Each year, millions of Americans come in contact with the justice system–ranging from 911 calls, police encounters, and court proceedings to jail sentences, probation, and parole– with a large portion of this population experiencing mental health problems. Among justice-involved individuals, 66% have a substance use disorder (SUD), around 30% have mood disorders (such as antisocial or borderline personality disorder, major depressive disorder, or PTSD), and 15-24% experience psychosis. Additionally, rates of mania or hypomania range from 7-14%, and 13-24% report a lifetime suicide attempt. 1 in 5 adults in the U.S. who die by suicide in the community have spent at least one night in jail in the past year.
Despite the pressing mental health needs within justice systems and affiliated community treatment systems, evidence-based practices that have been shown to improve mental health outcomes are not widely known or utilized. In addition, prior to this study, there was no comprehensive list of recommended best practices. In response to this need, Dr. Jennifer Johnson and colleagues reviewed the literature to identify recommended mental health practices for justice-involved individuals and conducted a study to report the availability of practices in counties across the U.S. The study surveyed leaders in community mental health services, substance use treatment providers, jail administrators, and probation officers from 950 U.S. counties.
The study identified 59 essential practices that counties can use to improve mental health outcomes for justice-involved populations. These practices include 27 general mental health approaches (such as jail diversion programs and permanent supportive housing) and 32 diagnosis-specific interventions (including medication and psychotherapy for common conditions). Key practices recommended by the study include supportive housing and Medicaid reactivation in local jails. mental health treatment diversion, problem-solving courts, crisis intervention teams, education on mental illness for families and caregivers, standardized mental health screenings, and counseling for physical pain. The results also revealed that these recommended practices are inconsistently available, estimating that each practice was accessible to justice-involved individuals in only 22-43% of U.S. counties.
This study underscores critical gaps in community mental health resources for justice–involved individuals and offers strategic guidance on addressing these needs, often through community-based services. For a complete list of these recommended practices, see the article published in Psychiatric Services and led by Drs. Jennifer Johnson and Maji Hailemariam at Michigan State University, Niloofar Ramezani at Virginia Commonwealth University, Jill Viglione at the University of Central Florida, and Faye Taxman at George Mason University, which offers a roadmap for counties seeking to improve mental health care for individuals involved in the criminal justice system.
Key Takeaways:
Most recommended practices are community-based rather than custodial.
In a survey of behavioral health and criminal justice administrators, each recommended practice was found to be offered in only 21.9%-43.0% of U.S. counties.
Priority areas for implementation include expanding access to permanent supportive housing, counseling interventions for physical pain, and Medicaid reactivation in local jails.
Johnson, J. E., Ramezani, N., Viglione, J., Hailemariam, M., & Taxman, F. S. (2023).
Recommended Mental Health Practices for Individuals Interacting With U.S. Police, Court, Jail, Probation, and Parole Systems. Psychiatric services (Washington, D.C.). Advance online publication. https://doi.org/10.1176/appi.ps.20230029