Part I: current Responses to Individuals with Mental Health and Substance Use Disorders and Corrections Involvement
figure 1. The Continuum of Mental Illness Impairment and Needs
Mental Health Problem
Mental Illness with Limited Impairment
Serious Mental Illness
Level of Need and How Prioritization of Services Should Be Made
Mental health professionals accept that recovery is not a linear process and people with SMI frequently experience relapses. Through a combination of therapies, medications, and social supports, most of these individuals will experience improved functioning. They may go through periods in which they decompensate and then improve—changing their level of impairment over time. The mental health system already encounters individuals under correctional supervision because of the large number of U.S. citizens on probation or parole and their high rate of mental health problems and symptoms.61 Individuals also enter correctional settings with a broad range of mental health needs—from slight to serious impairments. For example, more than one-third of inmates may have problems with sleep,62 which may be a management issue while in custody but by itself does not constitute a “mental illness” under DSM-IV-TR criteria. The vast majority of individuals under correctional supervision will have significant trauma histories,63 with a subset meeting the criteria for post-traumatic stress disorder that may require interventions.* When mental illness criteria are met and a diagnosis can be established, the condition still may not be associated with a significant disability. For example, an arrested person assessed with a generalized anxiety disorder might benefit from counseling and/or medication, but his or her symptoms may not interfere with completing routine tasks. Some of these individuals will exhibit behaviors or symptoms not associated with serious mental illness, yet pose significant jail or prison control and operational problems. They may not have been treated in the community because they were not prioritized in the public health system. At the high-needs end of the spectrum, individuals with SMI may have difficulties with activities of daily living, including maintaining their hygiene, complying with rules and adhering to routines, and concentrating and learning.† Treatment and requisite supports for individuals with significant impairments are likely to be initially intense and potentially long term, with recovery a slow process.
*Additional information on the importance of trauma-informed care related to the criminal justice system can be found in the National Institute of Corrections resource library at http://nicic.gov/Library/. † State-specific definitions for “serious” or “serious and persistent” mental illness will determine eligibility for certain services in the public mental health system.
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