N.C. Specialty Mental Health Probation aims to improve outcomes for people who have serious mental illnesses (2024)

By Rachel Crumpler

Jason Szybka became a probation/parole officer in Duplin County in October 2020. In the role, he crossed paths frequently with people with serious mental illnesses, such as schizophrenia and bipolar disorder. He saw how their mental health affected their lives in the community and their ability to meet supervision requirements.

Encounters such as these are common for the state’s approximately 2,000 probation/parole officers, who supervise close to 76,000 people living in communities across North Carolina.

Probation officers have the task of supervising the largest number of people with mental illnesses in the criminal legal system. An estimated 16 percent to 27 percent of the nation’s probation population have a mental health condition. Moreover, people on probation are more than twice as likely to have a mental illness as those in the general public.

In North Carolina, the most recent research — published in 2018 — estimated that 15 percent to 19 percent of the state’s probation population has a mental illness.

Szybka had a better understanding of mental illness than most people who become probation/parole officers. His degree in behavioral science and two years spent working with a mobile mental health crisis team in Onslow County got him familiar with how mental health crises often play out. As a result, he said, his approach to supervision has always centered around addressing mental health needs.

That focus became even more pronounced when he became a specialty mental health probation/parole officer two years ago; these officers work exclusively with people who have mental illnesses and co-occurring substance use disorders and receive training to gain more skills to manage these caseloads. Szybka now carries a smaller caseload — up to 40 people with serious mental illnesses — which gives him the ability to provide more intensive case management for these people who have more needs.

North Carolina’s Specialty Mental Health Probation program started in 2013 as an approach to better serve people with mental illness who generally experience worse outcomes in the community. In recent years, the program has scaled up substantially to serve more counties, adding 14 last summer and another 18 this year.

By the end of this year, North Carolina’s Specialty Mental Health Probation program will have 78 trained probation/parole officers and 58 chief probation/parole officers serving 56 counties, said Ashlee Barnes, a licensed mental health professional with the program.

A different approach

When he was a standard officer, Szybka said he carried a caseload of about 75 people and was still responsible for monitoring people’s mental health. But the North Carolina Specialty Mental Health Probation program allows officers to go the extra step in making connections to mental health care, including scheduling appointments, transporting people to appointments, picking up medications and consulting with doctors, if the officers are granted consent.

“Even the counties that don’t have the program, they still have these individuals,” Szybka said.“It’s just the program gives us a little more of a streamlined focus on how to appropriately handle, manage and get help for these folks.”

Szybka has seen the tailored approach pay off.

“I do feel that it is helping individuals,” Szybka said. “Moreso with the understanding that they do have special struggles going on that before had just been chalked up as someone ‘being crazy’ and just pushed into jail or just pushed over here or pushed over there.

“I’ve had folks on my caseload recently, who have never completed a probation period, who have never completed a post-release program successfully and who have now successfully completed one.”

The Division of Community Supervision, which oversees the state’s probation and parole program, plans to continue building capacity to bring the program to all 100 counties, Barnes said.

Tonya Van Deinse, a research associate professor at the UNC Chapel Hill School of Social Work who studies specialized mental health supervision, said implementing mental health probation is a forward-thinking approach to addressing the needs of this population.

“It really speaks to their understanding of just how much mental illness impacts these criminal justice outcomes — mostly as a barrier for people to remain compliant with the terms of supervision,” Van Deinse said.

Growing program

Probationers with severe mental illness often face increased challenges accessing housing, employment and behavioral health services — all of which can trip them up as they try to re-establish themselves and remain in the community. For probation officers who do not recognize the symptoms and behaviors associated with mental illnesses, these probationers can be more difficult to supervise. Research shows that justice-involved people with mental illnesses are at a higher risk of probation violations, having their probation revoked and being rearrested than people without mental illness.

“These folks need services and support,” Van Deinse said. “Mental health probation can help get folks who need the treatment back to the treatment system, which is where they’re going to be better served.”

Van Deinse was involved with the initial pilot program in Wake and Sampson counties that tested the approach. A group of people on probation who had a serious mental illness were randomly assigned to either the specialty mental health probation model or the standard approach to probation.

The results showed that the officers with specialized training made more mental health referrals, and there was more engagement in treatment for the people they supervised compared with those on the standard probation caseload.

The program’s capacity to serve more people with mental illnesses will grow when about 50 more probation/parole officers and supervising officers (known in the system as “chiefs”) complete specialty mental health probation training in June. Training includes information on diagnoses, symptoms, assessment of functioning in areas of daily living, de-escalation techniques and strategies for encouraging treatment adherence.

North Carolina’s program follows a national model of mental health probation that’s defined by five core elements:

• Probation officers have designated mental health caseloads.
• They have smaller caseloads.
• The probation officers receive ongoing mental health training.
• They frequently engage and coordinate with community resources.
• The approach is different, with an orientation geared more toward problem-solving than being punitive.

North Carolina added two other components to its program: The program’s four licensed mental health professionals conduct monthly clinical case consultations with officers to help them continue learning and brainstorming on the best ways to resolve challenging cases. Community engagement is also a key part of the program so that officers build networks with local providers and resources to help people succeed.

“Collaboration in the world of mental health and substance use plays such a vital role in determining a person’s outcome,” Barnes said. “We want to make sure that we’re doing our part to help with their reintegration into the community as best we can throughout their supervision process.”

North Carolina is a relatively early adopter of this approach to probation. In 2023, a study led by Van Deinse found from a representative sample that fewer than a third of counties across the country screen for mental health conditions, and only 27 percent of counties had specialized mental health supervision approaches.

Van Deinse said it’s clear that a different approach to probation is needed for this population, and she said she hopes to see implementation continue to build. She’ll be making that case to other community supervision agencies this summer at the American Probation and Parole Association’s Annual Training Institute in Indianapolis. She is scheduled to lead a workshop on how to implement mental health probation with leaders from the programs in North Carolina and Georgia — states that Van Deinse said are leaders in the nation.

More effective officers

Szybka, with his prior experience working with folks with mental illnesses, is unusual among specialty mental health officers. Most of them haven’t had that kind of background or training.

Barnes said that’s why there’s so much emphasis on ongoing training to help officers build competency.

“We are constantly thinking about what we can do to help our officers and chiefs gain more knowledge, more experience, more training and education around the world of mental health so that they can then use that knowledge and training to supervise this caseload more effectively,” Barnes said.

She said there have been positive responses to the training: Officers have told her that they have more confidence in their ability to help the people they supervise succeed. Before the specialized support, Barnes said, some officers said they felt, at times, like they were walking blind and missing opportunities for treatment interventions.

But Szybka said some of the best results he’s experienced come when probationers gain a better understanding of their conditions and start to address their mental health issues in ways they never have before.

For example, Szybka said one person on his mental health caseload with schizophrenia had psychotic episodes when they initially met. One episode landed him in the hospital with delusions. While there, Szybka visited him every day to check on his well-being and build rapport.

After he was released from a mental health facility two weeks later, the man went to visit Szybka at the probation office where he had a powerful realization.

“We had a great conversation,” Szybka said. “He said, ‘I didn’t realize until that hospitalization how real my schizophrenia is and the medication I have to take. I didn’t believe it before, but I believe it now. I know I have to take it in order to be okay.’

“That level of understanding from someone is a big deal,” Szybka said. “It really is a big deal because not a lot of folks gain that.”