Predictors of Shared Decision-Making with People Who Have a Serious Mental Illness and Who Are Under Justice Supervision in the Community

Background and Purpose: Shared decision making (SDM) is an effective method for promoting service involvement. Through the process of SDM, a partnership or a therapeutic alliance between those receiving and providing services is established and progress towards service goals is advanced when the interests of these two parties are aligned. As such, integrating SDM into services with formerly incarcerated persons who have a mental illness may increase their likelihood of engaging in recommended mental health and crime desistence programs. However, the literature is undeveloped as to how SDM can be promoted among community corrections (e.g., probation and parole) professionals serving people with serious mental illness (SMI). The purpose of this study is to identify, among probation and parole officials, predictors of positive attitudes toward the use of SDM with people under their supervision who have SMI. Results can inform efforts to promote SDM and, in turn, improve service engagement and ultimately enhance public health and safety.

Methods: The target population for this study was community corrections professionals who work directly with individuals who have SMI. Using an anonymous online survey, data were collected from 291 parole/probation professionals in 43 states and Washington, DC. Respondents were either currently working directly with adults who have SMI or currently employed as administrators or supervisors and able to set policy which shaped the terms of the community supervision of adults who have SMI. Regression modeling was used to identify relationships among professionals’ personal and agency characteristics, knowledge of various rehabilitation paradigms, and impressions of the capabilities of the people they supervise; and their 1) attitudes regarding the appropriateness of individuals’ with SMI to be involved in the development of their own supervision plans and 2) beliefs supporting the importance of establishing a working alliance among supervisors and supervisees that fosters the use of SDM.

Results: Agency and personal characteristics were unrelated to attitudes toward SDM. Perceptions of the capabilities of supervisees with SMI to contribute to supervision plan development and, to a lesser extent, familiarity with recovery-oriented mental health services were positively associated with attitudes toward SDM with this population. An indicator of “otherness” (i.e., disagreement with the notion that offenders with mental illnesses want the same things out of life as everyone else) also evidenced a strong relationship with attitudes toward using SDM.

Conclusions and Implications: It appears that, as symptoms of mental illness increase, so do the perceptions that the persons with SMI whom these professionals supervise are “too sick” to engage in SDM. As such, linking supervisees to psychiatric and supportive services, natural supports and personal medicine, which promote symptom amelioration and social functioning, may be conducive to the use of SDM in community corrections settings. Furthermore, training of community corrections professionals in mental health recovery principles and co-locating them with peer support services could raise awareness as to the capacities of people with SMI and reduce the social distance and stigma toward supervisees in a way that promotes SDM.