OBJECTIVE: This study examined a range of demographic, clinical, and criminal history factors as they relate to the intensity of offending for up to two years postrelease. METHODS: This study drew on data from 1,438 individuals released from Massachusetts state prisons between 2007 and 2009 who, while incarcerated, received treatment from the prisons' mental health services and were followed for 24 months postrelease. These data were used to explore predictive factors related to the intensity of criminal justice involvement, defined as number of arrests in the two-year follow-up period. RESULTS: Predictors of subsequent arrests included number of previous incarcerations and black race. Protective factors included older age, supervision by parole, and a drug-related or person-related governing offense on previous arrest. Clinical symptoms were not related to incidence of postrelease arrests. CONCLUSIONS: This study identified factors related to criminal history, such as type of charge, that were associated with the intensity of subsequent criminal justice involvement. These findings have not been reported in previous studies, perhaps because intensity of offending as opposed to a different dependent variable was used to measure criminal justice involvement. Further investigation should focus on whether the type of previous offense is related to postrelease risk factors for recidivism.

OBJECTIVE: In the context of an increasing correctional population and corresponding rates of mental illness and substance abuse among this population, this study focuses on describing the predictors of substance abuse service utilization for ex-inmates with dual disorders. Our aim is to assess the likelihood and characteristics of ex-inmates with mental disorders who access substance abuse treatment services within two years of correctional release. METHODS: Using merged administrative data on all ex-inmates with open mental health cases released from Massachusetts Department of Corrections and two County Houses of Corrections from 2007 to 2009 (N=2,280) and substance abuse treatment outcome data through 2011, we analyze the influence of demographics, behavioral and mental disorders, and criminal justice variables on entry into substance abuse treatment within 24 months post release. We also describe primary drug use and services utilized for all the ex-inmates who accessed substance abuse services (N=1,383). Regression techniques were used to analyze the probability of utilizing substance abuse treatment services by various demographic, behavioral, and criminal involvement characteristics. RESULTS: The prevalence of a history of substance use disorders is high in this population (69%; n = 1,285). Subsequently, at 24 months post release 61% (n = 1,383) of ex-inmates with open mental health cases utilized substance abuse treatment services. This group was disproportionately female, with a preincarceration history of substance abuse, an increased number of previous incarcerations, and more likely released under correctional supervision. CONCLUSIONS: Substance abuse is a chronic relapsing disorder and dual diagnosis is common among individuals with mental disorders involved with the criminal justice system. Their service needs and contacts across substance abuse, mental health, and criminal justice systems highlight individuals caught up in the institutional circuit. Study results point to the need for expanded and targeted dual diagnosis treatment approaches and relapse prevention for ex-inmates with mental disorders post correctional release.

Our study is the first-ever initiative to merge administrative databases in Massachusetts to evaluate an important public mental health program. It examines post-incarceration outcomes of adults with serious mental illness (SMI) enrolled in the Massachusetts Department of Mental Health (DMH) Forensic Transition Team (FTT) program. The program began in 1998 with the goal of transitioning offenders with SMI released from state and local correctional facilities utilizing a core set of transition activities. In this study we evaluate the program's effectiveness using merged administrative data from various state agencies for the years 2007-2011, comparing FTT clients to released prisoners who, despite having serious mental health disorders, did not meet the criterion for DMH services. By systematically describing our original study design and the barriers we encountered, this report will inform future efforts to evaluate public programs using merged administrative databases and electronic health records.

Describes a study which will establish a combined dataset “harmonizing” existing administrative databases to evaluate the effectiveness of the Massachusetts Department of Mental Health’s Forensic Transition Team (FTT). The FTT is a case coordinator-based reentry program that serves persons with serious mental illness (SMI) transitioning from prisons. As needed, the FTT coordinators advocate for clients by attending discharge-planning meetings, providing linkages to providers, and tracking clients’ progress for three months post-release. A Spanish translation of this publication is available for download.

OBJECTIVE: The belief that public mental health services should be regionalized has guided their delivery for the past four decades. But there have been few opportunities to observe and evaluate a service entity's shift from a centralized to a regionalized delivery system. This brief report focuses on the regionalization of the Massachusetts Department of Mental Health's forensic transition team, a service that manages community reentry from correctional settings for persons with severe mental illness. METHODS: Pre-and postregionalization episodes (N=957) were compared to examine the consequences of regionalizing the forensic transition team. RESULTS: Overall, engagement in services, a key forensic transition team outcome measure, improved postregionalization. Unexpectedly, the rate of loss to follow-up significantly increased among former county house of correction inmates. CONCLUSIONS: Overall, regionalizing reentry services increased the forensic transition team's capability and expertise in managing reentry for persons with mental illness. However, follow-up of individuals exiting county houses of correction remains a challenge.