From Carceral to the Community: Bringing Interventions Targeting Criminal Legal System Risk into Community Mental Health Settings for Individuals with Serious Mental Illness

Background and Purpose: Individuals with serious mental illness (SMI) are overrepresented in the criminal legal (CL) system and recidivate sooner and more often those without SMI. Interventions targeting individual-level risk factors for CL involvement have been shown to reduce recidivism among people with SMI, yet most are designed for delivery in carceral settings, even though the majority of this population receives care in community-based mental health settings. Consequently, interventions addressing recidivism risk within community mental health contexts are urgently needed. Here, we present findings from the early development stage of Forging New Paths (FNP), a novel, community-based intervention for system-involved individuals with SMI. To enhance FNP’s scalability and usability in community-based settings, we employed user-centered intervention research methods to elicit feedback from clinicians and administrators in a community mental health agency on ways to design the new intervention to optimize its usability in community mental health contexts.

Methods: We conducted four semi-structured, virtual focus groups with clinicians (n = 10) and administrators (n = 4) working in a community mental health center serving a large number of system-involved individuals with SMI. Each focus group began with a presentation of the initial prototype of FNP, which was followed by a series of questions designed to elicit participants’ perspectives on the key considerations for the design/delivery of the new intervention and considerations associated with implementing FNP in community mental health settings. Data were analyzed by a team of three coders using qualitative inductive thematic analysis.

Results: Focus groups discussions identified several ways to enhance the usability of FNP in community mental health setting, which converged around three themes: Aligning Delivery Mechanisms to Fit the Community Mental Health System, Supporting Social Learning, and Considering Social Care. Aligning Delivery Mechanisms to Fit the Community Mental Health System reflects participants’ suggestions for adapting how FNP is delivered to better fit community mental health contexts. This included using person-centered, non-stigmatizing language, integrating FNP into existing services that individuals are already accessing, and incorporating tangible incentives to support engagement. Supporting Social Learning describes participants’ recommendations for maximizing prosocial learning opportunities within FNP, which was viewed as essential for increasing the intervention’s acceptability and efficacy in community-based settings. Considering Social Care refers to the importance participants placed on ensuring that the content and delivery of FNP acknowledges and helps to address the basic social care needs that system-involved individuals with SMI in community settings frequently face.

Conclusions and Implications: Study findings point to practical strategies for strengthening interventions for system-involved individuals with SMI in community mental health settings. Our results highlight the importance of delivering these interventions in ways that acknowledge and address the complex social care needs of this population, while also reducing common barriers to engagement. Overall, study findings can inform efforts to better integrate interventions targeting individual-level risk factors for CL involvement into existing community mental health services, supporting efforts to transform these settings into the “ultimate intercept” of preventative engagement that disrupts the high rates of CL system involvement in this population.