positively impact the community reentry process. However, this impact has been inconsistent in studies of specific interventions. One possible explanation for this problem is the negative impact that substance use has on both criminal justice and treatment outcomes among people with SMI. This paper will examine the services utilization patterns of people with SMI after release from jail, and the impact of substance use on the receipt of services and recidivism.
Methods
Jail records and behavioral health claims were used to identify a cohort of 922 people with SMI released from a large urban jail system in 2003-04. Individuals’ diagnoses (schizophrenia spectrum and major affective disorders) and service utilization patterns were established using behavioral health claims records. Mental health services were categorized as follows: inpatient mental health & crisis, outpatient MH, MH case management, Drug & Alcohol, residential, other services. Descriptive and logistic regression techniques were used to examine service utilization patterns after release and the impact of substance use on receipt of services and recidivism.
Results
Only 37% of participants received any mental health or drug and alcohol services in the year after release. Among those who did receive services people with co-occurring substance use disorders were over 4 times more likely to receive residential services and 2 times more likely to receive mental health case management services as compared with individuals with SMI alone, but over 40% less likely to receive outpatient mental health services. Mental health or drug and alcohol services reduced recidivism by about 50% in the year after release. When mental health treatment was broken into specific service types this impact was sustained for outpatient mental health and mental health case management services, but not inpatient mental health treatment. However, despite the increased likelihood of individuals with dual diagnosis to receive most of the services found to have a significant impact on recidivism, these individuals were still found to be twice as likely to recidivate in the year after release in both bivariate and multivariate analyses that included controls for socio-demographic and service utilization factors.
Implications
This analysis demonstrates that more needs to be done to engage people with SMI in services during the critical time period after release. It also suggests that treatment alone may not be enough to address the relationship between substance use and recidivism among people with SMI. Participants in this study were more likely to receive many of the services found to reduce the risk of recidivism, yet these individuals still faced an elevated risk of recidivism. This suggests that the use of substances among people with serious mental illness creates multiple risk mechanisms for recidivism that require further study in order to determine which elements could be addressed in treatment and which ones require different forms of intervention.