(see Poster Gallery) Assessing Rural-Urban Differences in Screening for Mental Health Needs Among Individuals in County Jails

Background: One-in-every-three incarcerated individuals are held in jails (Sawyer & Wagner, 2022). Rural jails have increasingly contributed to the overall jail population (Kang-Brown & Subramanian, 2017). Research has found significant mental health service barriers in rural jails (Ward & Merlo, 2015), which is compounded by an increasing female population (Comartin, et al, 2021). Jails may be a point of intervention for individuals with mental illness and assessing how rural jails identify this need at booking is important. Thus, this study asks: How do rural jails differ from urban jails in who they identify as having a mental health need?

Methods: This exploratory study compares the demographic, behavioral health and criminal/legal histories of 3,797 individuals who booked into 3 rural jails (n=980, 25.8%) and 7 urban jails (n=2,817, 74.2%). Administrative jail data categorized mental health identification by: 1) through each jails’ practice-as-usual (PAU) and 2) the Kessler-6 (Kessler, 2002) taken on the screening instrument. Bivariate analyses (chi-square and independent samples t-tests) assessed differences between the individuals in rural jails and individuals in urban jails. Then, two logistic regression models were used to analyze the factors that correlated with each identification type (K6 or PAU).

Results: Individuals in rural jails were more likely to be female (29.4%, n=290; χ²(1)=10.55, p<.001), white (86.8%, n=846; χ²(1)=348.74, p<.001), and had insecure housing (40.2%, n=179; χ²(1)=8.58, p<.01); compared to their urban jail counterparts (24.1%, n=687; 53.0%, n=1,472; 33.1%, n=904, respectively). Individuals in rural jails were more likely to report: prior receipt of mental health services (30.1%, n=293; χ²(1)=9.62, p<.01), be on psychotropic medications (23.9%, n=233; χ²(1)=13.38, p<.001), substance misuse (64.3%, n=607; χ²(1)=49.56, p<.001) and a prior jail stay (45.2%, n=420; χ²(1)=6.18, p<.05), compared to those in urban jails (25.1%, n=698; 18.5%, n=511; 51.0%, n=1,374; 40.5%, n=1,096, respectively). Significantly fewer individuals were identified as having a mental health need by PAU in rural jails (7.2%, n=70; χ²(1)=172.70, p<.001), compared to those in urban jails (27.4%, n=760); while significantly more individuals screened positive on the K6 in rural jails (33.7%, n=330; χ²(1)=82.71, p<.001), compared to those in urban jails (19.5%, n=548). While a logistic regression model χ²(9)=498.570; p<.001) found individuals in rural jails have 1.5 times greater odds of screening positive for SMI on the K6 (AOR=1.502, p<.01), they have significantly lower odds (χ²(9)=739.334, p<.001, AOR=0.88, p<.001) to be identified by the PAU.

Conclusions: Individuals who book into rural jails have considerably higher behavioral health needs and other criminogenic risk factors, compared to their urban jail counterparts. Their mental health needs are less likely to be identified, which may lead to a lack of connection to diversion or treatment opportunities. Sparse availability of mental health professionals in rural communities is likely a contributing factor to the increased behavioral health needs in rural jails (Ward & Merlo, 2015). Future research should assess in-jail and reentry connections for those identified by the both measures. These findings continue to highlight the complex problems facing rural communities, highlighting inequities for those with behavioral health needs depending on geography.