Among adults with mental illness released from correctional centers, each month that passes after release without accessing mental health services is associated with a greater risk of reincarceration, according to a study published today in JAMA Network Open.
“Despite high rates of mental health needs, there is considerable evidence of low rates of treatment of mental disorders in correctional settings and upon release to the community, highlighting the urgency of scaling up interventions to meet these needs,” wrote Heather Palis, Ph.D., of the University of British Columbia and colleagues. “People who are incarcerated in provincial prisons in [British Columbia] have a reincarceration rate of approximately 50% in the 2 years following release. … [W]e expect this rate to be even higher for people with mental health diagnoses.”
Palis and colleagues used health and corrections data from the British Columbia Provincial Overdose Cohort, which contains a 20% random sample of the general population in British Columbia. The records were linked to British Columbia’s Client Roster, which includes health information. Participants were included if they had a complete record in the client roster between 2015 and 2018, had at least one release from a provincial correctional center during this period, and received a mental illness diagnosis in the year before release. Mental health service access was defined as visits to primary care offices, hospitalization, or emergency department visits. The authors also analyzed co-occurring substance use disorders (SUDs), defined as the presence of one hospitalization record or two outpatient records including an ICD-9 or ICD-10 code for SUD.
A total of 1,664 participants who were released from correctional centers 4,171 times during the study period were included in the study. Mental health services were associated with a reduced risk of reincarceration. For each additional month that passed between release and accessing mental health services, the risk of reincarceration increased by 4%. Among participants with SUDs, the reincarceration risk was lower when they accessed both SUD and other mental health services. Further, the authors found that outpatient emergency visits for mental health issues were associated with significantly higher risk of reincarceration compared with outpatient primary care visits for mental health services. “This emphasizes the pivotal role of regular contact with primary care services after release,” the authors wrote.
They concluded: “Scaling up of timely access to mental health services after release is critical. This must be done with attention to the service needs of people who have concurrent SUD and to people with the most severe mental disorder diagnoses, who face the highest risk of reincarceration.”
For related information, see the Psychiatric Services article “Prevalence of Mental Health Needs, Substance Use, and Co-occurring Disorders Among People Admitted to Prison.”
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