Community reintegration of prisoners with mental illness: A social investment perspective

Abstract

Responding effectively and efficiently to the needs of persons with mental illness returning to the community from prison requires identifying their differences in need and placement difficulties upon return and targeting reintegration investments to reflect these differences. This paper has three parts. The first part profiles the male special needs population in New Jersey prisons. These profiles describe behavioral health and criminal justice characteristics of 2715 male inmates with mental health problems, and are used to identify the scope and nature of the public's investment opportunity. The next part describes the costs associated with possible "investments." The special needs population is classified by need and placement difficulty, and then matched to reentry and community-based treatment programs. Costs are estimated for reentry planning and community-based treatment for the first year post-release. The third part recommends an investment strategy and a set of operational changes that might minimize the loss and maximize the return on the public’s investment dollar in mental health.

Introduction

In an average year in the United States, approximately 96,000 prison inmates will reenter the community with acute to severe mental health problems. The vast majority of these inmates received treatment for their mental health problems while incarcerated, and a significant part of that treatment included taking psychotropic medications (Beck & Maruschak, 2001, Ditton, 1999, Human Rights Watch, 2003). For inmates with mental health problems reentering the community from prison, treatment is critical. Treatment is the most effective and efficient method for assuring the best set of health and justice outcomes for the individual and society. There is ample research evidence that underscores the need for continuity of treatment for persons with mental health problems (Burns & Santos, 1995, Dixon, 2000, Lave et al., 1998). Active and continuous mental health treatment is the best defense against relapse, as well as the best offense for recovery. In turn, relapse prevention protects against recidivism (Beck & Maruschak, 2001, Draine & Solomon, 1994, Monahan et al., 2001, Solomon et al., 1994, Ventura et al., 1998).

As incarcerated populations grow in size and in their representation of mental illness, state and local officials are looking for ways to respond. Ways that comply with constitutional requirements and legal mandates, fit the contours of a fragmented public system, which relies increasingly on the private sector, and that are affordable. Their affordability is perhaps the most limiting and vexing challenge, especially in contemporary times of huge state budget shortfalls. The needs of mentally disordered offenders are complex and multi-dimensional, often including addiction problems and some form of personality disorder, and they are expensive if managed comprehensively. It is unlikely that there will ever be enough public funding, even in more prosperous times, to meet all their needs. For this reason, it is vital that policy makers carefully invest available funds in responses that are most likely to address needs that produce health and justice outcomes most valued by society.

Advanced here is the argument that the most sensible way to respond to the needs of offenders with mental illness is to treat their needs as an investment, and to evaluate alternative responses to their needs in terms of their yields (or rates of return measured in health and justice outcomes). States and local governments that seek to maximize the social return on their investments will invest both in high yielding interventions and systemic and structural changes that affect the depreciation rates of the outcomes produced by these investments. For example, it makes no social or economic sense to invest public dollars in stabilizing chronic mental health problems of inmates while they are incarcerated and then lose this “outcome” by gaps in treatment when the person moves from prison or jail to the community. Everyone loses, repeatedly, when this type of disjointed (and irrational) investment strategy is followed. From a social investment perspective, the challenge facing public officials is not mental illness in correctional or community settings; but, rather how to use scarce public dollars, intended to address mental health problems, to produce and protect mental health as a means for promoting prosocial behavior.

This paper has three parts. The first part profiles the male special needs population in New Jersey prisons. These profiles describe behavioral health and criminal justice characteristics of 2715 male inmates with mental health problems, and are used to identify the scope and nature of the public's investment opportunity. The next part describes the costs associated with possible “investments”. The special needs population is classified by need and placement difficulty, and then matched to reentry and community-based treatment programs. Costs are estimated for reentry planning and community-based treatment for the first year post-release. The third part recommends an investment strategy and a set of operational changes that might minimize the loss and maximize the return on the public's investment dollar in mental health.