Co-Occurring Disorders in Criminal Justice Settings

Evidence-based and Promising Practices for Individuals with Co-Occurring Disorders in Criminal Justice Settings

Several evidence-based practices for co-occurring disorders have been adapted for use with justice-involved people. Here are a few examples:

• Integrated Treatmentfor Co-occurring Disorders addresses both mental and substance use disorders in the same setting with cross-trained staff. One model that has been used with justice-involved people with co-occurring disorders is the modified therapeutic community. Integrated treatment approaches have been associated with positive outcomes, such as lower substance use and reduced criminal behavior.
• Assertive Community Treatment is known as Forensic Assertive Community Treatment (FACT) when modified for justice-involved people in contact with the justice system. FACT is an adaptation of ACT that focuses on helping people prevent arrest and incarceration.
• Cognitive Behavioral Therapy is an intervention that addresses current, destructive patterns of thinking and behaving. Cognitive behavioral approaches adapted for justice-involved people include treatment plans that are specific to each person. Treatments target individuals' risk, cognitive and criminogenic needs. These approaches also emphasize interpersonal skills.
• Illness Management and Recovery is a set of practices that provides people with skills to manage their mental illness in order to achieve recovery goals. Illness Management and Recovery has been modified for people with co-occurring disorders in prison and under court-ordered community-based treatment.
• Supported Employment is competitive employment designed to help an individual with mental illness select, find, and keep work. Continuous support services are offered during employment.
• Supportive Housing is permanent housing that links individuals with mental illness and co-occurring substance use disorders to supportive services. Supportive housing programs have been implemented for justice-involved people with co-occurring disorders who are high users of jail, mental health, and shelter services.

These modified practices focus on achieving public safety outcomes (e.g., reducing criminal behavior) by attending to motivation, criminal thinking, cognition, and traumatic experiences. When choosing training for staff working with individuals with co-occurring disorders in criminal justice settings, consider:

• Addressing trauma: Many people in the justice system with co-occurring disorders experience trauma. Addressing trauma is paramount for effective interventions. Trauma-informed systems reduce an individual's experience of retraumatization and improve responsiveness to treatment.
• Incorporating the risk principle: Positive outcomes can be achieved when the risk principle is incorporated into interventions such as Illness Management and Recovery. For instance, a modified form of Illness Management and Recovery contains modules that address processing jail and prison experiences, thinking styles, and managing negative emotions.

Resources and Links

• Adopting Evidence Based Practice for Justice Involved People with Co-Occurring Disorders Factsheets

  A review of the research for adapting evidence-based practices to criminal justice settings for justice-involved peoples with co-occurring disorders. This fact sheet series reviews research relating to the adaption of evidence-based practices for justice-involved people with co-occurring disorders. The fact sheets address assertive community treatment, cognitive behavioral therapy, illness self-management and recovery, integrated treatment for co-occurring mental health and substance use disorders, housing, supported employment, and motivational interviewing.

• A Call to Action: Ending an American Tragedy: Addressing the Needs of Justice-Involved People with Mental Illness and Co-Occurring Disorders

  This report highlights the needs of justice-involved people with co-occurring disorders and identifies the effective practices that communities can implement to meet those needs. The report provides four recommendations for immediate action: (1) the President should appoint a Special Advisor for Mental Health/Criminal Justice Collaboration; (2) federal Medicaid policies that limit or discourage access to more effective and cost-efficient health care services for individuals with co-occurring substance use disorders should be reviewed and action taken to create more efficient programs; (3) all states should create cross-system agencies, commissions, or positions charged with removing barriers and creating incentives for cross-agency activity at the state and local level; and (4) localities must develop and implement core services that comprise an Essential System of Care.

• Putting the Pieces Together: Practical Strategies for Implementing Evidence-Based Practices

  This guide describes the need for evidence-based practices that address public safety outcomes. It provides practical strategies for implementing principles of evidence-based practices in corrections settings.

• Understanding Evidence-Based Practices for Co-Occurring Disorders

  This paper describes evidence-based practices and how evidence is used to determine practices for working with people with co-occurring disorders. Examples of such practices are provided.

• Extending Assertive Community Treatment to Criminal Justice Settings

  This paper describes adaptations to the Assertive Community Treatment model for people with co-occurring disorders in criminal justice settings.

• Illness Management and Recovery

  This paper describes adaptation of Illness Management Recovery model for individuals with co-occurring disorders in criminal justice settings.

• Supported Employment

  This paper describes adaptation of Supported Employment model for individuals with co-occurring disorders in criminal justice settings.

• Moving Toward Evidence-based Housing Programs for Persons with Mental Illness in Contact with the Justice System

  This paper describes housing models for individuals with co-occurring disorders in criminal justice settings.