Transitions from Jail in the Rural Community for Adults with Mental Illness

Abstract

The purpose of this study was three-fold: 1.) to address the gap in our understanding of the factors that facilitate the use of community-based transitional support services post-release from jail when transitioning into the rural community for adults with mental illness and 2.) to address the gap in our understanding of the factors that inhibit the use of community-based transitional support services post-release from jail when transitioning into the rural community for adults with mental illness and 3.) to determine the acceptability of a biological sample to measure interlukin-6 (IL-6) for future research. Annually, nearly one million people are incarcerated in jails throughout the United States, with over 80% of them experiencing a mental illness. Rural communities have greater rates of disease burden and fewer community-based resources. These factors combined with the lack of mandated jail-to-community transition programs complicate the transitional experience for individuals living with mental illness. The transitional period, from jail to the community is filled with competing demands and can cause stress and anxiety. Acute stress has been associated with inflammation. This population often expresses resistance in providing biological samples, so aim three will allow for planning for future research involving biological specimen collection. This qualitative descriptive study provided a rich account of the inhibitors and facilitators experienced among individuals transitioning from the rural jail to the rural community while experiencing mental illness. Meleis’ Transitions Theory provided the conceptual underpinnings for this study. Data sources included interviews, a demographic data questionnaire and field notes. Data analysis was developed through qualitative content analysis through open coding, which allowed the researcher to build concepts and categories, forming themes. This iterative approach allowed for the grouping of similar codes and clusters. The results of this study illuminated several points. “Out of Jail but No Freedom” established the overarching theme for this study in which the facilitators and inhibitors of situational and health-illness transitions for adults with mental illness transitioning to the rural community is described. This research is significant for nursing practice and policy reform. Systematic reform is needed within jail medical operations, clinical models of community provided care, within policy that guides healthcare funding and delivery models, as well as court services. Mandated policies, unfunded and directed to be financially supported by communities further perpetuate disparities and social determinates of health, significantly impacting our most rural and socioeconomically depressed locations. This study illuminates the need for systematic reform within our medical divisions of rurally located jails as well as within public policy that guides healthcare funding and clinical models of care. It has become evident from this research the transition from jail is largely shaped by the experience while incarcerated. Individuals who experience jail incarceration have a right to evidenced-based standards of care, and transition programs to assist them back into the community.