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Justice-Involved Individuals, Mental Health, and the Revolving Door

  • September 30, 2022
  • Patients and Families, Serious mental illness, Treatment

On Sept. 20, 2022, the U.S. Preventative Services Task Force (USPSTF) released a draft statement recommending that U.S. adults under the age of 65 should be screened for anxiety 1. This recommendation underscores the emerging need for the inclusion of mental health screens as a part of everyday clinical practice and not simply reserved for behavioral health settings. More widespread screening will better inform treatment decisions, lead to referrals for care, and slow down, or in some cases even stop, the revolving door too often experienced by patients with anxiety.

Unfortunately, the revolving door is familiar to many who have struggled with various mental health disorders. In recent years the perception of mental health has experienced a paradigm shift in part due to famous individuals, both in the U.S. and abroad, bravely coming out of the shadows to share their own very relatable mental health struggles. Unfortunately, the stigma surrounding mental health and treatment for mental health disorders persists within many groups of people and it can negatively impact patient outcomes. However, if an individual with mental illness also happens to be justice-involved, they will likely face additional stigmas and an even more challenging road to recovery… a different revolving door.

Individuals with severe mental illness and substance use disorder are disproportionally represented within the criminal justice system. Many individuals experience exacerbations of their mental illness, for a myriad of reasons, often leading to their justice system involvement.

Even under the best circumstances, justice-involved individuals can accumulate additional emotional injuries during their interaction with the criminal justice system. These emotional injuries often go unspoken by the individual for fear of further stigmatization. The mental health of justice-involved individuals is often further jeopardized when they attempt to re-integrate into society.

Though many criminal justice reforms have centered on making mental health care more accessible to the justice-involved population, it is unclear how well these individuals are adequately able to engage with the services offered after release making successful re-entry into society difficult. Increased difficulty with engagement, regardless of cause, may lead to further mental health exacerbations, loss of sobriety, and the like, leaving the individual vulnerable and ultimately leading to re-involvement with the criminal justice system (i.e., recidivism).

Given these factors, how can mental health clinicians best help their justice-involved or formerly justice-involved patients find treatment success? To some degree, the answer to this lies within the mental health clinicians’ holistic approach to the patient evaluation, including a better understanding of the patient’s experiences within the criminal justice system and how that impacts the various aspects of the person’s life — the biological, psychological, and social components. A non-judgmental, patient-centered approach to better understand their needs for coordination of individualized care is paramount to the patient’s long-term treatment success.

Perhaps erasing the stigma of mental health in justice-involved individuals and assessing mental health as an essential “vital sign” will be the next paradigm shift? 2


Content Author

K. Maravet Baig-Ward, M.D., Ph.D.

UT Southwestern Medical Center

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