This report documents the key lessons learned and recommendations to help criminal justice and substance use treatment systems improve transitions between institutional and community care.
Health and Criminal Justice Populations
The U.S. Bureau of Justice Statistics reported that about 700,000 individuals returned to the community from state and federal prisons in 2012, and as many as 9 million people are estimated to cycle through local jails each year. These individuals suffer from disproportionately high rates of HIV/AIDS, hepatitis, diabetes, and other communicable and chronic diseases compared with the general population, and mental illness and substance abuse are especially prevalent. For example, about 17 percent of inmates in jails and prisons suffer from serious mental illnesses—more than three times the rate in the general population.
Individuals who are incarcerated have constitutional protections to ensure health needs are identified and addressed, but very few have consistent access to necessary health care services upon release. As many as 90 percent of those exiting the criminal justice system are uninsured, and few state or local corrections facilities have programs in place to enroll individuals in health coverage for which they might be eligible. The result is that most individuals returning to the community after incarceration are simply unable to access a consistent source of health care.
This presents challenges for both public health and public safety. Inadequate access to health care is associated with poor health outcomes, as well as higher rates of rearrest and reincarceration for those with mental health and/or substance abuse disorders. Yet, research suggests that assessing individuals’ health care needs and linking them to health insurance coverage and appropriate services and supports can improve health outcomes, and reduce recidivism among those with mental illness and substance abuse.
Estimates vary widely, but one national study concluded that well over half of all individuals exiting the criminal justice system each year will be newly eligible for coverage as a result of the Patient Protection and Affordable Care Act. For information on changes in health care policy, including health care reform, click here.
Justice Center Health Care Publications
The CSG Justice Center partnered with Dr. Faye Taxman from George Mason University’s Center for Advancing Correctional Excellence to develop guiding principles and process measures that can help guide cross-systems delivery of service.
An extensive data analysis coupled with over 50 in-person interviews with stakeholders in Salt Lake County’s justice and behavioral health systems led to the identification of key recommendations improve outcomes for people involved with the county’s criminal justice system, particular those with behavioral health disorders.
In this brief from the CSG Justice Center, an extensive data analysis coupled with over 50 in-person interviews with local and state leaders led to the identification of key recommendations for reducing the number of people with behavioral health disorders cycling in and out of jail.
Developed by the Substance Abuse and Mental health Services Administration’s (SAMHSA) GAINS Center for Behavioral Health and Justice Transformation in collaboration with the Council of State Governments Justice Center and the Bureau of Justice Assistance, the guidelines promote the criminal justice partnerships that are necessary to develop successful approaches for identifying individuals in need of services, determining what services those individuals need, and addressing these needs during transition from incarceration to community-based treatment and supervision.
- The health and health care of U.S. prisoners: Results of a nationwide survey.
- Prevalence of serious mental illness among jail inmates
- Discharge planning and continuity of health care: Findings from the San Francisco county jail.
- For people with serious mental illnesses: Finding the key to successful transition from jail or prison to the community.
- Lack of health insurance increases all cause and all cancer mortality in adults: An analysis of National Health and Nutrition Examination Survey (NHANES III) data.
- Incarcerated mentally ill: A growing issue in California.
- Health insurance eligibility, utilization of medical care, and child health.
- Unmet health needs of uninsured adults in the United States.
- Adults with behavioral health needs under correctional supervision: A shared framework for reducing recidivism and promoting recovery.
- As roughly 700,000 prisoners are released annually, about half will gain health coverage and care under federal laws.
External Health Care Publications
The purpose of this issue brief from U.S. Department of Health and Human Service’s Office of the Assistant Secretary for Planning and Evaluation is to highlight the importance of health insurance coverage for criminal justice involved individuals, particularly the importance of the expansion in Medicaid coverage made available through the Affordable Care Act
This guidance from the U.S. Department of Public Health and Human Services updates decades-old policy and clarifies that individuals who are currently on probation, parole or in home confinement are not considered inmates of a public institution.
The toolkit is designed to provide state officials with actionable information about policies and practices available to connect individuals involved in the criminal justice system to health care coverage through Medicaid.
This SAMHSA report describes the experiences, successes, and barriers encountered by a select group of state behavioral health agencies in adapting their service systems to address evolving changes in health care delivery and insurance.
This report from the National Alliance on Mental Illness discusses the limited insurance coverage for mental health and substance use care, despite the passage of two laws, the Mental Health Parity Addiction Equity Act (MHPAEA) in 2008 and the Affordable Care Act (ACA) in 2010.