Re-Entry Into Community

For people with mental health conditions who fail to receive appropriate services and supports, the justice system can become a revolving door. Periods of incarceration disrupt any treatment being received and progress toward recovery. Thus, the period post-incarceration becomes a critical time to support people to thrive. Federal policy can ensure that every community has access to the resources and evidence-based information it needs to provide effective supports post-incarceration.

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Solutions for Better Mental Health

Continuity of Care

Medicaid does not cover services during periods of incarceration. In many states, incarceration causes people to become disenrolled entirely. This can lead to dangerous gaps in care for people with mental health conditions.1Joseph W. Frank et al., “Increased Hospital and Emergency Department Utilization by Individuals with Recent Criminal Justice Involvement: Results of a National Survey,” Journal of General Internal Medicine 29, no. 9 (September 9, 2014): 1226–33, http://dx.doi.org/10.1007/s11606-014-2877-y. Research has found that ensuring enrollment post-release leads to higher rates of accessing mental health treatment,2T. N. Winkelman et al., “Health Insurance Trends and Access to Behavioral Healthcare Among Justice-Involved Individuals-United States, 2008-2014,” Journal of General Internal Medicine 31, no. 12 (December 2016): 1523–29, https://doi.org/10.1007/s11606-016-3845-5. 3Joseph P. Morrissey, Marisa E. Domino, and Gary S. Cuddeback, “Expedited Medicaid Enrollment, Mental Health Service Use, and Criminal Recidivism among Released Prisoners with Severe Mental Illness,” Psychiatric Services 67, no. 8 (August 1, 2016): 842–49, http://dx.doi.org/10.1176/appi.ps.201500305. which in turn has been linked to lower rates of recidivism.4B. Ray et al., “Access to Recovery and Recidivism Among Former Prison Inmates,” International Journal of Offender Therapy and Comparative Criminology 61, no. 8 (June 2017): 874–93, https://doi.org/10.1177/0306624x15606688. Before release, people should be enrolled in coverage and connected to services in the community.

View Action Items

  • The federal government should introduce incentives into its justice system funding for enrolling people in Medicaid before release and require protocols for connecting to community services similar to those required for hospital discharge planning.
  • The federal government should introduce a performance measure into its justice system funding of receiving mental health treatment 7- and 30-days post-release, similar to how hospital performance is measured.
  • The federal government should support jails and prisons to build processes that automate enrollment of incarcerated individuals in Medicaid using the documentation for which states may already have access.5Sachini N. Bandara et al., “Leveraging The Affordable Care Act To Enroll Justice-Involved Populations In Medicaid: State And Local Efforts,” Health Affairs 34, no. 12 (December 10, 2015): 2044–51, http://dx.doi.org/10.1377/hlthaff.2015.0668; C. A. Grodensky et al., “Medicaid Enrollment among Prison Inmates in a Non-Expansion State: Exploring Predisposing, Enabling, and Need Factors Related to Enrollment Pre-Incarceration and Post-Release,” J Urban Health, June 22, 2018, https://doi.org/10.1007/s11524-018-0275-1. 6Stephen A. Somers et al., “Medicaid Expansion: Considerations For States Regarding Newly Eligible Jail-Involved Individuals,” Health Affairs 33, no. 3 (March 11, 2014): 455–61.

Re-Entry Programming

Over the past several decades, access to re-entry services has increased dramatically and parole/probation practices are becoming more evidence-based. At the same time, evidence has developed on how to effectively support people with mental health conditions to participate in social and economic life. The growth of re-entry programming can be built on by integrating evidence-based support for mental health.

View Action Items

  • CMS should clarify how Medicaid-funds can be used with treatment while incarcerated and re-entry programming to ensure that they meet the needs of individuals with mental health conditions and provide guidance on reimbursement and liability issues associated with hiring peer support specialists with the experience of being justice involved.7M. Dooris et al., “Probation as a Setting for Building Well-Being through Integrated Service Provision: Evaluating an Offender Health Trainer Service,” Perspect Public Health 133, no. 4 (July 2013): 199–206, https://doi.org/10.1177/1757913913486036.
  • The federal government should fund additional demonstrations of specialty mental health parole and probation programs for justice systems.8Sarah M. Manchak et al., “High-Fidelity Specialty Mental Health Probation Improves Officer Practices, Treatment Access, and Rule Compliance,” Law and Human Behavior 38, no. 5 (October 9, 2014): 450–61, http://dx.doi.org/10.1037/lhb0000076.
  • The federal government should require re-entry programs it funds to create linkages with other community resources, including mental health services and supports, supportive housing programs, as well as other workforce programs that could continue to support individuals even after the re-entry period.9Freudenberg and Heller, “A Review of Opportunities to Improve the Health of People Involved in the Criminal Justice System in the United States.” CMS should issue the 1115 guidance facilitating care transitions at re-entry that was required in the SUPPORT Act.

Tailored Policies for Unique Needs

To be effective, mental health solutions need to address individuals' range of identities based on race, ethnicity, language, gender, or gender identity, sexual orientation, disability, veteran's status, or life circumstances. We recommend meaningful policies to combat a harmful legacy of one-size-fits-all solutions.

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