Part I: current Responses to Individuals with Mental Health and Substance Use Disorders and Corrections Involvement
Motivation or readiness is important for individuals’ success but may not be the best factor for determining program participation in prisons and jails. Unlike the constitutional protections that assure inmates have access to medical care, including mental health treatment and the management of substance withdrawal syndromes, individuals do not have the right to access all types of substance abuse treatment or the types of criminogenic risk-focused cognitive behavioral treatment programs that may be offered in a prison or jail. In facilities and in the community, access to these programs must be triaged. When there is an absence of clear eligibility and priority criteria, sometimes more highly motivated individuals in low-risk/low-need categories take up valuable cognitive behavioral treatment slots and mix with high-risk individuals. Current research clearly shows that not only does this increase the likelihood of low-risk individuals reoffending, it lowers the overall effectiveness of the program for higherrisk individuals.79 Using motivation as a filter for program participation is particularly problematic because the least motivated may pose a greater threat to public safety (moreover, there are interventions that can improve their motivational state). Sometimes courts or parole boards assign individuals to supervision and community-based services according to crime categories (e.g., violent, nonviolent, or drug-related) and not objective assessments of a person’s risk of reoffending. Without the benefit of assessment information, this can result in lower-risk individuals being assigned to scarce cognitive skills training programs, such as anger management. Not only do they take up valuable treatment slots, but their likelihood of recidivating is also not reduced. Current research points toward the “Risk-Need-Responsivity” (RNR) model for how corrections authorities should be identifying and prioritizing individuals to receive appropriate interventions.80 It has been found to be effective across settings (probation, parole, and prisons and jails) and offender populations (including individuals of diverse age, race/ethnicity, and gender).81 Although focused on the risk of reoffending, its approach also is instructive in connecting behavioral health needs to criminogenic risk. Because the RNR model is a foundation for the proposed framework that follows for coordinating and prioritizing corrections and mental health and substance use resources, it is important to understand its underlying principles. Risk Principle: Match the intensity of individuals’ treatment to their level of risk for reoffending.* Research shows that prioritizing supervision resources for individuals at moderate or high criminogenic risk can lead to a significant reduction in recidivism among this group. Conversely, intensive supervision interventions alone for individuals who are at a low risk of recidivism will do little to actually change the person’s likelihood of committing future criminal acts, and may even be *Some risk assessment instruments go beyond determining risks for reoffending and also try to ascertain the risks associated with technical violations of probation or parole that can lead to reincarceration (recidivism measures). There are also specialized risk assessment tools that have been developed to determine specific areas of risk, such as violent behavior and sexual offending behavior. These risk tools may be used in addition to assessing the risk of reoffending, but no risk tool exists that can predict the behavior of a specific individual.