The strategic planning team came to the conclusion that the fields of health, mental health, and substance abuse are interconnected, and thus will attract membership from the dame sets of people. In order to decrease repetitions, these focus areas have been combined into one health and well-being workgroup with two subgroups: mental health and substance abuse.
Individuals with mental health issues are overrepresented in correctional criminal justice settings. In a study of 20,000 incarcerated individuals, researchers found that 14.5% of the males and 31% of the females interviewed had a history of serious mental health issues (National Reentry Resource Center, n.d.).
Incarcerated individuals with mental health issues are twice as likely to violate community correctional supervision guidelines as are formerly incarcerated individuals without mental health issues (Prins & Draper, 2009). Many formerly incarcerated individuals who have mental health issues also have substance abuse problems, and these dual diagnoses further complicate compliance to correctional supervision (National Reentry Resource Center, n.d.).
Six evidence-based mental health treatment practices are proven to be clinically effective with people who suffer from mental illnesses. However, these practices have not been tested in criminal justice settings.
- Assertive Community Treatment (ACT). Community-based organizations come together to develop individualized treatment plans for clients.
- Life skills training. Individuals are taught basic living and coping skills.
- Integration/Collaboration. Individuals’ mental health treatment plans are aligned with their substance abuse services.
- Employment. Individuals are provided with supportive employment opportunities.
- Medications. As needed, individuals are encouraged to adhere to medications that will alleviate symptoms.
- Mental health education for the individual’s loved ones. Individuals, family members, and close contacts are educated about the illness at hand, how to manage the symptoms, and how to reduce stress (Prins & Draper, 2009).
To date, there is limited data on the mental health of probationers. CAIS provides very limited data on suicidality. Overall, the vast majority of probationers are not suicidal:
- More than three quarters (83.1%) of probationers have never thought about suicide.
- Fewer than one in ten (7.8%) probationers have thought about suicide.
- Nearly one tenth (9.1%) of respondents have tried to commit suicide.
Yet several groups are more likely to have a history of suicidality than others. Women and high-risk probationers are more likely to have attempted suicide. The percentage of high-risk probationers who have considered suicide is 13% compared with 5% of low-risk probationers.
Notably, Latinos and probationers categorized as “limit setting” on the CAIS are less likely to have attempted suicide.
In order to meet the mental health needs of formerly incarcerated people in Santa Clara County, the strategic planning team set the following goals:
To enhance the accessibility of mental health treatment services and medications for all ex-offenders after release.
- Identify moderate- and high-risk offenders with mental health issues prior to release.
- Develop a seamless transition into mental health services from county corrections and state prison.
Substance abuse affects the vast majority of probationers and parolees in Santa Clara County; 80% of the county’s adult criminal justice population has a history of drug and/or alcohol abuse (Santa Clara County Department of Correction, 2012). This does not account for crimes committed due to someone being under the influence of or in the pursuit of drugs and alcohol.
Substance abuse treatment would reduce recidivism among the currently addicted, formerly incarcerated population; a formerly incarcerated individual who has access to treatment in custody and receives aftercare is less likely to return to custody. Yet the existing substance abuse treatment infrastructure is struggling to serve this population.
Santa Clara County is steadily losing funding for substance abuse treatment. Over the past four years, treatment slots made available through the Santa Clara County Department of Alcohol and Drugs Services have been reduced by nearly 50% (Garner, 2012). In addition to the shortage of inpatient treatment bed space, there is a shortage of sober living environment options, especially those that allow children.
Notably, probationers themselves attribute criminal behavior to substance abuse. Overall, 45% of CAIS respondents attributed most of their criminal behavior to drug use. This response varied by risk level: 13% of low-risk respondent, 34% of moderate-risk respondents, and 74% of high-risk respondents attributed most of their criminal behavior to drug use.
To enhance the accessibility of substance abuse treatment services for all ex-offenders after release.
- Improve the coordination of and access to available alcohol and other drug abuse services for the reentry population with other health services providers, including public health, mental health, and homeless and employment services.
- Coordinate development of pre-lease substance abuse assessments to identify clients in need of extensive services to support recovery and full reintegration into their communities.
- Assess clients’ eligibility for public benefits.
- Determine the most appropriate level of care for each individual after release, based on alcohol and drug abuse assessment and clients’ response to treatment while incarcerated.
Compared to the general population, correctional populations suffer from a higher rate of chronic illnesses and communicable diseases. These diseases include, but are not limited to, coronary artery disease, hypertension, diabetes, asthma, chronic lung disease, HIV infection, and hepatitis B and C (Reentry Policy Council, n.d.).
Upon release from custody, many formerly incarcerated individuals do not have health insurance coverage, and hospital emergency rooms become their sole source of medical treatment. This is very costly to society because of the cost of emergency room care can be extremely high, and society inevitably must foot the bill. When individuals go to the emergency room, they often tend to do so after waiting until their symptoms are unbearable. This may be detrimental if the condition has worsened to the degree where it cannot be treated effectively.
Maintaining optimal physical health is one of the basic foundations for living a full life. Poor health may affect many aspects of formerly incarcerated individuals’ lives. For example, physical health has a strong correlation with housing status; people with poor health are more likely to be homeless or have inadequate housing than people in good health. Such is true with employment status; individuals in poor health are more likely to be unemployed than those in good health. People in poor health are also more likely to be depressed than individuals in good health. Depression can lead to the cycle of addiction and further complicate the reentry process. These are just a few examples of how poor physical health may hinder one’s ability to successfully reentry society; this list can be expanded tremendously. Therefore, it is imperative that the physical health needs of formerly incarcerated men and women in Santa Clara County be formally addressed.
To enhance accessibility to needed health care services for all ex-offenders after release by enrolling ex-offenders in Medicaid or other health benefits, if they meet eligibility criteria.
- Develop a coordinated mechanism for providing formerly incarcerated individuals with needed health services.
- Develop formal systems for handling health, mental health, and substance abuse needs of moderate- and high-risk offenders.
Reymundo Espinoza, Gardner Family Health Network
Aimee Reedy, Public Health Department
Meeting #1: Thursday, February 14, 2013
Health and Well-Being Workgroup Agenda_02 14 2013.docx
Meeting #2: Thursday, February 28, 2013
Meeting #3: Thursday, March 14, 2013
Meeting #4: Thursday, March 28, 2013
Time: 9:00-11:30 am
Location: Reentry Resource Center
151 W. Mission Street, San Jose