Part I: current Responses to Individuals with Mental Health and Substance Use Disorders and Corrections Involvement
incentives and sanctions to address compliance issues, and target individuals at higher risk for criminal activity.74 In many criminal justice settings, referrals to substance abuse treatment are not driven by clinical assessment but instead by plea-bargain decisions, drug-related charges, or positive drug tests. In these instances, prioritizing treatment for those who are dependent rather than abusing drugs and alcohol usually does not occur. A drug-related arrest or positive drug test does not directly correlate to addiction to a substance or the need for higher-intensity services and is not the best criterion for program participation. Having people with less problematic drug abuse disorders in residential treatment beds, for example, is not an effective use of these scarce treatment resources and is not considered good clinical care. Matching the person’s need for treatment to the appropriate intervention is particularly important in jurisdictions where there may be low-level diversion programs and higher-intensity probation-based treatment programs and drug courts. With some substance abuse treatment providers receiving the majority of their referrals from the criminal justice system, they are more familiar with the needs of the population than mental health care providers and may have specific training on how to address criminogenic needs.
Mental Health and Substance Use Appearing Together Among the general public, the co-occurrence of mental health and substance use disorders is not a random event. Individuals with substance use disorders are more likely to have a mental illness than those without a substance use disorder, and individuals with mental illnesses are more likely to have a substance use disorder than those without a mental illness.* Individuals with co-occurring disorders can enter the behavioral health system for services that address either their mental illness or substance use disorder. In the community, mental health and substance abuse treatment providers have tried to develop a no-wrong-door approach for accessing behavioral health care. Individuals with mental health and substance abuse needs can ideally be screened, assessed, and referred for treatment in either system. However, access to treatment is again driven by medical necessity and payment source, and prioritization for particular services may not be driven by need. Among the principles of care that govern work with individuals with co-occurring disorders are that, within the treatment context, both co-occurring disorders are considered primary; empathy, respect, and belief in the individual’s capacity for recovery are fundamental provider attitudes; and a coordinated system of mental health and *One such study found that individuals with schizophrenia were more than four times more likely to have had a substance use disorder during their lifetime than individuals without schizophrenia, and those with bipolar disorder were more than five times as likely to have had such a diagnosis. (See Darrel A. Regier, Mary E. Farmer, Donald S. Rae, Ben Z. Locke, Samuel J. Keith, Lewis L. Judd, and Frederick K. Goodwin, “Comorbidity of Mental Disorders with Alcohol and Other Drug Abuse,” Journal of the American Medical Association 264, no. 19 (1990): 2511–2518.)