Lack of access to medication, employment, housing, food, social supports, and health care can produce poor outcomes for many people who find themselves caught up in a revolving cycle of jail admissions and releases. Comprehensive and collaborative transition planning for individuals with mental and substance use disorders can disrupt this cycle and improve individual and system level outcomes.

8.5.1 Continuity of Care

Continuity of care is when two or more service providers or agencies work together to move a client from a higher or lower level of care. Examples may include someone moving from a residential treatment program to intensive outpatient or day treatment programming. Another example may include someone with a mental disorder living in group housing and becoming more symptomatic or having trouble accessing their prescribed mental health medication. Changes to the person’s mental health stability could result in needing to access a higher level of care (i.e., return back to a controlled environment, like a hospital).

Continuity of care is best practice among providers to ensure there is a smooth transition for the person accessing services from one level of care to another. Service providers must work together to ensure the person experiencing the mental disorder can successfully transition to the various services. Service providers must work to effectively treat the individual at the level of care that best meets their current mental health needs.

8.5.2 Mentoring – Peer Services

Over the past few decades, peer services have become more available to formerly incarcerated people. Peer services are “person centered” and highly focused on the peer relationship, versus clinical approaches. Peer mentors share their own lived experience to support the person moving towards change in their life. Peer services first began to gain recognition in the 1960s. At this time, Alcoholics Anonymous and Narcotics Anonymous was already a respected model to assist people working towards sobriety. Around this time, peers began to recognize that organizations and systems should not make decisions without the peer voice acknowledged and heard. In the 1970s, drop-in centers began to form to support people recovering from substance use disorders or mental disorders to have communal spaces with one another. In the 1980s, peer mentors for both mental disorders and substance use disorders began working in professional settings. Today, peer mentors can bill insurance companies to provide support to those receiving mental health services and substance use treatment services.

8.5.3 Medication Management

Mental health professionals work diligently to ensure people with mental disorders in their care are able to access and maintain connections to prescribed mental health medications. Medication management is the practice where a prescriber prescribes and manages the prescription for their patient. A prescriber will meet with someone about monthly to determine if the prescribed medication is effective in targeting their mental health symptoms. Prescribers will also inquire about side effects that may be impacting the person physically or emotionally. Prescribers are sometimes part of a team-based care approach, for example working closely with the mental health provider, case manager, and/or peer mentor assigned to the patient receiving care. Today, injectable medications to help treat mental disorders are more accessible and more widely used. It is also common for incarcerated people to be given a bridge of medications prescription prior to release from custody. A bridge of medication can assist in supporting someone to remain connected to their mental health medication regimen while they work to find an on-going prescriber in the community. Probation officers, community treatment mental health providers, and case managers are frequently working with the person with the mental disorder to ensure they remain connected to their treatment medication regimen they were taking and stabilized on while incarcerated.

8.5.4 Health Insurance Portability and Accountability Act (HIPPA)

All mental health treatment providers must follow the requirements set forth in the Health Insurance Portability and Accountability Act (HIPPA) of 1996, which prohibits unauthorized sharing of patient medical records. Probation officers sharing of information does not fall under HIPPA as all information obtained from probation is property of the Court. HIPAA can become a barrier to sharing helpful information among agencies particularly when separate agencies are attempting to provide quality continuity of care. In addition, different mental health agencies interpret HIPPA requirements and interpretations of the law differently, which can also cause inconsistencies with sharing of pertinent information to support a person with mental disorders in the various systems which they are often attempting to navigate.

8.5.5 Third-Party Risk Notification

Many professionals working in the criminal justice system are mandatory reporters, meaning they must report to the Department of Human Services (DHS) or law enforcement if someone is in imminent risk to themselves or others or have indicated that a child or elderly person is being abused or neglected. In addition, the Court often imposes a standard condition of supervised release where a probation officer must inform third parties of potential risk that the person under supervision may cause, known as third-party risk notification. For example, if a person under supervision has a previous charge of domestic violence, the probation officer would require that the person under supervision inform their romantic partner that they have a history of committing domestic violence. The probation officer is then required to confirm with the romantic partner that the person under supervision informed the person who is potentially at risk. Another example may be if a person under supervision applies to work at a bank and has a criminal history of robbing banks. The probation officer would require that the person notifies the bank of their history of bank robbery convictions and the probation officer would confirm with the bank that this notification occurred. Third party notification is different from duty to warn, which will be discussed in greater detail in Chapter 10.

8.5.6 Treatment Services versus Criminal Penalties

Oregon has  implemented legislation supported by voters that connect people struggling with substance use to treatment services instead of criminalizing their substance use. For example, Measure 110 was a ballot measure that was voted into legislation in 2020.  The purpose of Measure 110 is to make screening health assessment, treatment and recovery services for drug addiction available to all those who need and want access to those services; and to adopt a health approach to drug addiction by removing criminal penalties for low-level drug possession.

When voters passed the ballot measure, they recognized drug addiction and overdoses are serious problems that require expanded access to drug treatment. A health-based approach to addiction and overdose is more effective, humane, and cost-effective than criminal punishments. Making people criminals because they suffer from addiction is expensive, ruins lives, and can make access to treatment and recovery more difficult.

Multiple criminal sentencing laws regulating the possession of controlled substances changed from felonies to Class E violations on February 1, 2021.  A Class E violation is similar to a citation (i.e. a parking ticket).  In practice, if a law enforcement officer witnesses a person using drugs, they may cite them with a Class E violation.  On this violation, they are directed to contact a behavioral health program to complete a screening for treatment.  If they complete the screening, the small fine tied to the Class E violation is waived.  The State of Oregon policy reads that screening, health assessment, treatment and recovery services for drug addiction are available to all those who need and want access to those services.

As a result of this ballot measure, each county in Oregon established Behavioral Health Resource Networks (BHRNs).  These BHRNs are comprised of multiple behavioral health entities who work together to provide substance use treatment services.  Services provided by the BHRNs must be free of charge for those accessing treatment. Each BHRN must provide trauma-informed, culturally specific and linguistically responsive services (i.e. case management, peer services, housing support, harm reduction services, substance use treatment).  The Oregon Health Authority (OHA) has a fact sheet available for individuals who are seeking substance use treatment in the state. This connects individuals to a substance use assessment followed by the appropriate level of substance use treatment (Oregon Health Authority, 2021).