RESEARCH WEEKLY: Recovery Barriers for People with Serious Mental Illness Post-Incarceration
By: Kelli South
Incarceration complicates and sometimes negatively impacts the recovery prospects for individuals with serious mental illness. The common issues faced by anyone involved in the criminal justice system are exacerbated for those with serious mental illness, making their odds of recidivism high and odds of recovering lower.
A new study recently released in
validates these claims and backs them up with empirical evidence. The authors seek to fill the gap in existing research about recovery prospects specifically for individuals who have been incarcerated and have a serious mental illness. Major barriers to recovery associated with incarceration include societal factors that cause those with serious mental illness to be incarcerated at a higher rate than the rest of the population, lack of reentry services after incarceration and lack of alternative treatment options for individuals to keep them from entering into the criminal justice system.
A qualitative analysis of interviews with people with serious mental illness
The authors conducted qualitative interviews with 17 participants who have a serious mental illness and a history of criminal justice system involvement. They used a methodology called grounded theory, which looks for commonalities across the interviews and categorizes them into overarching themes.
The definition of recovery that the authors use in this study is different from some traditional health definitions: “Recovery in this context does not refer to a remission of symptoms alone. Rather, recovery is defined as regaining a quality of life, increased symptom management, hope, acceptance, and a renewed sense of self.”
The significant limitations of this study are worth noting. A sample size of only 17 people from a rural part of Northern California may not be generalizable to a larger population of people with serious mental illness. Additionally, the characteristics and demographics of the sample do not match up with the general population. Thus, the small sample size and differences between the sample participants and the country as a whole mean the authors cannot say how their findings might be affected by these limitations.
Barriers and facilitators for recovery
The themes that emerged from the interviews were categorized into five groups: institutional, community, relationship, treatment and identity factors. Researchers found major barriers to recovery in each of the categories and they also discovered facilitators to recovery in each category. Many of the barriers to recovery were associated with a lack of treatment for the participant’s serious mental illness while they were incarcerated and after they were released. Similarly, the benefits participants cited from their incarceration experience primarily occurred for those who gained increased access to community services and treatment during and after incarceration.
The findings of the first two themes, which provide insight into the broader policy issues, are summarized below.
- Barrier: Destructive Capacity
- Destructive capacity is defined as negative experiences during incarceration that harm mental health and quality of life. This includes loneliness, fear, disorientation, and deprivation associated with incarceration and amplified by inadequate treatment services in jail.
- Facilitator: Constructive Capacity
- Constructive capacity is defined as positive experiences during incarceration that may facilitate recovery prospects. These benefits occurred primarily for those who received increased access to mental health and substance use treatment programs and case managers, not to mention shelter, food, and medical care during incarceration that they were unable to access before.
- Barrier: Community Upheaval
- Community upheaval refers to the barriers to community resources once an individual is released from jail or prison. The findings “reflect the difficulties people with a criminal record and SMI have accessing basic resources such as housing, employment, medical care, mental health care, food, and basic amenities such as medication, phones, identification, and transportation.”
- Facilitator: Community Relief
- Community relief refers to the support individuals may receive after incarceration to access community services and resources. The findings show that some individuals found the help provided by their parole officer or other criminal justice associated programs vital to their ability to access “employment, medical care, and access to county behavioral health and other community services.”
Clinical and societal implications
The authors suggest their findings have clinical implications for potential improvement before, during and after incarceration. While the authors found incarceration to be an overall barrier to recovery from serious mental illness, they do acknowledge that a few participants gained access to resources that they otherwise would not have. The authors suggest that there are better ways to supply individuals with this increased access to services than incarceration.
They call for early intervention for those diagnosed with serious mental illness and for society to address systemic issues like trauma, poverty and substance use that can lead to incarceration. Further, the authors note a range of interventions that can help individuals with serious mental illness avoid the criminal justice system, including: “prison reform and sentencing, mental health courts, meaningful and structured activities during incarceration, increased rehabilitation programs, transitional housing, and consistent and effective assisted outpatient treatment (AOT) and assertive community treatment (ACT) programs upon release.”
Although this study is small and has significant limitations, the findings suggest that people with serious mental illness face significant barriers to a fulfilling life due to the burden placed upon them by the criminal justice system. The authors acknowledge the study’s limitations and call for their research to be replicated with a larger, more diverse sample of participants.