Serious Mental Illness‐Associated Socio‐Medical Needs and Imprisonment Risk in Reentry Clients

To examine whether the socio‐medical needs and imprisonment risk among transitional care clients with serious mental illness (SMI) differ from other transitional care clients. A retrospective cohort study was conducted of adults who entered the Formerly Incarcerated Transition (FIT) Program from 2018 to 2023 following a period of incarceration. At program entry, FIT clients were screened for socio‐medical needs and diagnoses, including those reflecting SMI. Imprisonment outcomes were assessed using administrative records. Cumulative imprisonment risk and relative risk of imprisonment were estimated comparing clients by SMI status. Among 759 clients, 78.1% were men, 53.6% were aged 31–50 years, 59.8% reported Black race, and 32.9% had SMI. Clients with SMI were significantly more likely to be female, aged ≤40 years, White race, recently without food, to have healthcare coverage, to be unhoused, and to be in need of housing assistance, disability benefits, or legal assistance. Cumulative imprisonment risk at 360 and 720 days for clients with SMI (0.14 and 0.21) was higher than for those without (0.08 and 0.11), p  < 0.001. In a multivariable proportional hazards model, SMI was associated with increased risk of imprisonment (1.75, 95% CI: 1.18, 2.60). Released persons with SMI have a particularly heavy burden of socio‐medical needs and high imprisonment rates in North Carolina (NC). Similar programs in other states should consider assessing outcomes among their clients with SMI. In NC, efforts are underway to facilitate greater care continuity upon re‐entry for people with SMI, including direct linkage to co‐located primary and psychiatric care.