According to the United State Department of Justice, more than 2 million adults were incarcerated at the end of 2015. For these millions of people, time spent in jail or prison is disruptive to many different parts of life, including relationships, finances, employment and health care. While people who are incarcerated are under the care of health care professionals, they may struggle accessing health care once they are released.
Though most incarceration systems provide some kind of health care for their populations, disruption in care can have negative effects. The large number of people incarcerated in the United States means that many people are affected by a lack of continuous health care, as pointed out by Edward Mulvey, PhD, professor of psychiatry, University of Pittsburgh School of Medicine.
“Health care works best when it’s coordinated and continuous,” said Dr. Mulvey. “It’s silly to think that we’re going to incarcerate people and then bring them back to their communities and think that somehow their health care is going to be continuous or of a quality that’s going to really address chronic problems effectively. And, the flip side is that when some people are incarcerated, they may receive some of the first health care they’ve gotten in many years. How is this supposed to continue?”
Disruption of health care is especially a problem for people who already have a higher risk for certain diseases. African Americans and Latinos have higher risk for heart disease, diabetes, some cancers and other conditions. The United States Department of Justice reports that in state prisons, African Americans are incarcerated at 5.1 times the rates of white people. Latinos are incarcerated at 1.4 times the rate of whites. People who already have a higher risk for some diseases and are incarcerated at higher rates may have a difficult time accessing continuous health care, including mental health care.
“In mental health care, there has been a big push for identification,” said Dr. Mulvey. “It’s estimated that around 20 percent of the prison population has a serious mental disorder at any given time. I think it’s fair to say that mental health services aren’t well-funded. The demands on the staff are high. The amount of time given to individuals with mental illness is often limited.”
Because of limited personnel and resources, Dr. Mulvey said that mental health screenings are mostly done to see if people are at risk for suicide. Beyond that, he believes there are many undetected and untreated mental health problems in jails and prisons. And, given that resuming health care after incarceration can be difficult, finding ongoing treatment for a mental illness, even though it is extremely important, may also be hard once the person returns to the community.
So, how is the health care gap bridged between the periods during and after incarceration? Dr. Mulvey said that peer support networks and community reintegration programs can greatly help. If people are engaged before release in planning how they will rebuild their access to health care, they may have greater success once they return to their communities.
“People need to get health care referrals and make plans before they leave to rebuild their lives,” said Dr. Mulvey. “It’s the smart and responsible thing to do.”
The Pennsylvania Department of Corrections (www.cor.pa.gov/) reports that 90 percent of inmates return home at some point. This means that, upon release, the individual returns to civilian life, with the hope of being a law-abiding citizen and reconnecting with life-sustaining functions, like employment and health care. This transition period is called “reentry.”
Pennsylvania is one of 35 states that works with the Center for Effective Policy, located in the greater Washington D.C. area. The center is doing research about the use of mentoring for assisting adult offenders in transitioning successfully from prison to the community. A mentoring relationship can provide “consistent support as needed, guidance, and encouragement that impacts participants in developing positive social relationships and achieving program outcomes such as job retention, family reunification, reduced recidivism, etc.” (www.reentrycoalition.ohio.gov/docs/initiative/coaching/Building%20Offenders’%20Community%20Assets%20Through%20Mentoring.pdf)
Mr. Raymond Miles, a Pittsburgh native, previous inmate, and owner of Realistic Reentry, LLC encourages family and friends of individuals in reentry stages to provide support.
“A change in behavior begins with a change in the heart,” says Mr. Miles. “If home is where the heart is, I encourage everyone to create a home that is welcoming, void of past experiences and erased of previous failures. As individuals, we can create an environment that supports change and promotes growth. As a community, we can hold accountable organizations and agencies that fail to do so.”
For more information about local reentry services, check out the PA 2-1-1 page at https://pa211sw.org/get-help/reentry-services/. This page provides information and resources on topics like transition, education, employment, counseling and legal assistance.
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