Team profile by Nicole Schramm-Sapyta, Maria Tackett, Jose Pliego San Martin, Bella Larsen, Liz Huynh, Maya Pandey, William Feng, Zoe Svec and Jordan Hamelsky

Beginning with the de-institutionalization movement of the 1960s, prisons and jails have become a major provider of mental health services in the United States. Durham County is no exception and has worked to provide many important services inside the County Detention Facility but also initiated many programs to help those with mental illness to avoid incarceration. More recently, communities have begun to realize that expanded mental health services are needed to support these efforts.

Our team’s research aims grew out of conversations with our community partners at the Durham County Detention Facility (DCDF), Criminal Justice Resource Center, Crisis Intervention Team and Stepping Up Initiative. We have a rich dataset that merges incarceration data with Duke Health encounters for all people detained at the DCDF from 2014-2020. The data are anonymized to protect confidentiality. 

Using this dataset, in 2022-2023, Zoe Svec and Jordan Hamelsky created an interactive map of Durham County, showing the census tracts of residence for all arrests and Duke Health visits for this population, paired with publicly available socioeconomic data. We show that poverty is correlated with both higher rates of arrest and higher numbers of health care visits.  

William Feng performed a series of interviews with stakeholders involved in the court system and developed a policy brief recommending improvements to the county’s Mental Health Specialty Court. He suggests ways to streamline its processes to serve more people in need of its services. 

Bella Larsen performed a detailed literature review on group therapy treatments for incarcerated women with Post-Traumatic Stress Disorder. She summarizes 12 recent studies to assess both clinical outcomes and adaptation to the unique needs of incarcerated people. Her work highlights the need for those who do therapy in prisons and jails to think about issues of privacy, trust and autonomy. 

Liz Huynh examined the interaction of the justice-involved population with the Duke Emergency Department and clinics, with a special interest in prescriptions for psychotropic medications. Her analyses replicated previous findings that serious mental illness and drug addiction are associated with higher rates of re-arrest. Next, she showed that interaction with Duke Health is associated with reduced likelihood of re-arrest. In addition, receiving a prescription for an anti-depressant, anti-psychotic, anti-anxiety, or drug addiction treatment medication is associated with lower likelihood of re-arrest. 

Bella Larsen, Maya Pandey and Jordan Hamelsky worked to examine the effect of cash bail policy reform on risk of re-arrest. In 2019, Durham’s District Attorney and District Court judges enacted policy changes to reduce incarceration based on poverty, and instead to make release decisions based on the severity of the alleged crime. The team showed that, before the pandemic, the policy was beginning to work as intended, resulting in a small increase in those released on their own recognizance after arrest for minor crimes. Those released on their own recognizance were less likely to be re-arrested in the 180 days after the initial arrest. 

However, both before and after the policy change, those with co-morbid serious mental illness and drug addiction were most likely to be re-arrested. A high number of prior arrests was also associated with a higher likelihood of re-arrest. These findings underscore the need for better treatment interventions for the justice-involved population with mental illness and drug addiction. This work was presented at the Academic Consortium on Criminal Justice Health. 

Mental Health and the Justice System in Durham County

Poster by Jordan Hamelsky, Liz Huynh, Bella Larsen, Maya Pandey, Zoe Svec, Jose Pliego San Martin, Nicole Schramm-Sapyta and Maria Tackett