Safety as care : exploring mental health care in the criminal justice context




Krebs, Andrew Vance

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Persons with serious mental illness (PSMI) are consistently over-represented in the criminal justice system. In an effort to reduce justice involvement and recidivism among PSMI, criminal justice and mental health systems have developed numerous intervention-related programs that emphasize increased access to psychiatric treatment and diversion. In practice, however, various institutional and organizational discrepancies between the two systems constrain the autonomy and decision-making power of the mental health professionals who work in these settings. I conceptualize these mental health professionals as boundary role incumbents, and I am particularly interested in exploring their attempts to reconcile the limitations placed on their service ideals. Furthermore, I am interested in exploring the collaborative and practical implications of this dynamics. The data for this project stem from a series of ethnographic observations with mental health professionals working in various justice-oriented contexts. In particular, this study focuses on mental health professionals who provide community-based crisis intervention services, jail-based mental health services, and community-based mental health services for adults on probation and parole. The programs in this study are located in a single Central Texas county, and represent a range of justice-mental health service models in the area. The ethnographic data, consisting of extensive fieldnotes, capture the work-related experiences of the mental health professionals operating in their respective fields. The analyses in this dissertation explore the ethnographic data within the context of each site, and I also present an overarching theme that considers the implications of the findings across all contexts. I find that mental health boundary spanners reconcile the tensions between their occupational constraints and service ideals by conceptualizing their work as ‘planting a seed’ among the individuals they serve, particularly with the hope that a pattern of sustained engagement with other direct services will emerge. However, given mental health boundary spanners’ loss of professional autonomy and the limited recourse available to the individuals they serve, I suggest that ‘planting a seed’ is the practical ceiling of these justice-mental health interventions, while ‘people processing’ is their norm. These findings contribute to contemporary discussions that contextualize the function and purpose of criminal justice and mental health reforms.



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