"People, places, and things:" Network factors matter in the experiences of mental health court participants

This paper presents findings regarding the relationship between the social networks of MHC participants and one important outcome, treatment adherence. Poor treatment adherence is associated with poor recovery among people with serious mental illnesses (Velligan et al., 2009); thus, understanding the factors that are associated with treatment adherence within the MHC context is an important contribution to the literature and one that is currently lacking. Structured and semi-structured interviews are drawn upon to do the following: (1) Describe the social networks of MHC participants; (2) Quantitatively estimate the associations between network factors and treatment adherence; and (3) Explore what factors impact mental health recovery and contribute to success within MHC programs from the perspective of MHC participants and key informants.Kelli E. Canada (University of Missouri)Includes bibliographical references

Intra-group Stigma: Examining Peer Relationships Among Women in Recovery for Addictions

This grounded theory study explores how women with histories of addiction perceive stigma while in treatment. In-depth interviews were conducted with 30 women participating in a residential drug treatment centre. Previous research has found that support from peers during recovery can be critical to managing illnesses. In fact, researchers have postulated that peers can be a more effective form of support than even family. This study extends existing literature indicating that peer support systems can be supportive, however they can also can be perceived as negative support that impose stigmas. Findings reveal that women perceive stigmas due to how various types of drug use violate societal expectations and conflict with notions of deservingness. Specifically, the hard users\u27\u27 (i.e. women who use heroin or crack cocaine) perceive stigmas regarding how their drug use violates norms of womanhood. Moreover, the soft users\u27\u27 (i.e. those who use alcohol or marijuana) perceive stigmas that their drug use is considered undeserving of support. This article explores the factors that contribute to stigma amongst populations who potentially face marginalisation from larger society. Implications for treatment and group work are discussed

Psychosocial and Re-Incarceration Risks Among Older Adults in Mental Health Courts

Objective Older adults are increasingly involved in the criminal justice system, yet there is limited research regarding their needs and experiences. This study examined differences in psychosocial experiences and reincarceration between older and younger adults with psychiatric disorders involved in the criminal justice system. Methods Participants (N = 80) were recruited from two mental health courts in the midwestern United States. Bivariate analyses examined age-related differences in psychosocial experiences and reincarceration between younger and older participants. Results Older adults, on average, experienced more treatment adherence and fewer probation violations than younger adults during the 6-month follow-up; however, they experienced comparable risk for reincarceration. Older adults\u27 substance use, service use, housing instability, and program retention were similar to their younger counterparts. Conclusion Despite older mental health court participants\u27 treatment adherence and reduced probation violations, they are at risk for incarceration, substance use, and housing instability

What Happens to Mental Health Court Noncompleters?

Mental health court (MHC) research consistently finds that defendants who successfully complete and graduate from the court are less likely to recidivate than those who do not. However, research has not assessed what happens to these noncompleters once they are sent back to traditional court. Using follow-up data on six years of noncompleters from pre-adjudication MHC, we examine what happens to these defendants in traditional court. Findings suggest that 63.7% of defendants' charges were dismissed, 21.0% received probation, and 15.3% were sentenced to incarceration. We examine the time to disposition and differences in defendant characteristics and disposition outcome as well as the relationship between disposition and subsequent recidivism. Results suggest that more severe punishments in traditional court are associated with recidivism. Logistic regression analysis shows that defendants whose charges were dismissed in traditional court were less likely to recidivate than those who were sentenced to probation or incarceration. Our findings highlight the need for future MHC evaluations to consider traditional court outcomes and support trends towards post-adjudication courts. Copyright © 2015 John Wiley & Sons, Ltd

What Gets Measured in Reentry Research? A Scoping Review on Community Reentry From Jail and Prison for Persons With Mental Illnesses

Research on reentry for individuals with mental illnesses leaving jails and prisons lacks outcome specificity and standardization needed to advance knowledge about the efficacy and effectiveness of interventions. This scoping review aims to provide clarity about reentry outcomes by: (a) ascertaining what outcomes are a focus in reentry research, (b) explicating how outcomes are defined, and (c) identifying commonalities or gaps in outcomes reported. A search of multiple databases yielded 415 articles for potential inclusion. After independent document review by two of the authors, 61 articles were included in the review. Recidivism was the most used construct, accounting for 58% of total outcomes and 95% of criminal legal outcomes. Behavioral health indicators were reported the second most frequently and other outcomes were rarely reported. Increasing the specificity of commonly used concepts while also expanding the breadth of outcomes considered is needed to build an evidence base this area of research

Role of Social Support and Ego Network Characteristics on Quality of Life: Implications for Persons Involved with Mental Health Courts

Mental health courts offer alternatives to incarceration for persons with severe mental illness who are involved in the criminal justice system. These courts have the dual function of ensuring treatment for persons involved in the court as well as ensuring the safety of the public. Persons with severe mental illness who are involved in mental health courts rely on others for support, such as family members. Others may buttress the participant from engaging in criminal activities and provide for needs of the participant. The supportiveness as well as the composition of one’s network members may play a role in the success of mental health court participants, such as successfully completing the mental health court program and avoiding incarceration. Little research has explored how social support impacts mental health court participants. We explored how the composition and sense of support of network members were associated with mental health court participants’ quality of life. We regressed quality of life on social support and network characteristics of 80 participants in two mental health courts. Findings suggest that perceived support is positively associated with quality of life, and the proportion of family in one’s network was negatively related to quality of life. Findings suggest that persons involved in mental health courts need supportive others in their social networks in addition to family. More research is needed to explore the reasons having a higher proportion of family members in one’s network is associated with lower quality of life. Practitioners need to pay attention to and leverage mental health court participants’ social networks to help improve their quality of life

Psychosocial and Re-Incarceration Risks Among Older Adults in Mental Health Courts

Objective Older adults are increasingly involved in the criminal justice system, yet there is limited research regarding their needs and experiences. This study examined differences in psychosocial experiences and reincarceration between older and younger adults with psychiatric disorders involved in the criminal justice system. Methods Participants (N = 80) were recruited from two mental health courts in the midwestern United States. Bivariate analyses examined age-related differences in psychosocial experiences and reincarceration between younger and older participants. Results Older adults, on average, experienced more treatment adherence and fewer probation violations than younger adults during the 6-month follow-up; however, they experienced comparable risk for reincarceration. Older adults\u27 substance use, service use, housing instability, and program retention were similar to their younger counterparts. Conclusion Despite older mental health court participants\u27 treatment adherence and reduced probation violations, they are at risk for incarceration, substance use, and housing instability

Feasibility and acceptability of an online mental health intervention for pregnant women and their partners: a mixed method study with a pilot randomized control trial

Abstract Background Untreated perinatal mood and anxiety disorders (PMAD) have short- and long-term health and social consequences; online cognitive behavioral therapy (CBT) interventions can reduce symptoms. Despite partner support being protective online interventions rarely target couples. This study builds on research on an existing CBT-based intervention, the Mothers and Babies Online Course (eMB), by testing its feasibility with prenatal couples. Methods We conducted a pilot, randomized, controlled feasibility trial using a 1:1 parallel design. To be eligible, participant dyads were pregnant people (between 13–30 weeks gestation and with a score of 10 or greater on either the GAD-7 or PHQ-9 scale indicating elevated symptoms of anxiety or depression) and their cohabitating partners, living in Missouri, with access to the internet; both in the dyad consented to participate. Recruitment occurred via Facebook ads, flyers, and a snowball approach. The intervention group received eMB, and the control group received a list of community resources. We examined retention and adherence data extracted from eMB analytics and study databases. All participants were given depression and anxiety scales at baseline, 4 and 8 weeks to test preliminary efficacy; satisfaction and acceptability were measured at trial end (i.e., eight weeks) and via interview. Results There were 441 people who responded to recruitment materials, 74 pregnant people were screened; 19 partners did not complete enrolment, and 25 dyads were ineligible. There were 15 dyads per group (N = 30) who enrolled; all completed the study. The survey response rate was 90% but partners required nearly twice the number of reminders. No participant completed all lessons. Mean depression and anxiety scores dropped over time for dyads in control (M = -1.99, -1.53) and intervention (M = -4.80, -1.99). Intervention pregnant people’s anxiety significantly decreased (M = -4.05; 95% CI [0.82, 7.27]) at time two compared to control. Twelve pregnant people and four partners participated in post-intervention interviews and suggested improvements for eMB. Conclusion Online dyadic interventions can potentially reduce PMAD symptoms. However, to feasibly study eMB with couples, strategies to increase program adherence are necessary. Tailoring interventions to overtly include partners may be advantageous. Trial registration ClinicalTrials.gov NCT05867680, 19/05/2023

Decarceration of older adults with mental illness in the USA – beyond the COVID-19 pandemic

PurposeAging and mental illness both represent significant public health challenges for incarcerated people in the USA. The COVID-19 pandemic has further highlighted the vulnerabilities of incarcerated people because of the risks of infectious disease transmission in correctional facilities. Focusing on older adults with mental illness, this paper aims to examine efforts to decarcerate US correctional facilities during the COVID-19 pandemic and whether these approaches may lead to sustainable reforms beyond the pandemic.Design/methodology/approachA narrative literature review was conducted using numerous online resources, including PubMed, Google Scholar and LexisNexis. Search terms used included "decarceration pandemic," "COVID-19 decarceration," "aging mental illness decarceration," "jails prisons decarceration," "early release COVID-19" and "correctional decarceration pandemic," among others. Given the rapidly changing nature of the COVID-19 pandemic, this narrative literature review included content from not only scholarly articles and federal and state government publications but also relevant media articles and policy-related reports. The authors reviewed these sources collaboratively to synthesize a review of existing evidence and opinions on these topics and generate conclusions and policy recommendations moving forward.FindingsTo mitigate the risks of COVID-19, policymakers have pursued various decarceration strategies across the USA. Some efforts have focused on reducing inflow into correctional systems, including advising police to reduce numbers of arrests and limiting use of pretrial detention. Other policies have sought to increase outflow from correctional systems, such as facilitating early release of people convicted of nonviolent offenses or those nearing the end of their sentences. Given the well-known risks of COVID-19 among older individuals, age was commonly cited as a reason for diverting or expediting release of people from incarceration. In contrast, despite their vulnerability to complications from COVID-19, people with serious mental illness (SMI), particularly those with acute treatment needs, may have been less likely in some instances to be diverted or released early from incarceration.Originality/valueAlthough much has been written about decarceration during the COVID-19 pandemic, little attention has been paid to the relevance of these efforts for older adults with mental illness. This paper synthesizes existing proposals and evidence while drawing attention to the public health implications of aging and SMI in US correctional settings and explores opportunities for decarceration of older adults with SMI beyond the COVID-19 pandemic