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Adults with Behavioral Health Needs under Correctional Supervision
While it is logical that people with the highest impairment should be prioritized for treatment, in practice, this is not always a population who receives services. Some individuals do not want treatment behind bars or when on probation or parole, and some individuals cannot afford it when released to community supervision.* Some mental health practitioners are reluctant to work with individuals with histories of violence and felonious behavior even though their need for treatment may by high. For many of these individuals, their high level of treatment need is related to personality or co-occurring substance use disorders. Some mental health systems are not easily accessed by people who fall into these latter categories of need and may lack trained clinicians with the skills to effectively change their destructive behaviors. Working with these individuals requires training in cognitive behavioral interventions as well as crisis management and de-escalation techniques. At times, it may not be appropriate to serve some individuals that pose the highest risk to public safety in traditional community mental health settings, although access to in-patient and residential care is limited in most communities.
Substance Abuse Treatment People with substance abuse disorders have varied treatment needs that can be identified along a continuum consistent with the severity of their disorder. Typically, treatment in the community focuses on individuals who are abusing or dependent on alcohol and other drugs. Individuals who use substances, but who are not abusing them or dependent on them, typically do not seek care and may not require formal treatment interventions. A SAMHSA report defines “substance use” as the use of alcohol or other drugs to socialize and feel their effects—use that may not appear abusive and may not lead to dependence.64 Determining whether an individual is abusing or dependent on a substance is of critical importance in prioritizing services for those most in need. Several of the criteria for substance abuse and dependence are the same, such as an inability to carry out daily activities, meet responsibilities, maintain education or employment, or avoid recurrent legal problems related to the substance use. Individuals are considered to be “dependent” if they have several of the previous problems and experience tolerance to drug effects, withdrawal, and an inability to reduce or control use.† Individuals have the greatest need for treatment when they are substance dependent and they experience
*Correctional supervision agencies can, however, often be useful in engaging people in treatment and may have resources to show individuals how to access care (e.g., some facilities have staff or partners to help inmates enroll for federal benefits as part of their reentry plan). † The DSM-IV Criteria for Substance-Related Disorders can be found at http://www.ncbi.nlm.nih.gov/books/ NBK26041/. Also see the glossary for other explanations of substance use and disorders. At the time of this white paper’s publication, the DSM-IV criteria were being revised, which may result in changes to how substance use disorders are defined along the continuum. The release of the final, approved DSM-V is expected in May 2013.