This article originally appeared in the School of Social Work 2024 Fall Impact Report.
People with mental illnesses have higher rates of substance use disorder, unemployment, housing instability and eroded social support. And they’re over-represented in the criminal legal system, including on probation.
Tonya Van Deinse, a research associate professor at the University of North Carolina at Chapel Hill School of Social Work, is an implementation science researcher who considers issues like these from a systems perspective. She says organizational relationships — or lack thereof — can contribute to the challenges of getting people with mental illnesses the treatment they need while on probation. The National Institute of Mental Health awarded her a K01 grant to learn more.
“Why is the system operating one way for people with mental health issues and another way for people without?” Van Deinse asked. “For me, it’s about justice and fairness.”
Van Deinse has been collaborating with the North Carolina Specialty Mental Health Probation program since its inception in 2013. The national, evidence-informed approach to supervising people with serious mental illnesses now operates in 56 counties across the state.
Probation officers receive ongoing mental health training to help people on their mental health caseloads get linked to treatment and other community-based resources to remain stable in the community and out of jails and hospitals. Trained officers use problem-solving strategies and motivational interviewing. The Division of Community Supervision in the N.C. Department of Adult Correction is expanding the program to all 100 counties in the coming year.
One core concept behind specialty mental health probation is service linkage, Van Deinse said. The program gives officers the tools and capacity to link people under their supervision to treatment and wraparound support. However, the process isn’t always straightforward, and even specially trained mental health probation officers face obstacles.
Van Deinse received a Career Development Award from the National Institute of Mental Health to build on the existing mental health probation model and address these challenges. The project, called the NETWORC study (Networking to Engage Treatment Working Within Officer Resource Collaborative) identifies barriers to collaboration between mental health officers and providers and then engages the local community to strengthen communication across organizations. The pilot program has started in four counties and leverages existing local services and relationships rather than creating new resources.
“We’re trying to get officers and providers in the same room and talk about what gets in the way of collaboration and coordination,” Van Deinse said. “We want them to come up with implementation strategies to address those challenges. Then we measure whether they work.”
While Van Denise’s efforts began a decade ago, she’d been aided for the past five years by Sonya Brown, social work administrator in the Division of Community Supervision. Brown has assisted Van Deinse in engaging community stakeholders and improving access to mental health service providers for those under specialty mental health supervision.
Brown said she appreciates the help bridging the justice and behavioral health systems, as it is important for communities and behavioral health service providers to understand the significant role an officer plays in connecting people with serious mental illnesses and co-occurring substance use disorders to care.
“The number of people on probation with serious mental illness is overwhelming,” Brown said. “Connecting them with resources is critical to our agency.”
A person under probation supervision must set and work toward accomplishing certain goals, such as holding a job, finding stable housing and avoiding rearrest. But mental health conditions can make complying more difficult.
The officers with specialty mental health caseloads approach their work with exceptional diligence to navigate systems so those under supervision can access treatment and recovery support. Brown said that officers would make referrals to a service provider agency, but without an established relationship with providers, the response was mixed.
“The work we do is person-to-person,” Brown said. “Building relationships and rapport is critical to good service delivery.”
North Carolina stands out in its approach to supervising people on probation who have mental health conditions. The Pew Charitable Trusts funded a national study in 2019 that Van Deinse conducted in partnership with the American Probation and Parole Association. The results revealed that less than a third of the counties in the U.S. had resources dedicated specifically to people with mental illnesses on probation.
Her NETWORC study is in its early stages. Van Deinse interviewed 40 representatives from state, regional and local probation and mental health service providers; her Health Interventions in the Legal System Lab (HILS Lab) completed the analysis. Van Deinse and Brown recently presented these findings to mental health probation officers and probation chiefs from the pilot counties and have officially launched phase two of the project.
“Now it’s time to start the action planning process and develop tailored implementation strategies,” she said. “Then we measure it, see whether it worked and go from there.”