Challenges to Employing Shared Decision Making With Adults Under Community Supervision Who Have a Mental Illness.

Adults under community corrections supervision and who have a mental illness (MI) are expected to comply with conditions of release which often include involvement with supportive social services. The rates of technical violation, arrest, and incarceration that result from failure to comply with these mandates are exceedingly high. Shared decision making among officer-supervisors and client-supervisees is a promising approach to promote engagement in community corrections services among supervisees who have MI. This paper reviews recent research on shared decision making and identifies three barriers to its implementation in this context: (1) a lack of role clarity, (2) a predilection for risk avoidance, and (3) stigma toward supervisees. Empirically supported recommendations are suggested to aid in overcoming these obstacles, facilitate shared decision making, and promote recovery among this population: (1) unification of supervisor rehabilitative and public safety roles, (2) maximizing opportunities for self-determination through low-stakes events and/or enhancement of supervisee strengths and capabilities, and (3) supervisor training in principles of mental health recovery.

Predictors of shared decision making with people who have a serious mental illness and who are under justice supervision in the community.

Shared decision making (SDM) can be an effective method for promoting service involvement among persons with serious mental illness (SMI). This survey study sought to identify predictors of positive attitudes toward the use of SDM with people with SMI who are living under probation and parole supervision. Supervising officers' (n = 291) perceptions of the capabilities of supervisees with SMI to contribute to their supervision plans, and their familiarity with recovery-oriented mental health services, were positively associated with attitudes toward using SDM. Training officers in common human goals and mental health recovery may advance SDM with supervisees with SMI.

The Effects of State Medicaid Expansion on Low-Income Individuals' Access to Health Care: Multilevel Modeling.

This study aimed to examine how states' Medicaid expansion affected insurance status and access to health care among low-income expansion state residents in 2015, the second year of the expansion. Data from the 2012 and 2015 Behavioral Risk Factor Surveillance System were linked to state-level data. A nationally representative sample of 544,307 adults (ages 26-64 years) from 50 states and Washington, DC were analyzed using multilevel modeling. The results indicate substantial increases in health care access between 2012 and 2015 among low-income adults in Medicaid expansion states. The final conditional multilevel models with low-income adults who had income at or below 138% of the poverty line indicate that, after controlling for individual- and state-level covariates, those who resided in the Medicaid expansion states were more likely to have health insurance (OR = 1.97, P < .001), have a usual source of care (OR = 1.37, P < .01), and receive a routine checkup (OR = 1.24, P < .01), and were less likely to not see a doctor because of cost (OR = 0.66, P < .001) compared with low-income residents in non-expansion states in 2015. Moreover, the significant interaction terms indicate that adults living in non-expansion states with income below 100% of the poverty line are the most vulnerable compared with their counterparts in expansion states and with those with income between 100%-138% of the poverty line. This study demonstrates that state-level Medicaid expansion improved health care access among low-income US residents. However, residents with income below 100% of the poverty line in non-expansion states were disproportionately negatively affected by states' decision to not expand Medicaid coverage.

Racial/Ethnic Differences in Contemporaneous Use of Mental Health and Substance Use Treatment Among Individuals Experiencing Both Mental Illness and Substance Use Disorders.

This study examined whether the well-established racial/ethnic differences in mental health service utilization among individuals with mental illness are reflected in the treatment utilization patterns of individuals experiencing both mental illness and substance use disorders, particularly in regards to the use of contemporaneous mental health and substance abuse treatment. Using pooled data from the National Survey on Drug Use and Health (2009-2013), the patterns of mental health and substance use treatment utilization of 8748 White, Black, or Latino individuals experiencing both mental illness and substance use disorders were analyzed. Multinomial logistic regression was conducted to test the relationships among racial/ethnic groups and the receipt of contemporaneous treatment, mental health treatment alone, and substance use treatment alone as compared with no treatment utilization. Results indicated that Black and Latino respondents were less likely to receive contemporaneous treatment than Whites respondents. Also, significantly associated with outcomes were several interactions between race/ethnicity and predisposing, need and enabling factors known to be associated with service utilization. The findings suggest that an underlying mechanism of racial/ethnic differences among individuals with co-occurring mental illness and substance use disorders in the treatment utilization may differ by the specific types of treatment and between Blacks and Latinos. Therefore, efforts to reduce these disparities should consider specialty in each treatment settings and heterogeneity within diverse racial/ethnic groups.

Racial-Ethnic Variation in Mental Health Service Utilization Among People with a Major Affective Disorder and a Criminal History.

Using a nationally representative sample, this study examined the extent to which the utilization of various mental health services was associated with racial-ethnic identity among people with major affective disorders who have a criminal history. Approximately 33.7 % of the sample received any type of mental health services in a given year. Multivariate models indicated that married Blacks and Latinos were less likely to use specialty mental health care than their white counterparts. To provide equitable mental health treatment for vulnerable subgroups of this population, mental health professionals should account for the heterogeneity of mental health care in diverse cultural contexts.

Does early onset of criminal behavior differentiate for whom serious mental illness has a direct or indirect effect on recidivism?

The involvement of people with serious mental illness (SMI) with the justice system may be a direct result of their disruptive/unsafe expression of psychiatric symptoms being responded to by law enforcement. SMI may also indirectly contribute to justice involvement, through exposure to environmental and social learning processes that place people with SMI at risk for criminal behavior. This study addresses the question: For whom does SMI directly or indirectly relate to criminal behavior? Mediation and conditional effects testing were used to examine the potential of early onset of criminal behavior to distinguish those groups for whom SMI displays a direct effect or an indirect effect on criminal recidivism. This study utilized a disproportionate random sample of 379 inmates released from New Jersey Department of Corrections; 190 of whom had SMI and 189 of whom did not have SMI. Data were collected from clinical and administrative records. Results indicate that criminal risk mediated the relationship between SMI and recidivism. This indirect effect was conditioned by whether the individual had a juvenile conviction. Specifically, for early start offenders, criminal risk was positively related to recidivism while this relationship was not observed for late start offenders. Juvenile criminal onset did not condition the direct effects of SMI on recidivism. A juvenile history of criminal involvement may signal the presence of heightened criminogenic need among adults with SMI. This simple indicator could function to differentiate for clinicians those adults who are good candidates for exploring further, and targeting for amelioration, criminogenic needs to reduce further criminal involvement. (PsycINFO Database Record

Criminal Justice Contact and Treatment Utilization Among People With Mental Illness and Substance Use Disorders.

OBJECTIVE: This study examined whether a history of criminal justice involvement is related to the use of contemporaneous mental health and substance abuse treatment among adults experiencing co-occurring disorders. METHODS: Pooled 2009-2013 data from the National Survey on Drug Use and Health were used to analyze patterns of mental health and substance abuse treatment utilization of 8,740 adults with past-year co-occurring disorders. RESULTS: Individuals with a criminal history were more likely than those without a criminal history to receive both types of treatment or substance abuse treatment alone. CONCLUSIONS: The criminal justice system appears to be facilitating mental health and substance abuse treatment among people experiencing co-occurring disorders but may also be overreliant on substance abuse treatment alone.

Associations between comorbid health conditions and the use of mental health services among adults with bipolar disorder.

Using a nationally representative sample, this study examined to what extent the number of comorbid health conditions was associated with various mental health service utilization among people with bipolar disorder. The results of logistic regression models indicate that a greater number of comorbid medical conditions were associated with higher odds of using specialty mental health service, while they were not associated with utilization of services provided by general health care providers. The type of bipolar disorder, functional impairment, and marital status were found to be associated with the use of a specialty service, while ethnicity was the only covariate significantly related to general health care use.

Serious mental illness, criminal risk, parole supervision, and recidivism: testing of conditional effects.

Adults with serious mental illness (SMI) who are released from prison tend to recidivate more quickly and at higher rates than similarly situated adults who do not have SMI. The current study examined whether this relationship with recidivism is mediated by criminal risk level and whether parole supervision can ameliorate the effects of SMI on recidivism. Findings indicate that SMI did exhibit a significant indirect effect with recidivism when considering its relationship with actuarially assessed risk. However, this indirect effect was not conditioned by whether the individual was released to parole; specifically release status did not moderate the relationship between risk and recidivism. The direct effects of SMI on recidivism were found to be conditioned upon release status. Specifically, we found no relationship between SMI and recidivism for parolees and a negative relationship between SMI and recidivism among nonparolees. Findings indicate a need for paroling authorities to find more effective ways of reducing criminal risk, which can decrease subsequent recidivism, among the individuals they supervise.

Quality of life after housing first for adults with serious mental illness who have experienced chronic homelessness.

This 1-year longitudinal study of adults who have recently transitioned from homelessness to Permanent Supportive Housing (PSH) focuses on quality of life as a primary outcome of interest. Eighty of 103 new tenants participated in structured interviews at the time of entry into their new home and at 12-months post-housing. t-tests assessed differences in community participation and quality of life measures at the 2 time points. Mixed effects models examined the impact of community participation on quality of life. Results show that time in independent housing was significantly associated with several domains of quality of life. Symptom severity was also significantly and negatively related to quality of life domains. Community participation was significantly related to frequency of social contacts only. These findings suggest that community participation is not critical to improving quality of life, and that despite concerns that individuals may feel isolated and lonely when living independently, satisfaction with one׳s living situation and family relationships nevertheless improves with housing tenure.

The relationships among depression, physical health conditions and healthcare expenditures for younger and older Americans.

BACKGROUND AND AIMS: Little is known about the extent depression adds to the costs of treatment for physical health conditions. This study examined the paths and the extent to which depression in conjunction with a physical health problem is associated with an increase in healthcare expenditures and how that is different between younger and older adults. METHODS: Data from the 2007 Medical Expenditure Panel Survey (MEPS) were analyzed. Depression status and physical health conditions were identified through ICD-9 codes. The multiple group structural equation modeling (SEM) was employed to examine the moderated mediation effects. RESULTS: Approximately 11% of adults had clinical depression. The multiple group SEM for both younger and older adult groups supports not only a direct effect of depression on expenditures but also an indirect effect via comorbid health conditions. Furthermore, the indirect effect was significantly more prominent among older respondents than among younger ones, indicating significant moderated mediation by age. CONCLUSIONS: Depression has greater effects on comorbid health conditions and an increase in total healthcare expenditures through comorbid conditions among older adults. Findings of this study suggest that proper detection and treatment of depression is beneficial in reducing overall healthcare expenditures, especially among older adults.

Prize-based contingency management for the treatment of substance abusers: a meta-analysis.

AIM: To review randomized controlled trials to assess efficacy of a prize-based contingency management procedure in reducing substance use (where a drug-free breath or urine sample provides a chance of winning a prize). METHODS: A meta-analysis was conducted on papers published from January 2000 to February 2013 to determine the effect size of studies comparing prize-based contingency management to a treatment-as-usual control condition (k = 19 studies). Parallel analyses evaluated the efficacy of both short- (k = nine studies) and long-term outcomes (k = six studies) of prize-based contingency management. RESULTS: The average end-of-treatment effect size (Cohen's d) was 0.46 [95% confidence interval (CI) = 0.37, 0.54]. This effect size decreased at the short-term (≤3-month) post-intervention follow-up to 0.33 (95% CI = 0.12, 0.54) and at the 6-month follow-up time-point there was no detectable effect [d = -0.09 (95% CI = -0.28, 0.10)]. CONCLUSION: Adding prize-based contingency management to behavioral support for substance use disorders can increase short-term abstinence, but the effect does not appear to persist to 6 months.

The association between criminal history and mental health service use among people with serious mental illness.

This study examined the extent to which a criminal history is associated with the use of various mental health services as well as related service use predictors among people with serious mental illness (SMI). Data were obtained from the National Comorbidity Survey Replication. The sample consisted of 1,588 adults with SMI, including major depressive disorder (n = 1,398) and bipolar disorder (n = 190). Chi square tests were conducted to compare respondent characteristics based upon the presence/absence of a criminal history. Logistic regression analyses were conducted to examine various mental health services usage among respondents while controlling for predisposing, enabling, and need factors. Approximately 30 % of respondents reported a criminal history. Those with a criminal history were more likely to use specialty mental health services (OR = 1.42, p < 0.05). Findings suggest that the criminal justice system may be serving as a substantial referrer to mental health services or that there is higher morbidity among people with SMI who have been justice involved.

Predictors of retention in a drug-free unit/substance abuse treatment in prison.

The high rate of dropout from treatment programs is a recurring problem in the field of drug dependence. The purpose of this study was to identify the predictors of retention in a prison-based drug-free unit (DFU). The relationships among subscales of the Addiction Severity Index (ASI) as well as motivation and personality profiles and length of stay in a DFU, of 57 prisoners admitted for the first time to the program were analyzed. The mean dropout rates were 52.9% at six months and 67.8% at one year. The mean length of stay was 195.05 days. Predictors of retention at six months included the ASI Family Composite Score, the motivation subscale Taking Steps, and Narcissistic personality trait score. Predictors of retention at one year included lower ASI Psychological Composite Score, higher scores on the motivation subscale Ambivalence, and higher number of charges pending at the time of admission to the program. Identification of these predictor variables may be useful for developing strategies to increase retention in the context of in-prison substance abuse treatment.

Comparison of major depressive disorder onset among foreign-born Asian Americans: Chinese, Filipino, and Vietnamese ethnic groups.

Using a nationally representative sample of 1280 Asian Americans, we examined the extent to which major depressive disorder (MDD) onset differs by ethnicity and its associated factors for each of the three ethnic groups: Vietnamese, Filipino, and Chinese. We employed the Kaplan-Meier method to estimate the survival and hazard functions for MDD onset by ethnicity, and cox proportional hazards models to identify socio-demographic and immigration-related factors associated with MDD onset. Approximately 7% of the entire sample had experienced MDD onset in their lifetime. Filipino immigrants showed the highest survival function, followed by Vietnamese immigrants over time. Those who were never-married or divorced were more likely to experience MDD onset when compared to their married or cohabiting counterparts. Those who immigrated at a younger age were more likely to experience MDD onset than were those who immigrated at an older age. However, there were ethnic variations in terms of the risk factors that were associated with MDD onset across these three ethnic groups. Findings from this study signal the importance of understanding the differing experiences of MDD onset by ethnicity.

Mental health service utilization among noncitizens in the United States: findings from the National Latino and Asian American Study.

Since the Welfare Reform Act of 1996, citizenship status has become an important consideration in mental health service utilization due to the restrictions on federal healthcare benefits for noncitizens living in the U.S. Using a nationally representative sample of Latinos and Asians, we examined the extent to which U.S. citizenship status was related to rates of mental health service utilization. We also identified several predictors of mental health service utilization among noncitizens. Noncitizens were about 40% less likely than U.S.-born citizens to use any mental health services. Findings are discussed in the context of healthcare policy and recent healthcare reform.

Matching consequences to behavior: implications of failing to distinguish between noncompliance and nonresponsivity.

Neither punitive nor therapeutic approaches alone are effective at addressing the dual public health and public safety concerns associated with managing criminal behavior perpetrated by people who have psychiatric and substance use disorders. The optimal solution may instead require the integration of both criminal justice supervision and treatment. Using problem-solving courts (PSCs) as a model, we focus on one dimension of this integrated approach, distinguishing between behavior that stems from willful noncompliance with supervision and behavior that results from nonresponsivity to treatment. First, we discuss the public health and public safety consequences of using singular approaches to address the criminal behavior of this population. We then present lessons learned from PSCs that distinguish between noncompliant and nonresponsive behaviors in making treatment and supervision decisions. Finally, we consider how the concepts of nonresponsivity and noncompliance may be extended, via policy, to probation and parole settings as well as mental health and substance abuse treatment services outside the criminal justice setting in order to enhance public health and safety.

Mental illness, criminal risk factors and parole release decisions.

Research has not examined whether higher rates of parole denial among inmates with mental illness (MI) are the result of the increased presence of criminal risk factors among this population. Employing a representative sample of inmates with (n = 219) and without (n = 184) MI receiving parole release decisions in 2007, this study tested whether the central eight risk factors for recidivism considered in parole release decisions intervened in the relationship between MI and parole release. MI was associated with possession of a substance use disorder, antisocial personality disorder and violent charges while incarcerated; however, these factors were not related to release decisions. MI was found to have neither a direct nor an indirect effect on release decisions. While results indicate that release decisions appear, to some extent, to be evidence-based, they also suggest considerable discretion is being implemented by parole board members in release decisions above and beyond consideration of criminal risk factors.