Recommendations for Implementation

Systems need to be in place to allow mental health and social service providers to coordinate with correctional and law enforcement agencies prior to and following the release of people with mental illness from correctional facilities. At a minimum, this means that community service agencies should be informed of the impending release of prisoners with histories of treatment for mental illness while in prison who will not be under community supervision.  Mental health service providers should then maintain records documenting contact and treatment subsequent to release. There is no reason for these records to differ in form or content from the records kept on contacts with any community client.

Depending on the system configuration, a community reintegration program may require considerable spanning of both jurisdictional and systemic boundaries. Incentives should be created for the community providers to do "inreach" to the correctional setting and begin the process prior to release.  Ex-offender contact information following release should be explicitly defined and a mechanism should be developed for locating individuals who do not keep their first scheduled appointment.

The "moment of release" from prison is often a crucial juncture in an offender's transition back to life in the community.  This is especially true for offenders with mental illness; it is important that these individuals are connected as seamlessly as possible with housing and services.   Mental health providers should be aware of the importance of the period immediately following a prisoner's release and work with corrections officials to develop transition plans, even for individuals who will not be under community supervision, that provide detailed strategies for the first days after a prisoner's release.  Responsibility to assume care of the individual between the time of release and the first outpatient appointment must be explicit.  This initial period of reintegration provides an opportunity for the mental health system to engage former prisoners from day one.  (See Policy Statement 21: Development of Transition Plan.)

Ex-offenders with mental illness return to the community burdened by a double stigma. The problems posed by their criminal history and mental health condition to finding housing and employment have already been discussed. More subtly, their status as ex-offenders with histories of mental health treatment can affect their social networks and family relationships as well, often leaving them in the same social situation that led to their arrest in the first place.

People with mental illness emerging from prison also frequently report particular discrimination on the part of the mental health service community. In many instances, mental health providers are reluctant to take on the perceived risks associated with clients who have criminal histories, especially if they include violence.[1]

It is important that programs be developed to meet the specific needs of offenders with mental illness who are transitioning from prison to the community. Correctional settings have had the responsibility for screening and identification of mental health issues as well as for providing treatment while incarcerated.  After those functions, the principle transition planning responsibility is to establish linkages between the ex-offender and future community services.  Working partnerships among probation, parole, the courts, neighborhood businesses, community housing organizations, and service providers can provide opportunities for the released offender to participate in restorative and therapeutic activities and community service projects.  Transition planning is equally important for individuals who will not be under community supervision as it is for those who will have some conditions placed on their release.

Programs serving released offenders need to develop a broad menu of services that can be matched to offender needs.  The service array should include attention to housing, health care, medications, case management, employment, income supports and entitlements, food and clothing, transportation, and child care. The result should be a community-based mental health service and support program that does not differ greatly from any intensely monitored community treatment program. If it is staffed by knowledgeable professionals and client-centered in its approach, it will best meet the needs of the released offenders with mental illness it serves.

Mental health staff need to be prepared to work with individuals who have been involved in the criminal justice system.  This requires training that will help to overcome the stigma attached to incarceration, address the special needs of individuals who have been incarcerated, and promote appropriate coordination with criminal justice agencies.  (See Policy Statement 31: Training for Mental Health Professionals.)

Mental health service providers should also consider encouraging development of a system of peer support for ex-offenders with mental illness. Finding that one is not alone in facing identifiable challenges associated with reentry can itself be an important support for men and women with mental illness coming out of prison. Peer support of this nature provides a ready and accepting social network, while those who have shared the experience can offer advice and suggestions likely to be received positively by the reentering ex-offender.  (See Policy Statement 39:  Consumer and Family Member Involvement, for more on peer services.)

Much is already known about the factors that affect a client's chances of establishing him or herself in the community upon release from prison. For instance, many clients have an immediate need for income-assistance, so re-establishment of benefits is an important step to be addressed at the earliest possible opportunity. Similarly, safe, affordable, permanent housing is closely correlated with success in the community.  For almost all persons with mental illness leaving prison, addressing housing needs must be seen as a high priority.

Maintaining contact between the mental health system and individuals who have entered it from prison also provides opportunities for other factors to be more clearly understood. It is important for the community provider to understand the factors that led up to arrest.  The planning of effective services involves attention to these matters to ensure services are delivered that reduce the likelihood of rearrest.  Community providers must incorporate this understanding into an individualized treatment plan.  The needs of a mother who has been incarcerated for crimes directly related to substance abuse will necessarily differ from those of a young male imprisoned on a personal assault conviction. It is important for any service provider to systematically evaluate its approaches, and in this area especially it is necessary to build training curricula on the experiences of those staff, clients, and families attempting to bridge the worlds of prison and mental health.  In a well-functioning system, recognition of individual needs will come with experience, and responsiveness will thus become more effective.

Example:  Forensic Transition Program, Massachusetts Department of Mental Health

Operated by the Massachusetts Department of Mental Health (DMH), the transition program is a statewide initiative that assists DMH-eligible preadjudicated and convicted inmates. It provides tracking and release planning services. Program staff collaborate with relevant departments, agencies, and vendors to facilitate the transition of ex-offenders with mental illness into communities across the state. They work with inmates with mental illness in correctional facilities at least three months before release to coordinate relevant psychosocial and criminal information for the transition and treatment planning process after release. Staff also provide case coordination and consultation to community providers for up to three months after release to address any immediate obstacles to client community adjustment.  The Forensic Transition Program works with inmates who will be under community supervision as well as those who have completed their sentence.[2]

By maintaining contact with recently released offenders with mental illness and providing effective services for them, community mental health providers demonstrate their willingness and ability to perform an important public safety function.