Research Snapshot: How likely is reincarceration among prisoners with serious mental illness?

What you need to know

High-frequency mental health service users account for a disproportionately high number of incarcerations. This study looks at the characteristics of this population. Researchers found that the most important predictors of reincarceration among those with mental illness are a diagnosis of schizophrenia/bipolar affective disorder (BPAD), homelessness, and crack cocaine or methamphetamine use. The most common offenses among this group are theft, robbery or breach of probation. Targeting resources more effectively and tailoring services for this population could lower the impact on criminal justice and mental health services.

 

This Research Snapshot was based on the article, “Patterns and Predictors of Reincarceration Among Prisoners With Serious Mental Illness: A Cohort Study,” which was published in The Canadian Journal of Psychiatry in 2020. Available at: https://doi.org/10.1177/0706743720970829. Accessed January 25, 2021.

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What is this research about?

Persons with serious mental illness (SMI) are more likely than those without SMI to be charged with a criminal offense. They are often incarcerated for minor offenses such as crimes of poverty, offenses related to substance use or minor offenses against judicial orders. These repeated brief incarcerations disrupt access to community services such as housing, income support or access to psychiatric care. A portion of this group also experience rapid and frequent incarcerations, leading to a disproportionate amount of overall service use and cost. Understanding the characteristics of those with SMI and frequent reincarcerations can be used to tailor mental health services to respond more effectively.

What did the researchers do?

This study included 4,704 incarcerated inmates who were discharged from a correctional mental health service at the Toronto South Detention Centre or the Vanier Centre for Women. Reincarceration in this study was defined as those being re-referred to the Forensic Early Intervention Service (FEIS) service, and high-frequency service users included those who had three or more incarcerations during a one-year period.

Researchers aimed to:

  • investigate the proportion and frequency of those who have mental health needs who are reincarcerated
  • define high-frequency service users
  • investigate diagnostic, clinical, criminological and social factors that predict frequency of return to custody and the amount of time between incarcerations.

All inmates are screened at reception upon arrival by correctional health staff using the Brief Jail Mental Health Screen, an 8-item mental health screening tool. Those who screen positive are referred to FEIS for assessment using the Jail Screening Assessment Tool. This assessment determines if mental health services are needed, including a referral for a psychiatric consultation. During discharge, a checklist is completed with the clinical diagnosis and services that the patient was referred to or received.

What did the researchers find?

Researchers found highly significant associations between the rate of reincarceration and having a diagnosis of schizophrenia/BPAD, homelessness, methamphetamine or crack cocaine use, offense types of theft/robbery or breach of probation, higher Brief Psychiatric Rating Scale scores, and shorter length of stay. Those with schizophrenia/BPAD were around twice as likely to have later reincarcerations. Gender was not directly associated with rate of return to custody. However, females who had schizophrenia/BPAD had a higher rate of return to custody due to the significant interaction effect of the variables studied. The severity of symptoms was also associated with rate of reincarceration.

As shown in previous studies, treatment with antipsychotic medication reduces offending, reincarceration and cost. However, continuity of community care is severely disrupted by incarceration, often leaving those released from custody without access to treatment or supports.

This study also replicates findings showing that homelessness was associated with significantly higher rates of reincarceration. Incarceration has the effect of reducing employability and straining relationships with family and social ties. Homelessness can lead to “crimes of desperation” and exposure to aggressive policing, especially of trespass or vagrancy offenses. High rates of mental illness are also among homeless people, leading to a three-way “trans-institutionalization” (e.g. moving from one institution to being dependent on another type of institution), magnified by a lack of affordable housing and substance use disorders. These variables are significant in defining the high-frequency service user group.

How can you use this research?

Focusing on the high-frequency service users with SMI may have the biggest impact in reducing the total number of incarcerations. This should include the provision of supportive housing, which has been shown to reduce overall costs to mental health services. Minor offenses such as breach of the terms of probation, failing to appear in court or to adhere to the terms of supervision, are more likely among those who have unstable housing, symptoms of a major mental disorder, and inadequate community supports. This further leads to reincarceration and the constant revolving door phenomenon. Targeted services and resources should be considered for these high-intensity services users.

Promising alternatives to incarceration and evidence-based interventions are available to provide services to help bridge the transition from jail to the community. Investment in these transitions, additional community services, and evaluating the efficacy and impact is required to address the problems faced by people with SMI released from jail to reduce reoffending. Future studies should investigate more specific diagnostic groupings and symptoms in relation to reincarceration, as well as measuring access to treatment on release and its impact on reincarceration.

Acknowledgements

This knowledge exchange activity is supported by Evidence Exchange Network (EENet), which is part of the Provincial System Support Program at the Centre for Addiction and Mental Health (CAMH). EENet has been made possible through a financial contribution from the Ministry of Health (MOH). The views expressed herein do not necessarily represent the views of either MOH or of CAMH.

While care has been taken in selecting and preparing the information included in this Research Snapshot, it is based on one research article. A comprehensive search was not completed to see if new evidence exists. As a result, the context behind the research, the terminology used, the research methods and the findings may not provide the full picture for this particular topic. Also, there might be a lag between when the study was conducted and when it was published, so it might not reflect the current evidence.  

Keywords

prison, corrections, mental illness, recidivism, women, homelessness, substance use disorders, revolving door