RESEARCH WEEKLY: Barriers to community treatment for people with SMI and criminal involvement By Shanti Silver (May 3, 2023) People with serious mental illness are vastly overrepresented in America’s prisons. After being released from prison, it is common for people with serious mental illness to be required to participate in community-based mental health treatment as part of their parole or probation. However, studies have found that people who are required to receive mental health treatment in community settings are just as likely to be arrested again as and more likely to be incarcerated again than people who are not required to receive treatment. This suggests that these community programs may not be doing enough to help people with serious mental illness to manage their symptoms and control other risk factors for criminal re-offending. It is important to understand barriers that may be preventing community mental health centers from providing effective treatment and reducing recidivism in this population. In a recent study from “The Journal of Qualitative Criminal Justice & Criminology,” researchers interviewed 61 service providers from 16 community mental health centers in Indiana to identify factors that impact treatment for people with serious mental illness who have been involved with the criminal system. Funding and budget constraints Insufficient funding was reported by 80% of service providers as a barrier to providing effective treatment to people with serious mental illness who have been released from prison. Staffing challenges and insufficient treatment resources were two of the challenges resulting from these budget constraints. Staffing shortages More than half of service providers (59%) in this study said that their budget made it difficult to maintain necessary staffing levels. Along with staff shortages, insufficient funding also caused a shortage of experienced staff. Community mental health centers often must hire staff without much experience, because low salaries make it difficult to attract experienced providers. Insufficient treatment resources One-third of service providers said that they lacked the budget to implement or expand treatments that they believed would be effective for people with serious mental illness and a history of criminal activity. These treatments included assertive community treatment teams, step-down programs, and even medications. As one administrator with over 50 years of experience described, “we have some really good ideas about what works, we don’t have the money to implement it. Which is very frustrating for us.” Organizational goals Many community mental health centers lack specific goals to reduce recidivism for patients with previous incarcerations. In this study, 70% of service providers reported that their program had no specific goals for people who had previously been involved with the criminal system. While some providers felt this made sense because their program is “all about treating the disease, not the crime because the crime is part of the disease,” others felt that this lack of attention to criminal activity indicated that community programs “don’t really … see the bigger picture of the recidivism.” External policies Sometimes, the policies of other agencies presented barriers to effective treatment for this population. For example, 33% of service providers mentioned that their ability to effectively treat patients was limited by policies made by the criminal system. These policies included mandatory reporting of positive drug screens and zero-tolerance policies, which made their patients view them as members of the criminal system instead of care providers. Policies from Medicaid were also mentioned as a source of difficulty by 59% of service providers. For example, providers mentioned barriers such as seemingly arbitrary decisions about what types of providers and services could be reimbursed and Medicaid’s requirement to complete documentation during treatment sessions, which detracted from the time providers could spend treating patients. Another barrier was Medicaid’s policy of automatically cancelling coverage for people who have been incarcerated. This policy forces people to reapply and be reapproved for coverage, which can take up to several months and can leave people unable to pay for treatment for a substantial period of time. Several service providers said that they dealt with this barrier through providing treatment outside of Medicaid-reimbursable hours. Implications Service providers described many factors that can impact the care of people with serious mental illness who have been involved with the criminal system, including budget challenges, their organization’s goals, and external policies. Importantly, this study’s findings suggest that many barriers may be eliminated or made less severe by policies that prioritize effective care for this population. While these findings cannot be generalized to other states, the results of this study suggest that there are numerous and complex barriers that prevent this population from receiving optimal treatment and reducing their recidivism. Reference Hood, B. (January 2023). Treating Criminal Justice-Involved Serious Mental Illness (SMI) Clients in the Community. Journal of Qualitative Criminal Justice & Criminology. Shanti Silver is a research assistant at Treatment Advocacy Center. View as Webpage To receive Research Weekly directly in your email inbox on a weekly basis, click here. 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