Understanding Unmet Behavioral Health Needs Among Formerly Incarcerated Persons: A Mixed Methods Exploration

Background & Purpose: Extant research has substantiated the prevalence of substance use and mental health disorders (i.e. behavioral health disorders) among incarcerated and formerly incarcerated populations. Behavioral health service utilization is crucial for justice-involved individuals re-entering their communities from prison as unmet treatment need increases risk for reincarceration. However, research finds that few incarcerated and formerly incarcerated individuals receive needed behavioral health treatment. Existing literature cites several reasons for unmet behavioral health treatment needs including limited understanding of health needs (e.g. behavioral health literacy). Research has also established social support is critical to positive post-incarceration outcomes, however, little is known about whether social support influences service utilization or behavioral health literacy among formerly incarcerated individuals. Given this gap in knowledge, this study aims to provide preliminary identification of how formerly incarcerated persons and their selected social support partner understand the treatment needs of substance use disorders (SUD), and, in turn, ways in which their understanding may impact their service utilization and/or help-seeking behavior.

Methods: This mixed method, exploratory study utilizes data from a larger study comprised of formerly incarcerated men (n=57) and their selected social support partner(s) (n=58). Univariate and bivariate analyses were conducted on the quantitative service utilization data that was collected periodically for 12 weeks post-release to complement the qualitative data. Qualitative data included 87 semi-structured interviews with the social support partners covering post-release experiences with the formerly incarcerated person. An a priori thematic analysis was conducted on the transcripts utilizing an inductive/deductive co-coding process allowing for broad to narrow focused coding; two members of the research team coded transcripts with one team member designated to lead the analysis and document the analytic decisions and rationale.

Results: Majority of the formerly incarcerated men identified as African American (91%) and had a mean age of 29 years (SD= 9.58). Most social support partners were a parent of the formerly incarcerated man (49%). Descriptives of service utilization data revealed only two formerly incarcerated men (4%) utilized substance abuse treatment post-release, with employment and education as their most perceived treatment need. Fisher’s exact tests did not yield statistically significant results indicating the formerly incarcerated participant’s perception of service need is not associated with their service utilization. Qualitative analyses revealed that most social support partners avoided using or did not know the language to use regarding the formerly incarcerated person’s SUD. Treatment needs were often attributed to focus on peer influences and spending more time at their residence/housing. Analyses did reveal that when treatment needs were recommended, social support partners reported employment and education services to be most needed for the formerly incarcerated person. Results provide preliminary evidence suggesting social support partners do influence the types of services accessed by formerly incarcerated persons with SUD.

Conclusions & Implications: Results broadly speak to behavioral health treatment as not an isolated issue, but as a systemic, multidimensional one. The findings of the study emphasize the need for psychoeducation during and after incarceration on SUD and the incorporation of social support into the treatment process.