1. Medication Adherence, Substance Use and Psychiatric Symptom Severity among Mental Health Jail Diversion Program Clients Elizabeth N. Burris, Evan M. Lowder, and Sarah L. Desmarais North Carolina State University Forensic Psychology in the Public Interest Lab

2. Background Mental health diversion programs –Designed to improve mental health outcomes –Connect justice-involved adults with mental illnesses to treatment Previous research –Diversion increases positive mental health outcomes (Broner et al., 2004; Shafer et al., 2004) Few studies examining predictors of mental health outcomes in this population Forensic Psychology in the Public Interest Lab

3. Background Adults with mental illnesses: –Co-occurrence of substance use (Hunt, Bergen, & Bashir, 2002; Wilk et al. 2006) –Problem of medication adherence (Janssen et al., 2006) Both factors associated with psychiatric symptom severity (Margolese et al., 2006; Drake 1989; Dixon et al. 1991; Bartko et al., 2007) Both hinder treatment progress (Owen et al., 1996; Fischer et al. 1996) Forensic Psychology in the Public Interest Lab

4. The Present Study Examine whether differences in psychiatric symptom severity between: –Adults with and without substance use –Adults who are and are not medication adherent Examine associations of substance use and medication adherence with changes in psychiatric symptom severity –Baseline to 3-month follow-up –3-month to 6-month follow-up Forensic Psychology in the Public Interest Lab

5. Sample 95 adults with mental illnesses (81.1% male) in a jail diversion program 30.5% co-morbid substance use diagnosis Substantial criminal histories –M = 6.69 (SD = 5.42) bookings in the past three years –M = 16.07 (SD = 14.99) lifetime jail bookings M age = 36.05 (SD = 12.46) years 44.2% African American 54.7% Hispanic/Latino Forensic Psychology in the Public Interest Lab

6. Measures Predictor: Medication adherence –“In the past 3 months, how often did you take the medication for mental health, alcohol or drug problems prescribed by the doctor?” –Missed <2 times = Adherent –Missed >2 times = Non-adherent Predictor: Substance use –Current substance use diagnosis –Addiction Severity Index (ASI; McLellan et al., 1992) Outcome: Psychiatric symptom severity –Brief Psychiatric Rating Scale (BPRS; Ventura et al. 1993) Forensic Psychology in the Public Interest Lab

7. Procedures Semi-structured interviews conducted by trained research assistants –Baseline, 3-month follow-up, and 6-month follow-up –All variables were measured by self-report Analytic strategy –Differences between groups at baseline and 3- month: T-tests –Predictive associations from baseline to 3-month and 3-month to 6-month: Mixed-design ANOVAs Forensic Psychology in the Public Interest Lab

8. Results Descriptive –Medication Adherence Baseline: 81.1% Adherent; 18.9% Non- Adherent 3- Month: 80% Medication Adherent; 20% Non- Adherent –Substance Use Baseline: 53.8% Substance Use; 46.2% No Use 3- Month: 51.5% Substance Use; 48.5% No Use Between-Group Differences in Symptom Severity –Medication Adherence Baseline: t(88) = 2.00, p =.048 3- Month: t(63) = 2.51, p =.015 –Substance Use Baseline: t(91) = 2.53, p =.013 3- Month: t(64) = 0.44, p =.661 Forensic Psychology in the Public Interest Lab

9. Results: Predicting Changes in Symptom Severity Forensic Psychology in the Public Interest Lab Medication Adherence at Baseline F (1,59) = 1.01, p =.314, n 2 =.02

10. Forensic Psychology in the Public Interest Lab Results: Predicting Changes in Symptom Severity Medication Adherence at Baseline F(1,36) = 0.06, p =.644, n 2 =.018

11. Results: Predicting Changes in Symptom Severity Forensic Psychology in the Public Interest Lab Substance Use at Baseline F(1,62) = 3.01, p =.088, n 2 =.05

12. Results: Predicting Changes in Symptom Severity Forensic Psychology in the Public Interest Lab Substance Use at Baseline F(1,37) = 0.72, p =.400, n 2 =.02

13. Summary of Findings Substance use and medication adherence: –Related to psychiatric symptom severity –However, may not predict changes in symptom severity in this population Forensic Psychology in the Public Interest Lab

14. Limitations Findings are limited by: –Self-report nature of the data –High rates of medication adherence –Sample homogeneity –Short follow-up period Forensic Psychology in the Public Interest Lab

15. Future Directions Further explore relationships between medication adherence, substance use, and psychiatric symptom severity –In other justice-involved samples –Across longer follow-up periods –In context of other treatment provision Forensic Psychology in the Public Interest Lab

16. Acknowledgments This project is funded by the Bristol-Myers Squibb Foundation. We thank the 11 th Judicial District Criminal Mental Health Project (CMHP) for its cooperation and support. Forensic Psychology in the Public Interest Lab

17. Thank you! Contact information: Elizabeth N Burris Email: enburris@ncsu.edu Lab Website: ncsuforensicpsychology.comncsuforensicpsychology.com Lab Facebook: facebook.com/fopsypifacebook.com/fopsypi Forensic Psychology in the Public Interest Lab