Health and service access challenges for correctional offenders with mental health and substance use problems in transition from incarceration to community: A literature review

Research Highlights: Continuity of mental health treatment, stable housing and employment promote more positive outcomes.

This study compiled a narrative review of the literature identifying: health problems and breakdown of access to care and services for offenders with mental health and substance use issues during transition from incarceration to the community, the factors contributing to these outcomes, and evaluated interventions or approaches for mitigating these harms over the last twenty years.

We searched key databases for publications on experiences or challenges of transition/release from incarceration among mentally ill and/or substance user populations for studies published in 1996 to present. The information was organized into three broad themes relating to challenges and outcomes during release from correctional institutions, contributing factors to these challenges, and interventions aimed at reducing poor outcomes. Contributing factors were further divided into individual (i.e., personal explanations for behaviour), structural (i.e., those dealing with economic and social environments), and systemic factors.

Individual factors related to addictions and personality disorders contributed to a heightened difficulty to remain engaged in treatment services. Structural factors, such as restrictive housing and employment policies or requirements, posed barriers that did not accommodate the specific needs of mentally ill and substance-using inmate populations. Systemic factors, including inadequate pre-release planning and unstable housing were obstacles to attaining social stability and engaging in treatment during the transition from incarceration to community.

Approaches most consistently beneficial across all outcomes were those that provided in-custody treatment with pre- and post-release care planning, arrangement and follow-up. Pre- or post-release interventions alone usually did not ensure consistent contact with and engagement of offenders in treatment during the critical point of release to ensure uninterrupted treatment during transition from incarceration to community. Offenders engaged in post-release mental health or substance use treatment experienced lower rates of hospitalization, drug use, death, and re-incarceration.

Interventions that provided both pre-release initiation of care and ensured continuation of aftercare through case management or enrolling offenders in community programs before release were associated with less relapse to drug use and return to risky pre-incarceration behaviour, lower likelihood of re-arrest, and higher levels of retention in treatment.

Many released offenders with mental health or substance use issues noted their most pressing needs upon release were for housing and employment or other financial assistance. Their inability to access or remain in mental health or substance use treatment after release was due to their primary need to pursue social stability (i.e., housing, employment).

Continuity of treatment for offenders with a mental disorder post release is important to improve outcomes but is jeopardized when other pressing social needs are prioritized. Stressors that contributed to poorer outcomes were lack of social support and challenges in obtaining financial and housing stability during reintegration.

Murphy, Y., Ali, F., Fischer, B. Health and service access challenges for correctional offenders with mental health and substance use problems in transition from incarceration to community: A literature review. (Research Report R-398). Ottawa, Ontario: Correctional Service of Canada.

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