Abstract: Mental Health Treatment Engagement after Jail: The Role of Community Mental Health (Society for Social Work and Research 26th Annual Conference - Social Work Science for Racial, Social, and Political Justice)

Mental Health Treatment Engagement after Jail: The Role of Community Mental Health

Sunday, January 16, 2022
Archives, ML 4 (Marriott Marquis Washington, DC)
* noted as presenting author
Danielle Hicks, MSCJ, LLMSW, Evaluation Project Manager, Wayne State University, Detroit, MI
Edita Milanovic, LLMSW, Research Assistant, Wayne State University, Detroit, MI
Erin Comartin, PhD, Associate Professor, Wayne State University, Detroit, MI
Sheryl Kubiak, PhD, Dean & Professor, Wayne State University, Detroit, MI
Background: Compared to people in the general population or prison, people in jail experience higher rates of mental health (MH), substance use (SUD), and cooccurring disorders (COD) (Bronson & Berzofsky, 2017; James & Glaze, 2006). Few jails implement discharge planning to facilitate treatment engagement and continuity of care (CoC) upon reentry, but these are critical due to the high risk for drug overdose (Binswanger et al., 2007) and suicide (Pratt et al., 2006) in this period. The current study examines the impact that individual characteristics, jail-based MH services, diversion programs, and discharge planning has on post-jail treatment engagement and CoC.

Methods: Jail administrative data among 9 counties was used to identify jail-based MH services, diversion services, discharge planning services (DPS), and post-release services (PRS). The sample included randomly selected DPS files from the MH provider in each jail in 2019 (N=450, 50 from each jail), in addition Medicaid administrative data was used to identify PRS for treatment engagement and CoC. The data is explored in three independent variable categories: demographics (sex, race, age, community mental health [CMH] consumer), past MH treatment (any MH treatment over the past year, past month, medication at jail booking), and jail programming (jail-based services, diversion, DPS). The main outcomes focus on PRS, which includes any post service (MH, COD, and/or SUD services within one-year post release), along with CoC (MH, COD, or SUD services within 14 days of release). Descriptive, bivariate, and logistic regressions analyses examine the relationships between variables.

Results: Broadly, 30.6% (n=126) received CoC, and 63.1% (n=260) received PRS. Bivariate analysis found women were more likely to receive PRS (x2(1, n=412)=4.5,p<.05) and White people were more likely to receive CoC than People of Color (x2(1, n=405)=3.8,p=.05). Individuals that received past MH services were more likely to receive PRS (x2(1, n=402)=9.5,p<.01) and CoC (x2(1, n=402)=13.9,p<.001). CMH consumers were more likely to receive PRS (x2(1, n=373)=108.6,p<.001) and CoC (x2(1, n=373)=45.2,p<.001).

Two logistic regression models predicted PRS and CoC. Both models had good model fit (PRS= χ2(10, n=297)=96.83, p<.001, 78.8% predicted cases, Nagelkerke R2=37.8%; CoC= χ2(10, n=297)=67.98, p<.001, 74.1% predicted cases, Nagelkerke R2=28.9%). While none of the jail-based MH programming correlated with either post-release outcome, being a consumer of CMH was; CMH consumers had 11.6 times greater odds of receiving PRS (CI: 6.208-21.739) and 14.7 times greater odds of receiving CoC (CI: 5.053-43.010).

Conclusions and Implications: Findings indicate people in jail who have an existing relationship with CMH are more likely to engage in treatment and maintain CoC upon community reentry. For people who are not engaged in CMH prior to incarceration, jail may be a point of intervention to assess for CMH eligibility and make connections to treatment if needed. Future studies should continue examining the role of CMH with jails, as well as policy implications for CMH funded services during and upon community reentry.