In Search of Legitimacy: Mental Health Treatment Coordination in Probation Programs

Background and Purpose: Approximately 1 million individuals with serious mental illnesses (SMI) are currently on probation, where an emphasis is placed on providing rehabilitative supports. Increasingly, these criminal justice interventions employ a positivist approach to serving probationers with SMI, often manifesting as mental health (MH) treatment provision and coordination. MH treatment is a relatively new priority in probation, and not all programs are equally equipped to coordinate the services needed by this population. How programs enact legitimacy to address such areas of clients’ lives is an important issue that the entire criminal justice system is wrestling with. To better understand the varied organizational elements that may constrain or enable a program’s ability to coordinate treatment for its clients, a qualitative analysis was conducted using data from three probation programs (standard probation, MH probation, and MH court) in Cook County, Illinois.

Methods: We conducted in-depth interviews with program staff (probation officers, case managers, and supervisors) exploring their experiences coordinating treatment for clients with SMI within the context of their respective programs. Thematic analyses of these 26 interviews led to the articulation of five primary areas that shape the professional’s ability to effectively coordinate treatment: funding and access to treatment; knowledge and expertise; legal means; non-legal means; and structure. How these organizational elements varied by program had considerable influence on staff members’ sense of legitimacy in engaging with clients around issues of mental illness and MH treatment.

Results: Across the programs, knowledge and expertise were discussed in the context of MH treatment coordination. Higher levels of knowledge about treatment providers and resources facilitates more active referral and case management activities, whereas a lack of knowledge impedes professionals’ self-efficacy to effectively engage with their clients with SMI. MH probation and MH court staff felt far more equipped to identify the needs of and coordinate services for clients with SMI than standard probation staff. Similarly, each program’s legitimacy in coordinating MH treatment is impacted by a variety of legal means, which provide technical leverage in setting and enforcing the expectations for participation in treatment. For example, in MH court, clients enter the program by signing a contract outlining engagement in behavioral health treatment, a process that fosters the court’s legitimacy in distinct legal terms.

Conclusions and Implications: These findings help us to further understand the specific organizational elements and individual capabilities of each professional that constrain or enable their ability to effectively incorporate MH treatment into the probation supervision experience. Efforts that increase the MH knowledge of all probation staff, not just those in specialized units, and that help create formalized internal processes, can impact the ability and confidence of probation professionals to engage with probationers with SMI, and to coordinate and monitor their treatment plans. If probation staff have clients with mandates for MH treatment or recognize under their care that their client(s) live with SMI, but they are not properly trained nor programmatically supported, efforts to incorporate MH content into probation supervision will likely fall flat, to the detriment of the client.