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By Monica E. Oss

Yesterday I took a look at the implications of expanded health insurance coverage for the “justice-involved” population (see A New Opportunity To Serve Justice-Involved Consumers) – and the challenges and opportunities of this population having uniform coverage for the first time. But the added complexity is keeping these consumers in the community.

Currently, 25% of inmates with a mental health problem had three or more prior incarcerations – compared to 5% of inmates without a mental health problem (see Mental Health Problems Of Prison And Jail Inmates). And, some studies show that 48% of inmates with mental illness are hospitalized in a psychiatric setting within 18 months of their release, while 64% are rearrested within the same time period (see On Mental Illness, Inmates, And Recidivism).

These are significant social and budget issues when you consider that the average cost per inmate of re-incarceration after failed community reentry is $50,000 (see Can We Save Even More Lives? Understanding the ‘Opportunity Costs’ of Regulation). Success in managing the health care needs of these consumers – and success in keeping these consumers from re-offending and returning to correctional institutions – demands more than just a medical home.

For example, housing is a big issue and a key to avoiding re-contact with the justice system. Most prisoners believe a stable place to live is important to successful reentry, according to the recent Urban Institute survey, Recent Findings from the Urban Institute on Housing and Reentry.  While the majority of returning prisoners stay with friends or family – those housing arrangements are most often temporary.  And, housing options for returning prisoners who don’t stay with family members or friends are extremely limited.  The survey concluded that there is a lack of evidence-based reentry housing programs for prisoners with mental illness released back into the community.

That said, many of the programs and approaches currently in use, whether considered evidence-based or not, have a significant positive return-on-investment (ROI) in terms of social costs. A study published in 2012 by the Washington State Institute for Public Policy (see Return On Investment: Evidence-Based Options To Improve Statewide Outcomes), provides an interesting analysis of the ROI of the various programs currently considered for this population. The study – based on work in Washington State that began in the mid-1990s – calculates the costs and benefits “to identify ‘evidence-based’ policies that have been shown to improve particular outcomes.”

Adult Criminal Justice:
Monetary Benefits and Costs of Evidence-Based Public Policies, as of April 2012 (costs marked in red)

Topic Area/Program

Total Benefits

(service life-cycle)

Benefits Minus Costs

Benefit To Cost Ratio

Employment Training/Job Assistance in the Community





Cognitive Behavioral Therapy (moderate and high risk)





Correctional Education in Prison





Drug Offender Sentencing Alternative (drug offenders)





Electronic Monitoring (radio frequency or global positioning systems)




No estimate available

Vocational Education in Prison





Drug Treatment in the Community





Work Release





Drug Offender Sentencing Alternative (property offenders)





Mental Health Courts





Supervision with Risk Need and Responsivity Principles (high & moderate risk)





Correctional Industries in Prison





Drug Courts





Drug Treatment in Prison





Offender Re-entry Community Safety Program (dangerously mentally ill offenders)





Intensive Supervision: With Treatment





Intensive Supervision: Surveillance Only





Domestic Violence Perpetrator Treatment Programs





Source: Washington State Institute for Public Policy


These data point out the need for a specialized coordinated care approach with not only integration of physical, behavioral, and social services – but some very specialized services.  Not surprisingly, vocational training, cognitive behavioral therapy, and educational programs lead the list of “high ROI” interventions. All great opportunities to address a growing social and financial issue.

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