Unmet Behavioral Health Need Among People on Probation: The Role of Social Work in Creating Social Change

Background and Purpose. The United States has more people under correctional supervision than any nation of the world. People on probation make up the largest group of all justice-involve persons. It is well established that people with behavioral health disorders are greatly over-represented in incarcerated populations, but relatively little is known about the behavioral health needs of people on probation. This study describes a census of individuals on probation in a large western metropolitan county, provides a conservative estimate of behavioral health need, and examines rates and predictors of treatment for people with need. Methods. Records for all probationers from October, 2011 to June, 2013 were obtained. Probation records were matched to Medicaid behavioral health service records using both “look back” and “look forward” techniques. Individuals who received one or more billed service for behavioral health before beginning community supervision were considered to have behavioral health needs. Arrests records were followed for each individual for one year. Results. Of the 3477 individuals who started probation during the observation period, 632 (18%) had a record of a billed behavioral health service before beginning probation or parole; 259 (7.4%) for mental illness only, 225 (7.45%) for substance abuse only, and 148 (4.26%) for both. Individuals were diagnostically heterogeneous; notably, 154 (24.4%) of individuals had received services for psychotic disorders, 130 (20.6%) for major depression, 71 (11.2%) for alcohol disorders, and 59 (9.3%) for opioid use. Only 267 of the 632 individuals with identified behavioral health needs (42.2%) received treatment after starting probation or parole. Those who received treatment subsequent to starting probation were older (39.1, SD = 11.5 versus 36.7, SD = 12.3, t (630) = 2.6, p < .02). Men were less likely to receive treatment than women (39.8% of men versus 52.5% of women, OR = .60, CI .40-.89. Whites were the most likely to receive treatment (50.3%). Blacks were significantly less likely to receive treatment (37.3% OR = 1.70, CI 1.17-2.48), differences for Hispanics (44.2%) and for other races (35.8%), did not attain significance. Type of offense (felony or misdemeanor) did not predict subsequent treatment. Conclusions and implications. Almost four million Americans are on probation. The behavioral health needs of this population are little understood. This study found a high level of unmet behavioral health treatment need and important demographic predictors of receiving treatment. Probation officers need basic training on mental health needs and resources in their communities in order to advance goals of public safety and social justice. Social workers form an important part of the criminal justice work force, and can also provide needed information, resources, and training to members of the criminal justice workforce to address this important problem.