Releasing Inmates with Mental Illness and Co-Occurring Disorders into the Cmmunity

Article excerpt

In his 2004 State of the Union address, President George Bush proposed a four-year, $300 million initiative for offender reentry into the community. He asserted that "America is the land of the second chance, and when the gates of the prison open, the path ahead should lead to a better life." However, many inmates with mental illness encounter serious obstacles that prevent them from finding that better life. (1)

These obstacles are highlighted in the settlement of the Brad H. v. New York City class-action lawsuit in which New York City agreed to provide mentally ill inmates with treatment and other supportive services when they are released from the city prisons. The plaintiffs charged that the prisons routinely discharged offenders with mental illness into impoverished neighborhoods without adequate release plans, government benefits, housing or other services. The prisons allegedly released offenders near subway stations between 2 and 6 a.m. with $1.50 and two subway tokens. The plaintiffs argued that failure to provide discharge planning to inmates with mental illness increases the risk that this group will relapse, engage in aggressive acts harmful to others, attempt or commit suicide, be unable to care for themselves, become homeless, and ultimately, be rearrested and returned to jail. (2)

New York agreed to provide psychiatric treatment, including outpatient treatment, and medication needed to maintain stability after release, assistance obtaining housing and access to and, in cases where the inmate is indigent, the means to pay for those services. This would be a monumental task for correctional agencies across the county considering the following data.

The number of offenders with mental illness is staggering. According to recent Department of Justice estimates, approximately 700,000 adults with mental illness entered U.S. jails, and approximately 75 percent of these individuals suffered from co-occurring disorders, particularly substance abuse.

Also, these offenders may display multiple health and mental health problems due to their lifestyles, which frequently include transient behavior, financial instability and high-risk behaviors such as intravenous drug use, smoking and multiple sex partners. Most offenders do not have health insurance and lack supportive, positive and enduring relationships, which contribute to their emotional and health instability.

Finally, the offenders are reentering communities where the mental health delivery system failed them in the first place. The shortage of community-based mental health services is epidemic. Community agencies that may be available often distance themselves from working with offenders and display reluctance to accept clients with criminal records. Frequently, offenders display excesses in bizarre, unusual and aggressive behaviors, and deficits in self-care skills.

Discharging From The Pennsylvania DOC

The Pennsylvania Department of Corrections comprises 26 prisons housing more than 40,000 inmates. Approximately 18 percent of the offenders carry a psychiatric diagnosis, and a subset of approximately 4 percent of the population is rated seriously mentally ill (i.e., they display "a substantial disorder of thought or mood that significantly impairs judgment, behavior capacity to recognize reality or cope with the ordinary demands of life," according to the DOC's official definition). The department tracks the inmates with mental illness via an automated mental health/mental retardation (MH/MR) tracking system. The DOC compared parole and max-out data for MH/MR inmates and non-MH/MR inmates during the 12-month period from April 2002 to May 2003. The data show that higher proportions of inmates with mental illness and serious mental illness are more likely to serve their full sentences rather than receive parole, as indicated by the following statistics:

* Inmates with no mental health history were paroled 81. …