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Co-Occurring Disorders in Criminal Justice Settings

Integrated Care for Individuals with Co-Occurring Disorders in Criminal Justice Settings

Individuals with co-occurring disorders who are in contact with the justice system often have multiple complex needs. People need access to:

  • Integrated services for mental and substance use disorders
  • Primary care
  • Housing
  • Income supports and entitlements
  • Education
  • Employment
  • Child care

These services are provided by different agencies that often are not coordinated. The result is fragmentation of both service systems and services.

Research shows that providing integrated treatment to justice-involved individuals with co-occurring disorders leads to positive outcomes, such as lower substance use and reduced arrests. It is especially helpful when supervision is coordinated between the correctional institution and the community.

Integrated systems require collaboration

Integrating systems and services does not demand the formation of a single system. Integration requires collaboration, which means working with and developing an appreciation for differing:

  • Cultures
  • Administrative approaches
  • Protocols
  • Policies

Collaboration can result in coordinated screening and assessment protocols, integrated treatment services, synchronization between service agencies and supervising officers, and management information systems. In an integrated system:

  • Planning occurs as a coordinated, cross-systems process. Example: A jail administrator and the county behavioral health director co-chair a stakeholder group charged with developing a strategic plan to implement transition planning for inmates with co-occurring disorders. Once the plan is implemented, the group provides oversight of the transition planning program.
  • Information is shared across systems. Example: As part of the planning process, the stakeholder group maps the flow of people through the criminal justice system in their community. Opportunities for intervention are identified and prioritized by the group. A data link is established in the jail where staff from the county behavioral health agency can review the daily intake roster to identify common service recipients.
  • Treatment and supervision plans are coordinated. Example: At the recommendation of the planning group, the jail starts using the same screening and assessment instruments for co-occurring disorders as the county behavioral health agency. The transition planners collaborate with the behavioral health agency to develop individualized treatment packages. Plans for supervision are coordinated between the transition planner, the behavioral health agency, and the probation department.
  • Agencies in different systems braid resources to provide services that are integrated and coordinated. Example: The salaries of the transition planners are supported by the jail and the behavioral health agency.

Resources and Links

  • This resource reviews the need for integrated treatment for co-occurring disorders in the justice system. It provides recommendations for action at different points in the criminal justice system.

  • Using the Sequential Intercept Model, this brief identifies opportunities where mental health and criminal justice partnerships can implement activities at the systems and services levels. Services level activities are categorized according to the five intercept points in the model: law enforcement, initial detention/initial court hearings, jails/courts, reentry, and community corrections.

  • This study describes how a number of mental illness and substance abuse-related deaths at a jail prompted sustained media coverage and urgent calls for reform. These incidents led to the formation of a Jail Oversight Commission, the construction of a central receiving center for individuals with mental illnesses and/or substance use disorders who would normally be taken to jail or local emergency rooms, specialized law enforcement response teams, a pre-trial services program, and a post-booking treatment diversion program.

  • Jail diversion programs are designed to bridge the gap in fragmented systems and break the cycle of recidivism for people with serious mental illness and co-occurring substance use disorders. As such, they reflect a holistic, systemic approach to mental health service delivery that will allow most people with mental disorders to live, work, learn, and participate fully and safely in their communities. This guide provides an approach for communities that are interested in developing jail diversion programs.

  • The GAINS Center is a national locus for the collection and dissemination of information about effective mental health and substance abuse services for people with co-occurring disorders in contact with the justice system. The GAINS Center's primary focus is on expanding access to community based services for adults diagnosed with co-occurring mental illness and substance use disorders at all points of contact with the justice system.

  • This issue brief summarizes the characteristics of mothers with co-occurring disorders who are involved in the criminal justice system, as well as strategies for interagency community collaboration. The brief also includes a spotlight on a community criminal justice treatment program in Maryland.

  • Families of consumers who are mentally ill and substance abusers often can be highly effective as advocates for systems change. They bring life skills, credibility, energy, and determination based on their commitment to helping their relatives. This brochure briefly summarizes the benefits, challenges, and strategies to involving family members of consumers as advocates. It also includes examples of programs that have done this successfully, as well as a resource list.