Abstract

People with mental illnesses are overrepresented in criminal legal systems internationally, making addressing mental health among this population a global public health concern. Across the world, community supervision agencies (i.e., probation and parole) have implemented a variety of innovative and evidence-informed approaches to improve outcomes for people with mental illness. However, the demonstrated success of these approaches in one region or country does not guarantee effectiveness in another due to significant variations in the implementation context, including differences in governance and administration, society and culture, and resource constraints. Applying implementation science methods throughout the phases of intervention (design and development, implementation, and evaluation) provides tools that can help translate innovations within and across different agencies, countries, and contexts. To highlight how implementation science methods can be used to adapt and implement health interventions within criminal legal system settings, this perspective uses the example of specialized mental health community supervision in the USA. Drawing on general implementation science principles and the Exploration, Preparation, Implementation, Sustainment (EPIS) framework, we articulate key questions and steps agencies can take to translate health interventions from theory into practice.

Abstract

Although many studies have investigated the disproportionate representation and negative experiences of justice-involved persons with mental illness (MI), we know less about probation/parole revocations among this population. Using statewide data and propensity score matching, we compare rates of rearrests and revocations between individuals with and without MI and assess the effectiveness of Specialized Mental Health Supervision (SMHS) in reducing the likelihood of revocation. In addition, we examine whether the risk score composition differs among participants of the SMHS program from clients with MI not placed on SMHS. Findings reveal that persons with MI are more likely to have a revocation, specifically for technical violations. In addition, SMHS does not significantly lower revocations after controlling for other caseload characteristics. Finally, those with higher risk scores were significantly less likely to be placed on SMHS caseloads. Considerations for SMHS implementation are discussed.

Abstract

Objective. The purpose of this study was to engage in a collaborative process with a variety of stakeholders to develop the Brief Intervention to Promote Service Engagement (BIPSE), which aims to enhance the therapeutic relationship between probation officers and probationers with serious mental illnesses (SMI).

Methods. The BIPSE intervention was developed through a multi-stage “design for implementation” process, including a series of stakeholder meetings, observations of probation supervision sessions, incorporating existing intervention approaches, and workshopping initial BIPSE components with three randomly selected officers from a specialized mental health probation unit. Acceptability and feasibility of BIPSE components were assessed through focus groups with probation officers, additional observations of probation sessions, and qualitative interviews with probationers with SMI.

Results. Two foundational components of the BIPSE intervention were identified during the stakeholder meetings and observations: 1. Engagement and 2. Shared decision-making. These two components inform and undergird the intervention’s third component, strategic case management. During focus groups, probation officers expressed interest in using the modified tools they were given and also saw the benefit of structuring their sessions. Probationers expressed their appreciation for the caring and collaborative nature with which their probation officers approached their sessions.

Conclusion. Building a therapeutic relationship between probation officers and probationers with SMI is an essential task toward improving mental health and criminal justice outcomes. The BIPSE development and refinement process demonstrates that interventions targeting the therapeutic relationship are acceptable to officers and clients, and can be tailored and feasibly structured into standard probation practices.