The convergence of justice, human services, and health care

In 2006, the Bureau of Justice Statistics reported that “At midyear 2005 more than half of all prison and jail inmates had a mental health problem, including 705,600 inmates in State prisons, 78,800 in Federal prisons, and 479,900 in local jails.These estimates represented 56% of State prisoners, 45% of Federal prisoners, and 64% of jail inmates.” The incidence of serious mental illnesses is two to four times higher among prisoners than it is in the general population. In a study of more than 20,000 adults entering five local jails, researchers documented serious mental illnesses in 14.5 percent of the men and 31 percent of the women, which taken together, comprises 16.9 percent of those studied — rates in excess of three to six times those found in the general population.10

There is little reason to believe that these statistics have changed markedly since this study. If we recall that 95% of those incarcerated will return to society, we realize that a large percentage of these individuals will continue to have mental health problems upon release.
We also know that between 35-60% of the released offenders (depending on which state) will return to prison or jail within 3 years. Our failure to make significant reductions in the rate of recidivism is testimony to the inadequacy of many offender re-entry programs. 
For the seriously mentally ill inmates in prison, release planning begins at intake, and under treatment including counseling and medication, a plan is developed for re-entry. There is a widespread recognition that inmates who have been prescribed psychotropic medications must continue this treatment upon release. The consequences for missing a medication are likely to be an instant relapse resulting in criminal activity. However, when an offender is placed under community supervision, whether probation, parole or an intervention program, it is the person in the supervisor position who must oversee the re-entry process. In every case, these overloaded case workers rely on social services to implement the kind of recovery programs which, we believe, will reduce recidivism.  Where a part of the intervention program calls for the treatment of mental health disorders that might have contributed to the original reason for incarceration, it is again the community supervisor who must often arrange for such treatment. In these cases, then, there is a critical need for a coordinated delivery of service in association with the responsibilities of supervision that must result if there is any hope of reducing the recidivism rates. Under these circumstances, there must indeed be a convergence of justice, social services, and health services.  
Thoughtful health care providers are emphasizing the ideas of integrated health care, or a continuity of care model to serve patients holistically, leading to a highly coordinated and deconflicted approach to patient and family care. Within the social services discipline, there is increasing recognition of the importance of dealing again holistically with the family as a unit and this model is gaining recognition in the juvenile justice world. We are beginning to understand better the importance of applying similar ideas of teamwork and coordination to developing offender re-entry programs where the clear objective is to assist the offender to create a stable life style that overcomes a criminal career path. 
For interdisciplinary teams formed from justice, human services, and health to succeed, two premises must be accepted: (1)  the constraints in defining a plan of action based on individual organizational boundaries must disappear, and (2) there must be developed easy ways to exchange information (knowledge) across these disciplines. Such a level of information sharing is critical to successful outcomes and involves courts, jail, prison, supervision, mental health, and substance abuse  agencies at the federal, state, and county levels, as well as private providers. 
Neither of these conditions for success is easy to implement, but the benefits from doing so are significant. 
Paul Wormeli
Board of Directors
Stewards of Change Institute

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