“You Don't Get No Help”: The Role of Community Context in Effectiveness of Evidence-Based Treatments for People with Mental Illness Leaving Prison for High Risk Environments

Abstract

Community reentry interventions for persons with serious mental illness leaving prison have operated under the tenet that linkage to mental health services is a paramount priority to achieving successful reentry. However, these interventions have produced mixed outcomes, especially related to psychiatric or criminal recidivism. As mental health evidence–based treatments are applied to this population, other environmental or community-level factors such as social disadvantage and poverty may enable or suppress the effectiveness of such intervention models. Such factors need to be considered as possible impediments to the effectiveness of these interventions as perhaps demonstrated in trials with other populations. Explicitly addressing these factors may help improve outcomes in some cases. In others, the impact of the risk environment may be stronger than what could be overcome with clinically focused intervention.