Mental Health Programs for Ex-offenders
What are Mental Health Programs?
“Mental illness is a medical condition that disrupts a person's thinking, feeling, mood, ability to relate to
others and daily functioning…Serious mental illnesses include major depression, schizophrenia, bipolar
disorder, obsessive compulsive disorder (OCD), panic disorder, posttraumatic stress disorder (PTSD) and
borderline personality disorder.”1 Mental health programs attempt to alleviate symptoms and daily
strains of mental illness and promote recovery.
Why are they important for ex-offenders?
Compared to the general population, prisoners are 2-4 more likely to be diagnosed with a serious
mental illness, including depression.2
 This translates to roughly 1/3 of all prisoners in the U.S. having been diagnosed with a mental
illness3
 There are 3 times more persons with mental illness in prisons than in psychiatric institutions4
Of these, ¼ has a co-occurring substance use disorder.5
 Rates are closer to 70% in jails6
Approximately 7,200 adults with mental illness were incarcerated in Missouri in 20087
 15% of inmates in 2002 were identified as needing mental health treatment8
Promising Practices of Mental Health Programs
Hire sufficient numbers of properly trained mental health staff9
Train additional staff to work effectively with persons with mental illness10
1
NAMI. (2013, January). What is Mental Illness? Retrieved from National Alliance for the Mentally Ill:
http://www.nami.org
2
Fazel, S., & Danesh, J. (2002). Serious mental disorder in 23,000 prisoners: a systematic review of 62 surveys.
Lancet, 359(9306), 545-550.
3
National Center for Substance Abuse and Prevention. (2010). Behind Bars II: Substance Abuse and America's
Prison Population. New York: Columbia University. Retrieved from http://www.casacolumbia.org/
4
Abramsky, S., & Fellner, J. (2003). Ill equipped: U.S. prisons and and offenders with mental illness. New York, NY:
Human Rights Watch.
5
National Center for Substance Abuse and Prevention, 2010;
Lurigio, A. (2011). People with serious mental illness in the criminal justice system: Causes, consequences, and
correctives . The Prison Journal, 91(3), 66S-86S. doi:10.1177/0032885511415226
6
Scott, W. (2008). Effective Clinical Practices in Treating Clients in the Criminal Justice System. Washington, DC:
National Institute of Corrections.
7
NAMI. (2010). State Statistics: Missouri. Arlington, VA: National Alliance for the Mentally Ill.
8
Trickey, M., Ashley, A., & Woodburn, J. (2005). Substance Abuse, Mental Illness, Crime and Incarceration.
Jefferson City, MO: Missouri Coalition of Community Mental Health Centers.
9
Abramsky & Fellner, 2003
10
Abramsky & Fellner, 2003
Prepared by Megan Foster, Graduate Intern
1
April 2013
Develop and expand continuity-of-care protocols between prisons and the community11
Collaborative relationships with police, shelters, emergency rooms and public defenders
Supported Employment
“An EBP for people with severe developmental, mental, and physical disabilities that matches them with
and trains them for jobs where their specific skills and abilities make them valuable assets to
employers.”12
Integrated treatment for co-occurring substance abuse or dependence
“Treatment and service provision to support recovery from co-occurring mental illness and substance
abuse through a single agency or entity” 13
 25% of prisoners with mental illness have a co-occurring substance abuse disorder14
Modified Therapeutic Community
“MTCs alter the traditional TC approach in response to the psychiatric symptoms, cognitive
impairments, and other impairments commonly found among individuals with co-occurring disorders.
These modified programs typically have (1) increased flexibility, (2) decreased intensity, and (3) greater
individualization.” 15 MTC is recognized as a model program by National Registry of Evidence-Based
Programs and Practices (NREPP)
Trauma-Informed Care
While it is difficult to measure fully, individuals with mental illness often have experienced higher rates
of trauma than the general population which is exacerbated by involvement in the criminal justice
system.16 Nearly 90% of individuals in jail diversion programs have experienced either physical or sexual
abuse.17 Rates of trauma for prisoners is significantly higher for women than men. According to the
GAINS Center, trauma history can pose a significant barrier to future interventions. Trauma-informed
care is not an intervention itself but is rather a method of interaction and philosophy that recognizes the
experience of trauma and trauma symptoms in the lives of clients.
11
Abramsky & Fellner, 2003
Blandford, A. M., & Osher, F. C. (2012). A Checklist for Implementing Evidence-Based Practices and Programs for
Justice-Involved Adults with Behavioral Health Disorders. Rockville, MD: SAMHSA’s GAINS Center for Behavioral
Health and Justice Transformation.
Substance Abuse and Mental Health Services Administration (SAMHSA). (2009). Supported Employment
Evidence-Based Practices (EBP) KIT. Rockville, MD: U.S. Dept of Health and Human Services. Retrieved from
http://store.samhsa.gov/product/Supported-Employment-Evidence-Based-Practices-EBP-KIT/SMA08-4365
13
Blandford & Osher, 2010;
Osher, F. C. (2006). Integrating Mental Health and Substance Abuse Services forJustice-Involved Persons with CoOccurring Disorders. Rcokville, MD: The National GAINS Center for Systemic Change for Justice-Involved People
with Mental Illness.
14
National Center for Substance Abuse and Prevention, 2010
15
Blandford & Osher, 2012
16
National Center for Trauma-Informed Care. (2013, February). Welcome Page. Retrieved from SAMHSA:
http://www.samhsa.gov/nctic/
17
Policy Research Associates. (2011). Final report of the evaluation of CMHS Targeted Capacity Expansion for Jail
Diversion Programs initiative. Delmar, NY: Policy Research Associates.
12
Prepared by Megan Foster, Graduate Intern
2
April 2013
Promising and Evidence-Based Programs
Diversion
Jail diversion are programs which identify individuals with severe mental illness and attempt to reduce
their time in jail or prison through diversion to community-based mental health treatment partners.
Crisis Intervention Team Model (CIT)
A CIT team is made up of specially trained police officers that work closely with mental health
professionals to de-escalate situations with individuals who have severe mental illness and divert them
from the criminal justice system and into mental health services.18
Mental Health Courts (MHC)
MHCs are post-booking diversion programs which work with offenders who have severe mental illness
to reduce their time in jail or prison and place them into appropriate community services. Both St. Louis
City and County have Mental Health Courts.19
Supportive Housing (see housing for more information)
Institutional Care
Institutional care facilities are residential and assume the comprehensive care for the individuals living
there. These needs include room and board but also ongoing mental health treatment. Such intensive
settings are not necessary for the majority of individuals with mental illness but are reserved for
individuals with limited capacity to function independently in society.
Behavioral Interventions (See Behavioral Adjustment Programs)
Assertive Community Treatment (ACT)
“A service delivery model in which a team of professionals from different disciplines provide services as
needed and based upon client needs.” 20
 Cross-disciplinary: can involve counselors/therapists, nurses, casemanagers, addiction specialists
 24/7 availability
 Appropriate for those with severe mental illness or high risk of inpatient hospitalization
Forensic ACT
Model of ACT adapted to working specifically with criminal justice-involved populations21
Illness Self-Management and Recovery
“An approach that involves teaching clients skills and techniques to minimize the interference of
psychiatric symptoms in their daily lives.” 22
18
For more information on St. Louis services, go here:
http://www.stlouisco.com/LawandPublicSafety/CrisisInterventionTeamCIT
19
See for more information and a full list of courts: http://gainscenter.samhsa.gov/grant_programs/adultmhc.asp
20
Blandford & Osher, 2012;
Morrissey, J., & Meyer, P. (2008). Extending Assertive Community Treatment to Criminal Justice Settings. Rockville,
MD: SAMHSA's GAINS Centerfor Behaviorial Health and Justice Transformation.
21
Blandford & Osher, 2012; Morrissey & Meyer, 2008
Prepared by Megan Foster, Graduate Intern
3
April 2013
Psychopharmacology
“Treatment that uses one or more medications (e.g., antidepressants) to reduce depression, psychosis,
or anxiety by acting on the chemistry of the brain.”23
Forensic Intensive Case Management (FICM) 24
Coordinated services to support clients in recovery and prevent recidivism using case managers with
individualized caseloads.
Measureable Outcomes
Short-Term
Alleviate symptoms and daily strains of mental illness and promote recovery

Allows for the treatment of co-occurring disorders
Stabilize symptoms so that the individual may care for themselves, attain housing and work productively
Reduce self-medication
Increase adherence to an effective treatment regimen
Long-Term
Reduced Recidivism
 A current MO DOC program providing transitional mental health services for individuals released
from prison had reincarceration rate of 25% after two years in FY08 and of 26% in FY09. Both rates
are lower than reincarceration rates for ex-prisoners without serious mental illness25
 A second program receiving referrals from Probation & Parole that subsidizes mental health
services for persons on supervision had a recidivism rate of 14.8% within the first year after
release26
 More broadly, treatment of mental illness by itself has not been shown to have a negative effect on
recidivism, however, it has been shown to affect an individual’s readiness for targeted
interventions focusing on criminogenic thinking.27
Barriers to Meeting Outcomes
Lack of sufficiently trained individuals to carry out effective therapies and interventions
Lack of willingness to adhere to treatment
22
Blandford & Osher, 2012;
Meuser, K., & MacKain, S. (2008). Illness Management and Recovery In Criminal Justice. Rockville, MD: SAMHSA’s
GAINS Center for Behavioral Health and Justice Transformation.
23
Blandford & Osher, 2012
24
Blandford & Osher, 2012; Morrissey & Meyer, 2008; See Case Management
25
Missouri Reentry Process. (2012). Report to the Governor 2011. Jefferson City, MO: Missouri Department of
Corrections. Retrieved from Missouri Department of Corrections.
26
Missouri Reentry Process, 2012
27
Lurigio, 2011
Prepared by Megan Foster, Graduate Intern
4
April 2013
Untreated trauma
Untreated substance abuse
Inability to treat or recognize co-occurring disorders or issues
Lack of access to affordable services
Resources
Substance Abuse & Mental Health Services Administration (SAMHSA):
http://www.samhsa.gov/
 Store (free and paid publications): http://store.samhsa.gov/home
 National Registry of Evidence-Based Programs and Practices (NREPP): http://nrepp.samhsa.gov/
 GAINS Center for Behavioral Health and Justice Transformation: http://gainscenter.samhsa.gov/
 National Center for Trauma-Informed Care: http://www.samhsa.gov/nctic/
 National Center on Substance Abuse and Child Welfare: http://www.ncsacw.samhsa.gov/
 Medication Assisted Treatment: http://www.dpt.samhsa.gov/
MedLines Plus : http://www.nlm.nih.gov/
National Alliance for the Mentally Ill (NAMI) : http://www.nami.org/
St. Louis Area Crisis Intervention Team:
http://www.stlouisco.com/LawandPublicSafety/CrisisInterventionTeamCIT
Prepared by Megan Foster, Graduate Intern
5
April 2013