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breaking the tragic cycle

Once released from prison, mentally ill ex-offenders are faced with the challenges of reintegrating into their communities. Those who do not make a successful transition relapse and return to prison. But across the country, community groups and prison and mental health officials are working together to break this cycle.

In 1999, New York City was routinely releasing its mentally ill ex-offenders into impoverished neighborhoods between 2 and 6 in the morning with only $1.50 in cash and two subway tokens. In a class-action suit against the city, several inmates claim that without provisions for continuing treatment of their mental illnesses or help finding housing, psychiatric care and government services, they were more likely to psychologically decompensate, become homeless, relapse into criminal activity, and return to jail. Though this case was settled out of court with the city pledging to provide services for its inmates after their release, variations of this story are being played out across the country.

In 2004, some 630,000 prisoners were released back into their communities, many of them with mental illness and co-occurring disorders such as substance abuse. Studies have shown that 60 percent of released offenders are likely to be rearrested within 18 months, and that mentally ill offenders are likely to be rearrested at an even higher rate. Experts claim that a major cause for recidivism among the mentally ill is the "epidemic" shortfall in community-based mental health services. "While offenders have a constitutional right to receive mental health treatment when they are incarcerated, they do not enjoy a similar right to treatment in the community," writes Lance Courturier, chief psychiatrist of the Pennsylvania Department of Corrections.

Experts and corrections officials like Courturier believe that the solution is to directly link prison mental health services to services in the community. The Consensus Project, a coordinated effort by the Council of State Governments to improve services for mentally ill offenders, recently released a report that recommends planning for post-release services almost from the day they arrive in the justice system. A successful system for reentry would coordinate efforts among specialists in a range of services, integrate treatment for mental illness and substance abuse, combine primary healthcare with mental healthcare, create and improve housing resources for the mentally ill, involve families and the community with the offender's treatment, and ensure that people with mental illness are accessing the full range of government entitlements for which they are eligible, such as Social Security Disability Insurance.

Across the country, communities and organizations are taking up this call, in some cases beginning services a year before an inmate's release and continuing them for as long as those services are needed. One such program, operated by the Allegheny County Department of Human Services in Pittsburgh, has reduced recidivism to less than 10 percent. It helps mentally ill offenders apply for social services, arranges for their temporary housing, supplies them with bus passes, and sets up appointments with community doctors so they can continue to receive their medications. In addition, the program also provides more personal services, such as arranging for someone to pick up offenders at the time of their release and take them shopping for $200 worth of clothing and toiletries.

Here are a few more examples of innovative community reentry programs, as well as Internet resources to help you find similar programs in your community.


Dependency Health Services and Central Washington Comprehensive Mental Health, Yakima (WA)
Dependency Health Services, a detoxification center, and Central Washington Comprehensive Mental Health (CWCMH), a mental health crisis center, are located in the same building and operate in tandem to provide "seamless" integration of treatment for mental illness and substance abuse. The organization's primary center in Yakima operates 24 hours a day, seven days a week and offers its services to all members of the community -- not just ex-offenders -- regardless of their ability to pay. Individuals may be admitted to either program but will receive services from both if he or she shows signs of a co-occurring disorder. The two programs share a medical doctor, initiate joint clinical interventions, and collaborate with other agencies including local hospitals and law enforcement. In addition, the center provides outpatient services, housing assistance, vocational rehabilitation, family therapy and parent training. "Integrated treatment," its Web site claims, "has helped better prepare people for reentry into the community and thus cut down on subsequent hospitalizations, crisis situations, and involvement in the criminal justice system."

FIR-St Program and Together House, Gaudenzia, Inc., Philadephia (PA)
Begun in 1968 as a single substance abuse center in a dilapidated North Philadelphia row house, Gaudenzia, Inc. is now a network of outpatient and residential treatment facilities, which operates 81 programs in 51 locations throughout Pennsylvania, Delaware and Maryland. For mentally ill offenders, Gaudenzia House offers two reentry programs in cooperation with the City of Philadelphia and the Pennsylvania criminal justice system. The FIR-St program (Forensic Intensive Recovery-State) identifies and clinically assesses incarcerated men and women who have mental health and substance abuse diagnoses. Then after parole or release, the Together House program places 22 men and 22 women in separate residential programs for up to nine months. There, in the context of a highly structured and closely supervised environment, the participants learn about substance abuse and relapse prevention, and practice life skills such as making and keeping doctor appointments, taking medications as prescribed, and renewing their prescriptions. The Together House program utilizes a modified Therapeutic Community (TC) model of treatment, which allows patients to gradually accept greater levels of responsibility with the goal of successfully placing them back into the community.

Assertive Community Treatment (or ACT), Nationwide
Assertive Community Treatment (ACT) is a treatment model that trains community groups to provide comprehensive, locally-based treatment to people with serious and persistent mental illness. Developed in Madison, Wis., in the 1970s, six states have statewide ACT programs (including Delaware, Indiana, Michigan, Texas, Wisconsin, and Rhode Island), and 19 others have at least one or more ACT pilot program. Unlike linkage or brokerage case-management programs that connects individuals to mental health, housing, or rehabilitation agencies, ACT programs provide highly individualized services directly to consumers. Participants receive the multidisciplinary, round-the-clock staffing of a psychiatric unit, delivered in the real world settings of their homes, local coffee shops or other places they may frequent. Staff members are trained in psychiatry, social work, nursing, substance abuse, and vocational rehabilitation. In addition to professionally trained providers, many ACT programs have recently added positions known as "peer counselors" or "peer advocates": individuals with a personal history of mental illness and recovery who can help provide insight into their experience of mental illness for others trying to recover.

Application of the ACT model varies, but here is a sample of well-known programs:


"Ill Equipped: U.S. Prisons and Offenders with Mental Illness"
Read a 2003 Human Rights Watch report titled "Failure to Provide Essential Services" that describes the shortfalls in the reentry process for mentally ill offenders.

American Correctional Association
The April 2005 issue of the ACA journal Corrections Today focuses on the issue of offender reentry. Several articles from the issue are available for free download in PDF format. Of particular relevance are the following articles:

  • "Releasing Inmates with Mental Illness and Co-Occurring Disorders into the Community." Written by Lance Courturier, Frederick Maue and Catherine McVey. Co-authored by the chief psychologist at the Pennsylvania Department of Corrections, this article profiles seven of the state's exemplary linkage programs.
  • "Engaging Communities: An Essential Ingredient to Offender Reentry." This article by Reginald A. Wilkinson describes the community resources necessary to make offender reentry a success. Read FRONTLINE's interview with Wilkinson, the past president of the American Correctional Association and the current director of the Ohio Department of Corrections and Rehabilitation.

An Explanation of Federal Medicaid and Disability Program Rules
According to the Consensus Project: "Many offenders with serious mental illness are eligible to participate in federal benefit programs upon release. Few, however, are actually enrolled when they return to the community, and, as a result, their access to medications and treatment -- typically essential to compliance with conditions of release for someone with a mental illness -- is severely limited." This fact sheet outlines eligibility requirements for offenders applying for federal benefits programs.

Search for reentry programs in your state through these Web sites. Note: If your state or community is not represented, contact your State Department of Corrections.

The Consensus Project
Search by type of program or location for 25 participating programs devoted to offender reentry for the mentally ill.

Reentry National Outreach Campaign
Search by type of program for nearly 100 reentry programs in dozens of states. Most of the programs geared toward the mentally ill are in the "Health" column.

Assertive Community Treatment Association
Only six states (DE, ID, MI, RI, TX, WI) currently have statewide ACT programs. Nineteen states have at least one or more ACT pilot programs in their state. To find an ACT-affiliated program near you, contact the national ACT association through their Web site.


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posted may 10, 2005

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