Every time I explore that very fuzzy interface between the mental health system and the corrections system, my takeaway is that it is a mess that needs a solution beyond the current silos of policy and funding. I had the same takeaway from last week’s session, Serving The Criminal Justice Population: Reentry & Community Mental Health Programs, at the 2015 OPEN MINDS Strategy & Innovation Institute, where we had a lively session on community reentry programs. Our panelists presented three very different approaches to community reentry in three different states – Betsy Hardwick, Chief Operating Officer & Program Administrator, ReEntry Project for Offenders with Special Needs, Professional Consulting Services in Michigan; Sharon Sidell, Ph.D., Executive Director, Be Well Partners in Health, LLC, in Illinois; and Jan Tarantino, Associate Director, Resources for Human Development, in Louisiana.
The session started with a restatement of the all-to-familiar statistics about the current U.S. corrections system. The facts that jump off the page?
- More than 1.5 million people are incarcerated in prisons in the United States, and about 700,000 are released each year.
- In 2011, 688,384 men and women — approximately 1,885 individuals a day — were released from state or federal custody and 4.8 million offenders were under community supervision by the end of 2011.
- 16% of that population has a mental illness, or an addictive disorder (35%), or both (45%) (see Addiction & The Criminal Justice System).
- A survey of 40 states found that the average yearly cost of incarcerating one person is about $31,000.
- Reducing the state prison population by only 1% (about 14,000 persons) would result in a savings of nearly $450 million.
During the most recent recession, with state budgets in crisis, there has been growing support for strategies that can reduce corrections costs without hindering public safety. So funding for reentry programs have increased. All three panelists spoke to some of the critical features – transportation, health insurance, housing, and longitudinal case management and support – that rely on a coordinated network of health and community services and supports across the continuum of care. But, while the approaches to community reentry programs to prevent recidivism of populations with special needs are well developed – they are rarely funded adequately.
Therapeutic Diversion, a Collaboration between Cook County Illinois Department of Corrections (CCDOC) and Be Well Partners in Health, provides management of reentry process with no availability of supplemental funding. CCDOC currently houses approximately 8,000 inmates – 33% have a serious mental illness, and of the 33%, more than 70% have a co-occurring substance use disorder (SUD). They created the Therapeutic Diversion project, which is run by Be Well Partners in Health, to facilitate community reentry for these citizens. Over the 15-month time period (June 1, 2015 to October, 2016), the care management team will select 500 persons for the program, provide intensive services upon discharge for those with an SMI, and follow those persons for six months. The goal is to engage a minimum of 250 persons who will avoid incarceration within the six-month follow-up period, post-discharge. The Therapeutic Diversion program doesn’t have funding to provide supplement services and supports, but Illinois has expanded Medicaid, so health insurance coverage is available post-discharge.
Resources for Human Development (RHD) – which runs multiple re-entry programs in multiple states – provides interventions for a small portion of the population in Louisiana with its Reach-In CARE/LA-SAFE Focused Outreach Case Management Program. Its focus is to serve women who are involved in the criminal justice system, child welfare system, and have substance abuse issues. This program has a jail-based, ten-week program at the Jefferson Parish Correctional Center, and then post-release community-based services funded by a variety of sources, including (but not limited to) SAMHSA, Parish Human Services, state general dollars, and TANF. The continuum of care in the greater New Orleans area was built over the last 10 years, and includes four parish crisis teams, four ACT teams, and residential crisis stabilization. Unlike the situation in Illinois, Louisiana has not expanded Medicaid, so health care coverage is one of many challenges for their reentry initiatives.
Michigan had the most well-developed model for community reentry. The ReEntry Project for Offenders with Special Needs is a single statewide initiative managed by Professional Consulting Services (PCS). The program funds both care coordination and supplemental funding for gap-filling expenses. The program starts with the parole board, who selects offenders that are active with mental health programs at the facility and approves them for a deferred parole that is managed by the ReEntry Project for Offenders with Special Needs. Following a needs assessment, PCS develops an individualized and fully funded after-care plan (which could include supplemental funding for services, medications, housing, transportation, etc.) in conjunction with the returning county. The parole board can, at its discretion, approve the parole request based on the after care plan. If parole is granted, PCS provides door-to-door transport on the day of release and oversees and coordinates the aftercare plan for approximately nine months post-release.
The outcome statistics for the ReEntry Project for Offenders with Special Needs are impressive. Since 2009, over 6,500 offenders have been part of this program. Of these, 67% had not been incarcerated within three years of release. This compares to baseline data that shows 50.0% of mentally ill parolees returned to prison within three years for either a new sentence (16.2%) or as a parole violator technical return (33.8%). All the panelists agreed that community reentry for sex offenders was particularly problematic. They described the difficulties of finding housing for returning citizens on the sex offender list, and, the broad range of offenses (including public urination and prostitution) that can get citizens on that list.
The panelists provided great insights into this critical area of health and social service management. One that has great opportunity – if we can get policy and finances aligned. For more, check out these OPEN MINDS Market Intelligence reports (free for download for all OPEN MINDS Circle premium-level members) – Which States Terminate Rather Than Suspend Inmate Medicaid Benefits?