Program Profile: Mental Health Services Continuum Program (Calif.)

The program targets persons on parole with mental health problems and provides services to enhance their level of individual functioning in the community. The overall goal is to reduce recidivism of mentally ill persons on parole and improve public safety. The program is rated Promising. Persons on parole who participated in the program showed a statistically significant reduction in the odds of being returned to custody.

A Promising rating implies that implementing the program may result in the intended outcome(s).

Program Goals

The Mental Health Services Continuum Program (MHSCP) was designed to reduce the symptoms of mental illness among persons on parole, by providing timely, cost-effective mental health services that enhance parolees’ level of individual functioning in the community. The program targets inmates with mental health problems who are under the jurisdiction of the California Department of Corrections and Rehabilitation (CDCR) and are expected to be paroled in the next few months. The overall goal is to reduce recidivism of mentally ill parolees and improve public safety.

Target Population

The MHSCP was designed for persons on parole who received mental health treatment while in prison under the Mental Health Services Delivery System of the CDCR. The program also targets parolees who have been in a Mental Health Crisis Bed as well as those being released from any Department of Mental Health facility.

To be eligible for the MHSCP, persons on parole must have a diagnosis of one or more of the following Diagnostic and Statistical Manual of Mental Disorders, 4th Edition (DSM-IV) psychiatric disorders: schizophrenia (all subtypes); delusional disorder; schizophreniform disorder; schizoaffective disorder; substance-induced psychotic disorder (excluding intoxication and withdrawal); psychotic disorder due to a general medical condition; psychotic disorder not otherwise specified; major depressive disorders; bipolar disorders I and II; and medical necessity (any other major mental illness diagnosis that requires treatment due to the acuity of the illness).

Mental health designations are used to determine the level of treatment need for persons on parole upon release. They receive one of two designations: 1) Correctional Clinical Case Management System (CCCMS), which requires one or more of the DSM-IV diagnoses and a stable functioning in the community as well as a Global Assessment of Functioning (GAF) Score above 50; or 2) Enhanced Outpatient Program (EOP), which also requires one or more of the DSM-IV diagnoses and an acute onset or significant deterioration of a serious mental disorder, hallucinatory experience, dysfunctional or disruptive social interaction, impairment of Activities of Daily Living, and a GAF Score of 50 or less.

Program Components

The MHSCP includes

• Pre-release assessment of mentally ill inmates who are close to being paroled
• Pre-release benefits eligibility and application assistance
• Expanded and enhanced post-release mental health treatment for mentally ill persons on parole
• Improved continuity of care from the Mental Health Services Delivery System to the community-based Parole Outpatient Clinic (POC)
• Increased assistance for reintegration into the community upon discharge from parole

Within 90 days of an inmate’s estimated parole release date, a social worker from the regional Transitional Case Management Program–Mental Illness (TCMP-MI) conducts a face-to-face assessment with the inmate. That assessment is updated within 30 days of the inmate’s release. The social worker merges the assessment information into the Parole Automated Tracking System database. The TCMP-MI liaison verifies the information and sends it to the appropriate POC. The POC liaison for the MHSCP consults with the inmate’s parole agent of record and schedules an initial appointment with the persons on parole. The appointment is scheduled to occur within 3 working days of release for EOP parolees and within 7 working days for CCCMS parolees.

Once persons on parole are released from prison, they return to one of four parole regions in California. EOP parolees are required to receive at least eight consecutive weekly POC appointments within the first 60 days following release. CCCMS parolees are required to receive at least four consecutive weekly POC visits within the first 30 days of the initial appointment. Treatment that may be provided to persons on parole includes medication management, group therapy, individual therapy, and case management.

Study 1

Farabee and colleagues (2008) assessed the effectiveness of the Mental Health Services Continuum Program (MHSCP) to reduce recidivism of persons on parole with mental health problems. A comparison was conducted between inmates who received pre-release assessments by Transitional Case Management Program (TMCP) social workers and non-assessed inmates. The sample (N=106,667) included inmates released between January 1, 2003, and December 31, 2007. The assessed treatment group included 45,764 inmates. The assessed group was 84 percent male, with an average age of 38.6 years. The race/ethnicity breakdown was 34.2 percent African American, 20.8 percent Hispanic, 41.7 percent white, and 3.3 percent other. The non-assessed comparison group included 60,903 inmates. The non-assessed group was 85.9 percent male, with an average age of 38.1 years. The race/ethnicity breakdown was 33.2 percent African American, 23 percent Hispanic, 40.4 percent white, and 3.5 percent other. There were significant differences between the groups on background characteristics, which were controlled for in the analysis.

The primary outcome of interest was recidivism, which was based on their return to custody, regardless of the reason. Recidivism was based on release cohorts, rather than on individuals, which means that one person on parole could have accounted for multiple returns to custody.

A multivariate logistic regression was conducted to predict the likelihood that assessed persons on parole would be returned to custody within 12 months of release. For this analysis, a cohort of persons who committed a crime who were released between January 1, 2003, and December 31, 2006 (N=74,015) were used, because a policy change to the MHSCP in early 2007 may have affected the results. The analysis included six control variables (age, gender, race/ethnicity, commitment offense, parole region, and severity of mental health problems) and two primary variables of interest related to the MHSCP transitional process: 1) whether inmates were assessed by a TMCP social worker prior to release; and 2) whether inmates had at least one Parole Outpatient Clinic contact following release.

Farabee and colleagues (2008) conducted a cost analysis of the Mental Health Services Continuum Program (MHSCP) by estimating the incremental cost savings associated with avoided incarceration costs with the receipt of the transitional services under the program. The study authors found that pre-release assessments were associated with annual savings of $2,357 for each Enhanced Outpatient Program (EOP) parolee and $1,049 for each Correctional Clinical Case Management System (CCCMS) parolee, compared with non-assessed parolees. In addition, it was found that having one or more Parole Outpatient Clinic (POC) contacts following release was associated with an annual savings of $4,881 for EOP parolees and $2,861 for CCCMS parolees, compared with parolees who had no POC contact.

These sources were used in the development of the program profile:

These sources were used in the development of the program profile:

California Department of Corrections & Rehabiliation. 2015.”Mental Health Services Continuum Program.” Accessed December 22, 2015.

https://www.cdcr.ca.gov/parole/parole/mental-health-services-continuum-program/

Following are CrimeSolutions-rated programs that are related to this practice:

Adult Reentry Programs

This practice involves correctional programs that focus on the transition of individuals from prison into the community. Reentry programs involve treatment or services that have been initiated while the individual is in custody and a follow-up component after the individual is released. The practice is rated Promising for reducing recidivism.

Evidence Ratings for Outcomes

Crime & Delinquency - Multiple crime/offense types

Rehabilitation Programs for Adults Convicted of a Crime

This practice includes programs that are designed to reduce recidivism among adults by improving their behaviors, skills, mental health, social functioning, and access to education and employment. They may become participants in rehabilitation programs during multiple points in their involvement with the criminal justice system. This practice is rated Promising for reducing recidivism among adults who have been convicted of an offense.

Evidence Ratings for Outcomes

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Why might a practice's outcome ratings differ from the ratings of specific programs encompassed by that practice?