SMI Adviser Series Highlights Care of People With SMI Returning to Community After Incarceration

“Talk to each other.”

That’s the advice Debra A. Pinals, M.D., has for psychiatrists, mental health professionals, and peer counselors working with individuals with serious mental illness (SMI) who are returning to the community from jail or prison.

“As a psychiatrist who has practiced in jails and prisons, in community mental health centers, and in emergency departments, I know we often have peer support professionals—people with lived experience with mental illness, substance use, and even criminal justice systems—on site who are working with our patients, though we may not interact with them,” Pinals told Psychiatric News. “All too often, it is as if there is a barrier between us and them, but there shouldn’t be barriers—we are part of the same multidisciplinary team working toward the same goal of recovery in the community.”

Pinals is director of the Program in Psychiatry, Law, and Ethics at the University of Michigan Medical School and a forensic expert for SMI Adviser, APA’s clinical support system for people with serious mental illness. SMI Adviser is funded by the Substance Abuse and Mental Health Services Administration.

Communicating with other care team members is one of the take-home lessons from a series of three videos developed by SMI Adviser, titled “Providing Care After Release From a Carceral Setting to Individuals With SMI.” In the series, Pinals talks to other forensic experts with experience working with people who have been in carceral settings, case managers, and peer advocates about the challenges and satisfactions of caring for this population.

The dialogue series is designed for clinicians and provider staff at all levels who want to make a positive impact on the lives of individuals with SMI transitioning back into the community from jails and prisons. Pinals and her colleagues discuss effective collaboration strategies, common challenges faced by this population and those treating this population, and practical approaches to improve care.

The interview series is a continuation of an initiative on individuals with SMI in the criminal legal system begun last year by SMI Adviser in which Pinals interviewed psychiatrists who worked in jails and prisons. “We talked about what challenges they had, what lessons they learned, and what they loved about the work,” she recalled. “I love these dialogues—they are fun and pithy and educational. Hearing from practitioners about their enthusiasm for working in the criminal justice system with people with SMI was so inspiring.”

This year’s topics include the following:

• “Building a Strong Foundation for Reintegration”: Pinals talks with public psychiatrist Elizabeth Ford, M.D., and case manager Wanda Nixon about preparing individuals for a smooth transition back to the community.

• “Supporting Early Community Integration”: Psychiatrist Danielle Kushner, M.D., who works in carceral settings, and recovery support specialist Daryl McGraw talk about the power of teamwork between clinicians and peers in supporting early integration back into the community.

• “Maximizing Engagement to Reduce Recidivism”: Pinals speaks with forensic and public system psychiatrist Merrill Rotter, M.D., and peer advocate John Ramos about practical strategies to engage and understand patients’ recovery goals upon community re-entry.

Effective collaboration calls for a deliberate effort on the part of the care team to communicate with each other—regardless of degrees or levels of training. “Though we are coming at care of the individual with SMI emerging from the criminal legal system with different perspectives, we can leverage each other’s strengths to help individuals achieve more stability and achieve their recovery goals,” Pinals said.

To psychiatrists especially she advises: “If there is a peer support professional in the workforce, reach out to him or her and talk about how you can work together. Recognize that it’s not just you alone caring for the patient.”

Individuals with SMI who have spent time in jail or prison have a story to tell that mental health professionals need to hear. “We need to honor their experience,” Pinals said. “They have had complex journeys, and if we take the time to listen to people and their stories, it will help us provide better care.”

Being incarcerated is traumatizing, and returning to the community can be exceptionally challenging. “We need to be mindful about how quickly life can become problematic and how important it is for us to ‘be there’ for our patients,” Pinals said. “They may have multiple challenges along with SMI—substance use, employment difficulties, family problems. Being holistic in our approach is important, and it’s why the others on our team, including peer support specialists, are so important.”

And more psychiatrists are needed in this field. “We need people who are interested in serving these populations, and there has been far too much stigma around it,” Pinals said. “Whether you are working on an inpatient psychiatric unit or in the ED or a community mental health center, the reality is that you are going to see people who have been involved in the criminal legal system. We have a lot to learn about serving these populations better. Watch these videos; they may inspire you.”

SMI Adviser offers free continuing education credit, expert consultations, and resources to help frontline clinicians and staff—including physicians, nurses, pharmacists, psychologists, social workers, and peer support workers—provide evidence-based care to individuals with SMI. The latter include those living with schizophrenia, bipolar disorder, or major depressive disorder. ■