Continuity of mental health care during the transition from prison to the community following brief periods of imprisonment

Abstract

PurposeThe prison-to-community transition period is one of high risk and need, particularly for those with mental illness. Some individuals cycle in and out of prison for short periods with little opportunity for mental health stabilization or service planning either in prison or the community. This study describes the socio-demographic, clinical and criminal justice characteristics of individuals with mental illness and frequent, brief periods of imprisonment, examines continuity of mental health care between prison and the community for this group, and reports on their post-release mental health and criminal justice outcomes.Design/methodology/approachThis study examined a sample of 275 men who had recently entered prison in New South Wales (NSW), Australia, who had been charged with relatively minor offenses and had been identified on reception screening as having significant mental health needs. Baseline demographic and mental health information was collected via interview and file review and contacts with the prison mental health service were recorded for the period of incarceration. Follow-up interviews were conducted 3 months post-release to determine level of health service contact and mental health symptoms. Information on criminal justice contact during the 3 month period was also collected.FindingsThe majority (85.5%) of the sample had contact with a mental health professional during their period of incarceration. Mental health discharge planning was, however, lacking, with only one in 20 receiving a referral to a community mental health team (CMHT) and one in eight being referred for any kind of mental health follow-up on release. Of those followed up 3 months post-release (n = 113), 14.2% had had contact with a CMHT. Of those released for at least 3 months (n = 255), one in three had received new charges in this period and one in five had been reincarcerated.ConclusionContinuity of mental health care for those exiting prison is poor, particularly for those with mental health needs experiencing brief periods of imprisonment, and rates of CMHT contact are low in the immediate post-release period. These findings suggest a need for early identification of individuals in this group for timely commencement of intervention and release planning, and opportunities for diversion from prison should be utilized where possible.

Psychiatric admissions in young people after expiration of criminal justice supervision in Australia: a retrospective data linkage study

“…Our findings align with a previous NSW study among prisoners which demonstrated mental health service engagement rates of 85.5% during supervision. However, only 14.2% engaged with community-based mental health services postrelease 23…”

Psychiatric and legal considerations for ketamine treatment within prison settings

“…It is imperative to consider not only the legal dimensions, as expounded upon here, but also the medical implications ( 59 , 67 ). The scarcity of studies exploring disorder-specific pharmacological interventions within the prison environment can be attributed to methodological complexities, such as monitoring follow-up and selecting appropriate outcome measures ( 46 , 53 ). In view of the fact that penal authorities need to offer even better health services than those available to the general population to reach comparable health outcomes ( 14 , 66 ), we advocate the investigation of ketamine treatment for PLP dealing with depression and suicidal ideation under controlled conditions.…”

“…However, the fact that PLP are insufficiently represented in health research complicates data-driven decision-making ( 3 , 45 ). Studies in prisons are often hampered by discontinuity of care and tight financial constraints ( 53 , 54 ), which limits longitudinal research on the effectiveness of clinical interventions.…”

Identifying incarceration status in the electronic health record using large language models in emergency department settings

“…We stratified temporal relationship to incarceration because there are different health risks associated with each. As an example, transition into and out of correctional facilities is disruptive and traumatic and can have differential effects on health [ 22 ]. Additionally, there are likely different health system level interventions that are feasible to improve care for currently and formerly incarcerated individuals due to the role of departments of corrections in managing health care.…”