Re-entry

Prisoner health is community health—over 95% of those incarcerated ultimately return to the community (over 700,000 every year from federal and state prisons, and over 9 million from jails), disproportionately to disadvantaged communities.

Given what we know about the health burdens of incarcerated populations—including high rates of chronic disease, substance abuse, and mental illness—reentry is a critical time for engaging people in much-needed health services. While some medical needs may have been addressed in prison, many issues will require additional treatment in the community, and substance abuse and mental illness may not have been addressed at all. Additionally, jail detainees receive limited medical services due to their relatively short terms of incarceration.

Prison reentry poses the challenges of securing housing, employment, and available public assistance, all while re-connecting with family and friends. Amidst the competing demands of the reentry period, obtaining health care—enrolling in coverage, making appointments, or refilling prescriptions—often falls by the wayside. However, it is also a time when former prisoners are most vulnerable; studies have documented both high risk of death, particularly overdose death, and emergency department usage in the weeks immediately following release.

Appropriate intervention in addiction, mental illness, and chronic infectious diseases among the reentering population could lead to improved public health and criminal justice outcomes. Considering the large numbers of people living with infectious diseases who pass through corrections, proper management of infectious disease behind bars and as people transition back into the community may serve to control the spread of epidemics. Similarly, treating addiction or engaging in harm reduction education may decrease the risky drug use that transmits diseases, and also has the potential to reduce recidivism.

References

Hughes, T. & Wilson, D.J. (2015). Reentry Trends in the United States. Department of Justice, Office of Justice Programs, Bureau of Justice Statistics.

Patel, K., Boutwell, A., Brockmann, B. W., & Rich, J. D. (2014). Integrating Correctional And Community Health Care For Formerly Incarcerated People Who Are Eligible For Medicaid. Health Affairs (Project Hope), 33(3), 468–473. doi:10.1377/hlthaff.2013.1164

The items included here are intended to provide tools for general readers as well as researchers and students who are interested in learning more about Re-entry. This list is neither comprehensive nor exhaustive, but is intended to help a reader dive deeper into the subject matter at hand. We will be updating articles on a monthly basis.

Wellness and Illness Self-Management Skills in Community Corrections
Kelly PJ, Ramaswamy M, Chen HF, Denny D. Issues Ment Health Nurs. 2015 Feb.
“Community corrections provide a readjustment venue for re-entry between incarceration and home for inmates in the US corrections system. Our goal was to determine how self-management skills, an important predictor of re-entry success, varied by demographic and risk factors. In this cross-sectional study, we analyzed responses of 675 clients from 57 community corrections programs run by the regional division of the Federal Bureau of Prisons. A self-administered survey collected data on self-management skills, demographics, and risk factors; significant associations were applied in four regression models: the overall self-management score and three self-management subscales: coping skills, goals, and drug use. Over one-quarter (27.2%/146) of participants had a mental health history. White race, no mental health history and high school education were associated with better overall self-management scores; mental health history and drug use in the past year were associated with lower coping scores; female gender and high school education were associated with better self-management goals; female gender was associated with better self-management drug use scores. Self-management programs may need to be individualized for different groups of clients. Lower scores for those with less education suggest an area for targeted, nurse-led interventions.”

Serious mental illness, criminal risk, parole supervision, and recidivism: Testing of conditional effects
Matejkowski J, Ostermann M. Law Hum Behav. 2015 Feb.
“Adults with serious mental illness (SMI) who are released from prison tend to recidivate more quickly and at higher rates than similarly situated adults who do not have SMI. The current study examined whether this relationship with recidivism is mediated by criminal risk level and whether parole supervision can ameliorate the effects of SMI on recidivism. Findings indicate that SMI did exhibit a significant indirect effect with recidivism when considering its relationship with actuarially assessed risk. However, this indirect effect was not conditioned by whether the individual was released to parole; specifically release status did not moderate the relationship between risk and recidivism. The direct effects of SMI on recidivism were found to be conditioned upon release status. Specifically, we found no relationship between SMI and recidivism for parolees and a negative relationship between SMI and recidivism among nonparolees. Findings indicate a need for paroling authorities to find more effective ways of reducing criminal risk, which can decrease subsequent recidivism, among the individuals they supervise.”

Mental Health and Substance Abuse Service Engagement by Men and Women During Community Reentry Following Incarceration
Begun AL, Early TJ, Hodge A. Adm Policy Ment Health. 2015 Feb 8.
“Individuals reentering the community following incarceration are at high risk for experiencing mental health and substance use problems. This longitudinal study explores patterns and barriers for engaging treatment services during early reentry. Seventy-five men and 62 women in jail, prison, or community based correctional facilities (CBCFs) participated in pre- and post-release interviews. Findings indicate that services were engaged at a lower-than-needed rate and barriers were greater for individuals leaving jails compared to prison or CBCF. Exploratory factor analysis of the barriers instrument is presented. Implications for extending service access to this population are discussed, as are future directions for research.”