Behavioral Health Literacy: Implementing a New Construct to Address Disparities Among Currently and Formerly Incarcerated Populations

The criminal justice system is a major contributor to racial, economic, and health disparities across the United States. Millions of people cycle into and out of prisons and local jails each year with significant negative public health consequences across the nation. Currently and formerly incarcerated individuals have disproportionately high rates of behavioral health disorders (BHDs) compared to individuals not in the justice system. Nearly 7 of the 11 million individuals who cycle through local jails every year have a BHD and nearly two-thirds of the 2.1 million US prisoners have been diagnosed with either a mental health or a substance use disorder. BHD symptoms increase risk for individuals to become incarcerated, which often worsens individuals' symptoms during custody, and untreated BHD symptoms are associated with increased rates of re-arrest, reincarceration, and overdose fatality after release. As incarceration disproportionately affects individuals of color, it both creates and exacerbates existing and well-documented BHD racial health disparities. These racial health disparities extend beyond incarcerated individuals to negatively affect their family members, shaping community health and fueling generations of health disparities. Although lack of motivation to seek out and engage in BHD treatment is often used to explain these outcomes, low levels of help-seeking and treatment engagement for BHDs among this population is likely better explained by individuals' limited understanding of BHDs and when and how to access appropriate treatments.

We developed behavioral health literacy as a new construct to guide intervention development and facilitate linkage between individuals with BHDs and appropriate treatment options. Behavioral health literacy is defined as an individuals' capacity to obtain, process, and understand basic behavioral health information and to become aware of supports, symptom management, services, and treatment options for helping to redress potential negative impacts of BHDs. This definition builds upon the health and mental health literacy literatures and fills substantive gaps in both constructs.

This roundtable will examine the intersection of behavioral health literacy, racial health disparities, and existing BHD response systems including law enforcement, community-based BHD crisis responses, and correctional staff. Discussion will focus particular attention on increasing accessibility of information about BHDs to increase knowledge and catalyze treatment engagement for correctional populations. One presenter will discuss how behavioral health literacy fills gaps existing in the health and mental health literacy approaches. One presenter will propose an intervention research development agenda on behavioral health literacy programs for currently and formerly incarcerated individuals, including the development of culturally relevant and culturally competent behavioral health literacy assessments and interventions. The final presenter will examine the potential impact of behavioral health literacy on correctional populations, their families, and the community and correctional response systems. Our goal is to stimulate lively dialogue and debate on the utility of behavioral health literacy interventions and its potential role in achieving equity throughout the criminal justice system.