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Behavioral Health issues in the criminal justice system

Health Desk | 7/10/2014, 9:23 a.m.
In 1999, as a doctoral candidate at the Johns Hopkins Bloomberg School of Public Health, Jarrett returned to Project L/EARN ...

A Project L/EARN alumnus works to reduce recidivism through support and treatment

Has America’s criminal justice system inadvertently become a storehouse for people with behavioral health problems?

For Nicole Jarrett, Ph.D., a senior policy analyst with the Council of State Governments (CSG) Justice Center, the question is more than academic.

“Often, correctional administrators can’t tell you who in their system has a behavioral issue and who doesn’t,” said Jarrett, a 1994 graduate of the Robert Wood Johnson Foundation-funded Project L/EARN program. “That creates problems, both behind the walls and after release.”

A 2009 study of 20,000 adults in five U.S. jails found that 17 percent met the criteria for serious mental illness — prevalence rates at least three times higher than those found in the general population. The following year, an analysis of substance abuse among the nation’s prison population concluded that 65 percent of inmates met the criteria for alcohol or substance dependence, yet only 11 percent received treatment.

“Systems — including community providers — need to collaborate so that each individual gets the appropriate treatment and support,” said Jarrett, adding that more people inside the system are on probation or parole than are incarcerated.

A 2012 white paper co-authored by Jarrett set forth the scope of the problem — and a possible solution. Adults With Behavioral Health Needs Under Correctional Supervision: A Shared Framework for Reducing Recidivism and Promoting Recovery, issued by the CSG Justice Center, National Institute of Corrections and Bureau of Justice Assistance, proposed a framework for identifying and treating people with behavioral health issues who come into contact with the system.

Jarrett sees that framework as integral to producing better outcomes for those with mental health or substance use disorders, or both.

“It’s not just a public health issue,” she said. “It’s a public safety issue.”

A defining moment

Public health is Jarrett’s passion — a path forged during her undergraduate studies at Rutgers, where she also attended Project L/EARN. The intensive, 10-week summer internship is designed to increase the number of health researchers from groups that traditionally have been under-represented in health-related graduate programs.

Jarrett calls it a defining moment. “Project L/EARN introduced me to research,” she said. “Paired with researchers working in the field, I learned how to take a project through to completion. It was the hardest I’d ever been pushed academically, but it gave me the confidence to pursue graduate studies.”

In 1999, as a doctoral candidate at the Johns Hopkins Bloomberg School of Public Health, Jarrett returned to Project L/EARN as an instructor. She later served as a program mentor during her post-doctoral fellowship at Rutgers.

“I genuinely believe in the model. The multidimensional training, plus mentorship from people who’ve gone through the process of getting grants and doing research — that’s invaluable,” she said. “I appreciated the opportunity to give back.”

Support for Mental Health and Substance Abuse Disorders

The immersive research experience of Project L/EARN has paid dividends throughout Jarrett’s career. Her keen analytic eye informed much of her tenure as director of health policy for the Baltimore City (Maryland) Health Department in the early 2000s.

Working closely with the community-based Men’s Health Center, Jarrett found that large numbers of men seeking care had recently been incarcerated and struggled upon returning to the community. “A lot of them were hopeful when they were released, but got discouraged when they couldn’t find employment, housing, or treatment,” she said.