An estimated two in five people who are incarcerated have a history of mental illness, according to the National Alliance on Mental Illness. Most receive no treatment for their mental health issues during their incarceration in state and federal prisons.
When they are released, these people are often still coping with mental health problems. But care can be equally hard for them to find on the outside, especially while they are struggling to get on their feet.
Yale’s Arielle Baskin-Sommers is helping to fill that gap for formerly incarcerated persons in the New Haven area. Baskin-Sommers, a professor of psychology, in the Faculty of Arts and Sciences, and of psychiatry, at Yale School of Medicine (YSM), has started a mental health care program at the Transitions Clinic in New Haven. Located at the Yale New Haven Health Long Wharf Medical Center, the program is part of a consortium of more than 40 community health centers nationwide that care for recently released individuals. It was co-founded by Emily Wang, a professor of medicine and of public health at YSM.
In her research, Baskin-Sommers focuses on risky and impulsive behaviors, a specialty that makes her especially suited to work with this population. She runs two labs at Yale. One is the Adolescent Brain Cognitive Development Study, the largest long-term study of brain development and child health in the United States. Her lab (one of 21 involved in the study nationally) is primarily looking at what environmental and neural factors might predict risky and impulsive behavior later in life.
The other is the Mechanisms of Disinhibition Lab, where she and her students work with adults who have faced severe consequences because of risky behaviors. Most of the participants have been arrested, and at least half have been incarcerated.
“Some of our adult research is mechanism-focused, where we collect behavioral data and neuroimaging data to look at what’s really happening in the brain,” she said. “The other part of it is we collect as much information as we can about the individual and their interactions with family, friends, and their neighborhood, as well as what state they live in. We are trying to determine what are the accumulation of factors that might lead someone to not only engage in risky, impulsive behavior, but engage in it in a way that is going to impact their life very substantially.”
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A licensed clinical psychologist, Baskin-Sommers is also part of Yale’s Justice Collaboratory, which brings together scholars from across the disciplines at Yale and elsewhere to work toward an evidence-informed justice system.
Baskin-Sommers sat down with Yale News to talk about her work at Transitions, the types of mental health challenges she sees among clients there, and how Connecticut’s Department of Corrections is trying to change the way it handles incarcerated individuals in mental distress. The conversation has been condensed and edited.
How did you get involved with the Transitions Clinic in New Haven?
Arielle Baskin-Sommers: Emily Wang and I got to know each other in 2018. She was describing how so many people are being released from prison not only with physical health problems but with mental health problems, and how they’d have to be referred elsewhere to address their mental health needs. And a lot of the outside clinics have barriers that make it hard for people who are formerly incarcerated to even get in. So in 2019 we started this collaboration where I volunteered to go to Transitions every Friday and see patients for a mental health check. For those who were already connected to services, I was just reinforcing something they were already doing. More often than not, however, they weren’t connected, so we did shorter-term therapy, or sometimes assessments to figure out what was going on. I’ve had graduate students in Yale’s clinical psychology Ph.D. program do their training through the clinic as well.
Now it’s been built out and we’ve had so much demand that we just got funding to have a mental health clinician full time. We’ll be able to provide far more services. I will still be working there, but mostly in terms of supervision.
Why has the demand for services increased so much?
Baskin-Sommers: A few reasons. One, we know that a lot more people were released from facilities during and after COVID, so there were a lot more people coming back into the community. Also, I think we’ve now established ourselves as a group that can be trusted and provides good services. And then I think it is just general shifts in peoples’ mindsets around who sees a therapist. There’s still stigma around seeking mental health services, but you see in all populations an increased awareness of the value of interacting with someone around your mental health.
What kinds of mental health issues do you commonly see in this population?
Baskin-Sommers: Their mental health problems tend to be quite complex. Most people we see carry multiple diagnoses. For example, post-traumatic stress disorder [PTSD] and substance-use disorder, or schizophrenia and substance-use disorder, as well as anxiety, depression, bipolar, personality disorder. They are also generally a pretty treatment-naïve group of individuals. Even if they are mandated treatment while still incarcerated, they might not totally receive it because of long waitlists and just not having enough clinicians in the facilities. And what they get is typically not evidence based.
On top of the mental health problems, they’re also dealing with significant social and financial strain. There is a lot of stuff going on for them. And this is why the clinic is so amazing: you have the medical doctors there, led by doctors Lisa Puglisi and Emily Wang, you have us, you have students from the law school volunteering, and you also have a community health worker who was formerly incarcerated. She can connect patients with the appropriate social services, like helping them get bus passes or find housing. The clinic is unique in that it provides a wraparound service.
In your experience, do complex mental health issues factor into someone’s incarceration, or are they more often an outcome of being incarcerated?
Baskin-Sommers: Both. We have some people where clearly their mental health problems contributed to their criminal activity. We have some people where, as far as I can tell, there was no clear mental health problem prior to their crime. The trauma some people were exposed to through their crime and/or in the prison environment can lead to significant mental health problems though. So it really varies for people. But I think many people we’ve seen had undiagnosed mental health problems for a very long time and had a lot of adversity early in their life. There were long-standing issues that never got addressed, in part because there aren’t enough resources, certainly for more-impoverished communities.
Are you working with any individuals who are still incarcerated?
Baskin-Sommers: I’ve worked with some state corrections officers [COs] who needed guidance on how to handle mental health issues. An officer from the state Department of Correction reached out to me and said that they were overwhelmed by the amount of mental health issues they were seeing at some of their institutions. They are trying to address that and to train the corrections officers to interact in this type of way. But they desperately need more training.
I designed a two-day training for them. The first part was basic psychoeducation around mental health problems that are commonly presenting in incarcerated individuals, and how to communicate with those individuals. We started with the basic science because I wanted the COs to know that it is not the case that everyone’s brain and environment is the same. For example, there are ways the environment got under their skin and shaped their behavior. Then the second day was about therapeutic skills. If someone’s acting erratically, if someone’s really emotional, if someone’s seemingly impulsive or aggressive, how do you help them in those moments? We walked through a set of skills and had them practice.
A couple of my grad students helped with teaching some of the skills and role playing. The COs seemed to really get a lot out of it. But it was also very collaborative in that I would say things and they would be skeptical, so we would kind of talk through it and come around to, okay, here’s why you might want to try this.
What are some examples of the kinds of interventions you suggested?
Baskin-Sommers: We spent a lot of time on distress tolerance — how do people not make a situation worse when they’re feeling really emotional? The COs said sometimes they interact with individuals who are just yelling at the top of their lungs or crying hysterically, and they don’t know what to do, particularly when they also need to get those individuals in a line or to go somewhere. We walked through skills that range from breathing techniques to distracting techniques that the COs could do with them, or prompt them to do on their own. Then we also went through some communication skills. How do you motivate people to want to change their behavior? A lot of the COs were trained to just tell the person to do this thing or tell them what their goal is. But if the person is not invested in that same goal or doesn’t want to do that thing, then there’s going to be conflict or pushback. We talked about ways to phrase questions and engage people in a way that helps get their buy-in.
Is there a growing awareness among the general population about the links between mental health issues and incarceration?
Baskin-Sommers: I do think there’s a growing awareness, not only about the links between mental health problems and criminal behavior, but that incarceration can make existing mental health problems worse and create new ones. Polls have shown that the majority of American citizens want money spent towards treatment in the community rather than incarceration — even for violent crimes.
The intervention is very different in parts of Europe than here. Take the Netherlands, for example. When people there first come into contact with the law, and are then convicted, there’s a very thorough assessment to determine if they should be going to a more traditional type of prison or a forensic mental health facility. We don’t really have that here. And not only are traditional prisons much more humane there, but the forensic mental health facilities use evidence-based treatments that are targeted for someone’s specific mental health problem in a way that’s much more systematic and thorough than it is in the United States. That’s not to say there aren’t some programs in the U.S. that do better, but the average facility is not able to provide adequate treatment.
