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Adults with Behavioral Health Needs under Correctional Supervision

on an outpatient basis by a mental health professional or general practitioner, while people with more serious or acute need for treatment and stabilization may be treated at an in-patient facility. For most cases, the objective of in-patient care is to stabilize patients so they may continue their recovery in the community. Society’s increased value on serving individuals in the least restrictive environment has led to greater emphasis on providing the appropriate level of supports for individuals to live in the community. Although individuals going through an acute crisis can receive care at a hospital emergency room (ER), mental health professionals seek to minimize inappropriate use of ERs because they are extremely costly and may reflect a breakdown in continuity of care. Someone with a mental illness may access the treatment system through any setting. However, inability to pay for services, lack of awareness of symptoms, misinformation about treatment, and fear may delay or prevent an individual from getting diagnosed and treated. Moreover, access to treatment is primarily guided by ability to pay and the payment source. Employer-sponsored health insurance provides a pathway to a wide range of healthcare professionals. A privately insured individual may receive care regardless of level of impairment. In these cases, prioritization is not driven by need but by ability to pay. Individuals whose income or disability qualifies them for Medicaid benefits are limited to accessing providers that accept Medicaid (and new patients). The uninsured often have the most limited options and rely on the resources provided by targeted, special programs in the mental health safety net. Public health officials typically prioritize mental health dollars for people with serious mental illnesses by setting strict eligibility criteria for accessing publicly funded treatment services. However, even with this prioritization, the treatment capacity in any one jurisdiction rarely matches the demand. The guiding principles for treatment include individualized treatment planning, consumer centeredness, cultural competency, the use of evidence-based practices, and the belief that recovery is possible.58 SAMHSA has defined recovery as “a process of change through which individuals improve their health and wellness, live a selfdirected life, and strive to reach their full potential.” 59 While acute interventions for individuals with mental illnesses focus on ensuring the safety of the individuals and their community, recovery remains the ultimate intended outcome for service interventions. The assessment process can include the use of tools to help determine the appropriate level of care for individuals.60 Other than overt threats to self or others, individuals’ risk to public safety is not directly assessed in most mental health assessments. Accordingly, the risk for committing a future crime is not a factor used to prioritize treatment. Figure 1 demonstrates a relationship that is somewhat intuitive: as individuals’ level of functional impairment increases, so does their need for treatment and support. At the low-needs end of the spectrum are people with mental health problems whose symptoms do not meet the threshold for a clinical diagnosis of a mental illness. Individuals at the high end experience significant functional impairments as a result of their mental illness.

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