For Better Outcomes, Let’s Improve Coordination With Community Care
As correctional health and mental health services are more widely understood to be a piece of the larger public health system, the question many correctional health care providers ask is, “How can we more effectively transition individuals both into and out of our correctional facilities?”
Barriers to Continuity
Although there are a number of excellent court-based programs designed to divert individuals with serious mental health, substance abuse or psychological trauma, individuals who do not succeed in these programs often end up behind bars. How quickly and in what format health care information is transferred to correctional health care providers is important to ensure that medications and treatment are continued without interruption.
And yet, few localities have a well-defined mechanism for communicating this information effectively and efficiently. Surely in this age of advanced technology, there is a way to codify essential health care information and move it in a timely fashion throughout our public health care system while simultaneously safeguarding patient privacy.
Similarly, individuals whose medical, mental health and/or substance use problems have been stabilized while in prison or jail will need additional community support when they are released. Research suggests that without strong community support, the chance of recidivism among these individuals increases significantly. Clearly, they need ongoing medical and mental health support with community health care providers, and how efficiently and effectively their individual treatment needs are communicated to these health care providers is, once again, essential for continuity of care. While this is an obvious statement to make, the process is fraught with problems.
Many jurisdictions do not have effective communication mechanisms by which to transfer relevant treatment information from correctional to community health care providers. Additionally, releasees may not have the mental capacity to follow through with health care appointments or adhere to prescribed medication and treatment regimens. They may not have the financial ability to pay for health care services due to their lack of employment, nor have quick access to Medicaid benefits that were terminated with incarceration. They may not have access to the transportation needed to access this care.
In addition, community-based health care providers may be reluctant to treat individuals who were incarcerated. In many cases, postrelease adjustment for those with chronic medical, mental health and/or substance use disorders is further complicated by a lack of adequate housing and the family or community support needed to help these individuals navigate postrelease issues and problems.
Smoothing the Way to Successful Reentry
While these problems are significant, some jurisdictions are finding innovative ways to address many of these issues. For example, some correctional systems are implementing prerelease programs as early as six months prior to release. Through these programs, soon-to-be-released individuals are educated about common obstacles that others have found postrelease and how they overcame these obstacles. They are informed about community-based programs and services that may be of benefit to them and how to access these programs. Community health care providers are also brought into the correctional facility and introduced to their future clients and their treatment programs and individual needs. This “in-reach” approach gives the patient and the community-based provider an opportunity to establish a therapeutic relationship before release.
Other jurisdictions are using an extensive “out-reach” approach to managing releasees. These programs typically use a multidisciplinary team approach designed to aggressively address the various needs of each released individual. These programs, sometimes called assertive community treatment programs, assign each person to an individual “navigator” or team of individuals who assist with housing, employment, treatment and transportation needs and provide the community-based support and encouragement that is often lacking, but desperately needed for a successful community reentry. In some programs, navigators will pick the client up at the prison or jail gate and provide transport to community supported housing.
Research suggests that these in-reach and out-reach programs can reduce recidivism. However, the obvious problem for many jurisdictions is that these programs are very labor-intensive and, therefore, costly. Furthermore, such programs are lacking in many jurisdictions, particularly in rural settings. However, given the high cost of multiple incarcerations, along with the fact that people with chronic medical and mental health problems recidivate more often and spend more time incarcerated than those without such problems, it may be time to consider innovative approaches that invest resources to address these problems as early as possible and in the least restrictive environment required.
To accomplish these objectives would require better coordination between individual law enforcement and community health care agencies, more effective sharing of health care data, possible tweaking of HIPAA laws and better integration of correctional health care into the larger public health care system.
– Thomas J. Fagan, PhD, CCHP-MH, is the chair of the NCCHC board of directors. This column first appeared in the Summer 2019 issue of CorrectCare, Vol. 33, Issue 3.