Grant: Project Grant

Serious mental illnesses such as psychosis are becoming more common among people incarcerated in British Columbia (BC) due to rising methamphetamine use, brain injury after non-fatal overdose, and gaps in community mental health care. Most people incarcerated in provincial correctional centres are released within weeks or months, demonstrating the importance of correctional health services to population mental health. Antipsychotic medications are evidence-based treatments that can reduce psychotic disorder symptoms and prevent relapse. Many people stop taking medication, which can lead to rapid worsening of symptoms, self-harm, hospitalization, or repeat involvement with the justice system. In correctional settings, untreated psychosis can result in placement in segregation units or transfer to a forensic psychiatric hospital for involuntary care. To reduce symptom severity, contingency management is an approach that provides small rewards for healthy behaviours, such as accepting medication. This three-year study will use novel linked administrative health data to describe people with psychotic disorders in BC provincial correctional centres and evaluate whether contingency management increases medication uptake. We will also examine whether treatment reduces time in segregation, involuntary transfers, and aggressive incidents. Findings will inform decisions about expanding contingency management in BC provincial correctional centres and efforts to improve access to mental health care during custody and after release.