A new study by Amanda Butler, Tonia L. Nicholls, Hasina Samji, Sheri Fabian, and M. Ruth Lavergne – first published online in Criminal Justice and Behavior – takes a new approach to studying the effects of mental illness and substance use disorder on incarceration and recidivism. Although several prior studies have noted the prevalence of these disorders among incarcerated individuals, researchers have been unable to draw firm conclusions about how they may act as predictors of recidivism. This study has opted to focus on the metric of time between release and reincarceration among prisoners within Canada’s British Columbia (BC) province, providing a new, quantitative data point to consider.
Background and Research Purposes
Within the Canadian correctional system, it is considered best practice to perform a routine screening of individuals being taken into custody at a correctional facility. This screening attempts to identify health needs and provide necessary remedies while an individual serves their sentence, including treatment for mental health issues and substance use disorders. However, resources are limited when it comes to providing further assistance beyond incarceration, such as programs that transition prisoners to community-based services or forensic care, and those that work to discourage reoffending. As a result, research has shown that recidivism is a high risk among justice-involved individuals after their release – and that mental health or substance use disorders can be exacerbating factors.
The researchers refer to several studies published in the last 15 years to describe the current body of evidence available related to recidivism. Points noted as relevant background include:
- Justice-involved individuals with mental illness are more likely to be reincarcerated and remain in custody for longer sentences than those who do not present with mental illness.
- Incidences of violent crime occurred at higher rates among offenders with mental illness, moreso when these offenders also had a substance use disorder.
- In comparative studies of offenders who presented with mental illness, substance use disorder, co-occurring disorders (COD), or neither, those with COD were found to be most likely to re-offend – in some cases experiencing multiple reincarcerations within a six-year period – and spend the least amount of time reintegrating within their communities before committing a crime.
The researchers also note, however, that this research predominantly relied upon health records to gather diagnostic information, which do not take into account certain variables among the population of incarcerated individuals and may also under-report the actual prevalence of illness.
“Rates of recidivism are used worldwide as a measure of the effectiveness of criminal sanctions and offender management programs. Recidivism is common, as shown in a recent systematic review, including studies from 25 countries, which found that 2 years postconviction, the rate of rearrest is between 26% and 60% (Yukhnenko et al., 2019).”
Methodology
The study focused on 13,109 individuals within the BC correctional system who had been released from prison between October 1, 2012, and September 30, 2014. The sample excluded individuals who were on immigration holds and those who had been transferred into federal custody. The data on each individual were gathered from two sources – the Jail Screening Assessment Tool (JSAT) and the Corrections Operations Network (CORNET) database, both administered by BC Corrections.
Diagnostic Categories
Similar to previously published research, this study grouped individuals within four distinct categories: those who indicated mental health or substance use disorders alone, those with COD, and those who indicated neither. This information was pulled from the JSAT results of each study subject, which recorded histories of mental health needs and treatment as well as histories of abuse involving controlled substances including alcohol, marijuana, and other drugs.
Sociodemographic, Clinical, and Criminal Justice Variables
The study considered a multitude of different distinctive variables for each subject available within the JSAT and CORNET data sets. Sociodemographic variables included:
- Sex
- Age
- Indigenous status
- Marital status
- Housing status
- Employment status
- Education
- Social or family support status
Clinical variables included:
- Intellectual disability
- Past traumatic brain injury
- History of suicide attempts
- Personality disorder traits or other psychiatric symptoms such as depression, hallucinations, or psychosis
Criminal Justice variables included:
- Incarceration within the prior year
- Sentenced or remanded custody status
- Length of incarceration (more or less than 30 days)
These variables in particular had been identified through prior research as predictors of recidivism.
The researchers examined a period for each individual lasting up to three years after their release from incarceration. They used CORNET data to determine if an individual had experienced reincarceration for a new offense or breach of probation within that time, had not been reincarcerated, or had passed away before the end of the period. While reincarceration statistics alone would not capture minor offenses as evidence of recidivism, the data was still considered relevant for the study’s purposes due to the likelihood that mental illness or substance use could be aggravated by the inherent characteristics of imprisonment (such as separation from family or exposure to violence).
Findings and Interpretations
Within the research cohort the study made note of several distinct associations between variables, including the following:
- Nearly half of the subjects with COD or substance use disorders only had completed a high school education.
- Over half of the subjects with COD (60%) were receiving some form of government assistance.
- Approximately 78% of subjects with COD reported being unemployed at the time of their incarceration.
With regards to the key purposes of the study, the research observed that approximately 61% of the cohort had experienced reincarceration within a period of three years (1,095 days). The study found that those with COD had the shortest median time to reincarceration, at 220 days, while those with substance use disorders only experienced a median time of 263 days. These numbers sharply contrasted with the median time for subjects with mental health disorders only (806 days) and those with no disorders, whose probability of recidivism remained above 50% at the three-year mark. The researchers also found that there were a few variables that tended to indicate a lower chance of recidivism, such as having a university education, being over the age of 45, and being female.
“In terms of clinical complexity, people with COD were the most likely to have an intellectual disability or a head injury, past suicide attempts, and/or psychiatric symptoms. Among those with COD, 46% had an intellectual disability or head injury, compared with 23% of those with no disorder.”
Conclusions
Following the findings of prior studies, the initial hypothesis of this study had assumed that justice-involved individuals with substance use disorders or COD would be most likely to experience reincarceration sooner than those with no disorders or mental disorders only. This hypothesis was ultimately affirmed, and given greater nuance by the complexity of the data gathered from the JSAT and CORNET systems.
The researchers also elaborate on several implications of these findings, supported by past studies, including:
- Treatment and services to support people during incarceration and after their release from custody are vital to reducing recidivism.
- Poor social support, financial insecurity, and unstable housing prospects increase the likelihood that recently released prisoners will reoffend.
- Drug criminalization as public policy has a capacity to create many of the conditions that lead to recidivism, such as increased barriers to employment.
The demonstrated connection between substance use disorders and COD in particular to a likelihood of recidivism leads the researchers to conclude that there must be greater collaboration between correctional, health, and social services to confront these issues.
Source: Mental Health Needs, Substance Use, and Reincarceration: Population-Level Findings From a Released Prison Cohort (Amanda Butler, Tonia L. Nicholls, Hasina Samji, Sheri Fabian, and M. Ruth Lavergne) https://journals.sagepub.com/doi/10.1177/00938548241238327
