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Addressing the Challenge of Community Reentry among Released Inmates with Serious Mental Illness

by Jacques Baillargeon, Stephen K. Hoge, &  Joseph V. Penn (2010).  American Journal of Community Psychology, 46 (3-4): 361-375.

The authors of this essay argue that current and former prisoners do not receive "adequate mental health services" while they are in jail or prison, as they receive transitional services, or when in community outreach settings. Based primarily at the University of Texas Medical Branch in Galveston, they argue, "Incarceration is extremely disruptive to social attachment; the process of reentry and reintegration into the community is greatly complicated by a number of social and behavioral factors. Moreover, there are significant difficulties involved in negotiating transitional care across agency boundaries as patients move from correctional settings to community-based health care. Even within the mental health system, the burden of stigmatization attached to incarceration impedes the acceptance of formerly incarcerated patients into community outpatient programs." Broad-based changes are needed, they say, to establish adequate fiscal support and "a culture of acceptance in the clinical community."

Baillargeon, Hoge, and Penn describe a series of challenges confronting the community reentry of ex-prisoners with serious mental illness: the criminalization of the mentally ill, the high level of prisoners with severe mental illness, the provision of adequate psychiatric care during incarceration, psychosocial and economic challenges such as unemployment and homelessness  facing these men and women once released from confinement, and problems gaining access to community mental health services. They also examine a number of promising strategies for improving the transition of mentally ill prisoners to the community, including discharge or transition planning and linkage to appropriate mental health services and fiscal resources helpful for establishing a feasible community presence. Funding streams recognized in this article on the federal level include the Mentally Ill Offender treatment and Crime Reduction Act of 2004 and the second Chance Act of 2007; on the state level they recognize the mentally Ill Offender Crime Reduction Program in California. County-based programs worthy of note, they suggest, include the Community Reintegration of Offenders with Mental Illness and Substance Abuse in Erie, Pennsylvania and the Hampden County Correctional and Community Health Program in Springfield, Massachusetts.

The authors conclude, "The failure of many released prisoners with serious mental illness to obtain adequate community-based mental health care appears to be the result of multiple factors, including inadequate treatment programs and discharge planning services during incarceration and an insufficient number of public mental health care programs in the community. Furthermore, services that are provided by mainstream community-based mental health centers may be largely ineffective in meeting the distinct treatment needs of a substantial portion of mentally ill returning prisoners, including those with co-occurring substance use disorders and a history of treatment resistance. Additionally, some community-based mental health programs are simply unwilling to provide services for those with a history of incarceration."

Other key points made in this article include the following:

  • Only a few studies have examined the extent of mentally all prisoners returning to communities for mental health services, and those that have indicate that these individuals have difficulty locating them.
  • Discharge or transitional planning is essential for the aftercare of mentally ill offenders released into the community
  • Only a few studies assess the relationship between serious mental illness and criminal recidivism, and these few studies are weakened because of small sample sizes, short follow-up periods, and samples of low-end misdemeanants.

For further information, contact Jacques Baillargeon, Department of Preventive Medicine and Community Health, Division of Correctional Managed Care, University of Texas Medical Branch, 301 University Blvd., Galveston, TX 77555, (e-mail)

Posted Thu, Aug 4 2011 4:58 PM by Tracey Vessels
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