The Impact of Jail-Based for-Profit Mental Health Providers on Post-Jail Treatment Engagement

Background: Individuals recently released from jail are among the most vulnerable and underserved populations in health care settings. After a jail stay, individuals are at elevated risk of experiencing more adverse events and processes, including benefits termination, substance misuse, unemployment, and homelessness. For those with serious mental illness (SMI) especially, a lack of engagement with upstream services can result in deteriorating mental health (MH) and overall well-being, increases in the likelihood of repeated contacts with law enforcement, and even death. Swiftly connecting individuals with SMI to MH services after a jail stay is crucial for stabilization, increasing wellness, and avoiding the revolving door of jail and hospitalization. As correctional facilities and the services provided within them are increasingly privatized, there is little information on how the privatization of MH services within jails has impacted treatment engagement. Even further, we know little about how for-profit provider status impacts post-jail treatment engagement. Methods: This exploratory study uses data from 2019 to compare post-jail treatment engagement of individuals with SMI who are reentering the community from a jail with a for-profit MH provider (n=3) to jails with non-profit MH providers (n=7). Independent variables collected include demographic (age, race/ethnicity, gender, geography type of jail) and behavioral health history (prior MH treatment, psychotropic medication use, substance misuse, receipt of jail-based MH services). Logistic regression analysis was used to predict post-year MH service engagement by provider type (for-profit/non-profit), while controlling for demographic and behavioral health history variables. Results: A total of 1,238 individuals screened positive for SMI. The majority were White (72.3%, n=887), male (66.2%, n=819), with a mean age of 34.4 years (SD=10.8). Almost half (46.3%, n=573) were booked in jails with a for-profit MH provider and the other half (53.7%, n=665) were booked in jails that had a non-profit provider. Over one-third (37.0%, n=458) engaged in MH treatment in the year after jail release. A logistic regression model, controlling for demographic and behavioral health history (χ2(13, n=936)=130.456, p<.001), found that individuals with SMI with a for-profit jail provider had significantly lower odds of engaging in MH treatment in the year after jail release (AOR=.592, p<.01, 95% CI:[0.423, 0.828]). Conclusion: This study revealed that being booked into a jail with a for-profit provider was correlated with a significantly lower probability of engaging in MH treatment in the year after jail release. A lack of engagement with upstream service providers during such a pivotal time may contribute to increased behavioral health crises that erode individuals’ well-being and lead to increased costs downstream as individuals are ensnared in the criminal-legal system and use emergency medical services more often.