Treating Substance Use and Mental Health Disorders in Correctional Settings
8 Pages Posted: 9 Dec 2019 Last revised: 17 Dec 2019
Date Written: August 18, 2019
Accidental overdose is the leading cause of death for Americans under the age of 50 – a veritable national public health emergency. While this issue rightly captivates headlines and the attention of policymakers, fatal drug overdose is only the tip of an iceberg of a far deeper crisis in substance use, suicide, and mental health problems in the United States. The criminal legal system plays an outsized role in this crisis. An estimated 65% of the 2.3 million people in US prisons and jails have a diagnosable substance use disorder, more than seven times the background rate. Nearly 15% of incarcerated men and 30% of women also have diagnosable mental health disorders. There is broad recognition that, in the context of mass incarceration, correctional institutions act as the de-facto national substance use and mental health safety net. Correctional health efforts to address these health conditions often fall below the medically-accepted standards of care, however. Using opioid use disorder (OUD) as a case study, this Memorandum examines key barriers and facilitators in aligning treatment behind bars with the best available evidence.
Each phase of involvement in the criminal legal system –from the point of crisis pre-arrest, through detention, and post-release – is an opportunity to address substance use disorder and mental health challenges. This means that criminal legal institutions must: (a) screen and diagnose; (b) treat; (c) monitor and support; and (d) triage individuals to appropriate health care and prevention services. The Sequential Intercept Model provides an apt conceptual framework for how key inflection points can help operationalize necessary health care along a five-phase continuum. This Memorandum highlights the case of substance use treatment using opioid agonist therapy (OAT) within the Rhode Island Department of Corrections (RIDOC).
Keywords: opioid agonist therapy, OAT, opioids, substance use disorder
Suggested Citation: Suggested Citation