Principles of Community-Based Behavioral Health Services for Justice-Involved Individuals

Richmond, Va. – In March 2019, the Substance Abuse and Mental Health Services Administration (SAMHSA) released a guide for community-based behavioral health services for justice-involved individuals. This guideline is meant to promote a quality, evidence- and community-based behavioral health treatment system that is responsive to all individuals with mental health and substance use disorders. Individuals with behavioral health issues disproportionately comprise the population in jails and prisons, they are also more likely to stay in jail longer, have increased risk for self-harm, and receive more frequent punitive responses to infractions than their neurotypical counterparts. When they reenter their communities, they require continued behavioral and physical health care services.

SAMHSA lays out eight principles, based on current research, to help individuals who come out of the justice system land successfully on their feet within their communities. These principles are meant to provide a foundation for “realizing a quality, community-based behavioral health treatment system.”

Principles of Community-Based Behavioral Health Services

Principle 1: Community providers are knowledgeable about the criminal justice system.

This begins with law enforcement officers. This initial contact can lead to entry into pretrial services, adjudication, sentencing, or corrections. “Understanding the criminal justice system can help community providers facilitate continuous and coordinated treatment and services for justice-involved individuals with mental health and substance use disorders.” It can also help providers understand where opportunities exist to divert clients into treatment.

Principle 2: Community providers collaborate with criminal justice professionals

This will lead to improvements in public health, public safety, and individual behavioral health outcomes. Collaboration is crucial for ensuring continuity of care for individuals transitioning from incarceration into the community. This collaboration necessarily includes sharing information, responsibility, and accountability. “For individuals under the supervision of community corrections, partnering with parole and probation professional can facilitate coordinated care and adherence to supervision requirements.”

Principle 3: Evidence-based practices are used to provide high quality clinical care

“Evidence-based programs and practices for mental and substance use disorders should be used for all individuals, with adaptations specific to justice involvement when appropriate.” These adaptations should specifically address criminal thinking and cognitive-skills training, and treatment should address motivation, problem solving, skill building, and building prosocial supports and activities. In addition, treatment should help clients develop lasting cognitive, social, emotional, and coping and refusal skills.

Principle 4: Community providers understand and address criminogenic risk and need factors

“Criminogenic risk is the likelihood that an individual will engage in future illegal behavior in the form of a new crime of failure to comply with conditions of probation or parole.” Criminogenic needs are those factors which increase the likelihood of re-offense. These factors are malleable and responsive to intervention, but behavioral health treatment alone cannot reduce recidivism. Effective treatment should address an individual’s mental illness, substance use, and criminogenic risk and need factors.

Principle 5: Integrated physical and behavioral health care is part of a comprehensive treatment plan

Chronic health conditions require coordinated care across providers, and formerly incarcerated populations are at increased risk for serious and complex chronic conditions. Incarceration can exacerbate existing conditions, making comprehensive, whole-person care even more important for this population. “By integrating physical and behavioral health care, community providers can offer whole-person care that is well coordinated and convenient for an individual, thereby improving access to and engagement with services.”

Principle 6: Services and workplaces are trauma-informed to support health and safety

Involvements with the justice system are correlated with exposure to traumatic events. This trauma can be physically or emotionally harmful and can have lasting effects on an individual’s functioning and mental, physical, social, emotional, or spiritual well-being. “While incarcerated, individuals may experience trauma specific to the jail or prison setting… [and] Prior trauma may be compounded by experiences of trauma while incarcerated.” Promoting safety and trust within a workplace by creating and promoting a trauma-informed approach to services can minimize risky situations for both clients and practitioners, ultimately improving the safety and well-being of all persons involved.

Principle 7: Case management incorporates treatment, social services, and social supports

By incorporating treatment, social services, and social supports into case management, the likelihood of recidivism is reduced. Individuals reentering communities from jails and prisons face unique obstacles in finding housing, employment, and health care services. Effective case management can play an important role in connecting individuals to services.

Principle 8: Community providers recognize and address issues that may contribute to disparities in behavioral health care and the criminal justice system

“Different population groups, often based on race, ethnicity, gender, sexual orientation, and economic status, have disparate access to high-quality behavioral health treatment and experience disproportionate representation in the criminal justice system.” Understanding these structural biases can help to prevent further perpetuation and interference with positive outcomes.

Incarceration can be a major destabilizing factor in someone’s life, but it doesn’t have to be. You can download SAMHSA’s full report here. The goals of improving behavioral and physical health, promoting social wellbeing, and preventing or reducing the likelihood of contact with the criminal justice system are possible. Clinical and case management skills of community providers are the foundation of effective treatment for justice-involved individuals.