Safe Reentry From Jail

1. Safe Reentry From Jail Presented at: Criminal Justice – Behavioral Health: Partnerships Promoting Integrated Healthcare San Antonio, Texas January 2017

2. Substance use and mental illness are driving factors in justice-system involvement 68% 64% 56% 53% 19% 17% 16% 9% 4% GenERAL State Prison Local population Jail General State Prison Local population Jail General State Prison Local Population Jail SUBSTANCE USE DISORDER ANY MENTAL HEALTH PROBLEM SERIOUS MENTAL ILLNESS Sources: James and Glaze, 2006; Ditton, 1999 and Metzner, 1997 as cited in Osher, D’Amora, Plotkin, Jarrett, and Eggleston, 2012; Mumola and Karberg, 2006; Karberg and James, 2005; NSDUH at SAMHSA, 2013

3. Prevalence of Chronic Illness Source: Marcuschak, LM, Berzofsky, M. Medical Problems of State and Federal Prisoners and Jail Inmates, 2011-12. US Department of Justice February, 2015.

4. Detention & Reentry = High Risk Time During Detention: • High risk of suicide • High volume of detoxifications • Jails not always medically prepared or trained At Release: • 12-20x higher death rates • Overdose, suicide, homicide, heart attack

5. Familiar Faces • Small number of people who frequent the ER, jail and homeless shelters • Consume high volume of resources in health, safety and housing systems

6. Hope for Positive Outcomes • 40 years of research and practice nationally • Shows providing behavioral health services reduces future arrests, increases employment, improves health status • NIDA Principles emphasize continuity of care

7. Challenges of Working at Jail Release • Unpredictable release day/time -Based on legal case, not health status • Lengths of stay highly variable so discharge planning pre-release is challenging

8. Challenges of Working at Jail Release 3. Legal release status - 50% released with further supervision - 50% released with no further supervision - Voluntary patients as soon as released 4. Health status at release - Short stay (1-2 days)—may still be intoxicated - Moderate stay (3-14 days)—initial medical care, on some medications, but limited release planning

9. Challenges of Working at Jail Release • Community infrastructure to receive patients after release? -A brick and mortar center is only part of the solution… a robust continuum of community- based crisis services is essential for success

10. What’s Going On Around the County?

11. Jails = Insurance Enrollment Sites • Most large city jails in expansion states have some kind of program for screening, application assistance • Some programs are quite large, nearly universal • Others targeted – Focus on medical or discharge or…. • Finding 40-60% of new detainees are coming in already covered

12. Jails = Health Care Linkage Sites • Most large city jails are building linkage programs • Chicago IL • Expanded jail inreach • Building release center • Louisville KY • Building jail release (enrollment + social workers) • Expanded care capacity for people leaving jail through partnership with community providers, major health system

13. Seattle WA • Major Familiar Faces initiative • Engaging Medicaid managed care companies to work within their jail pre-release

14. Maureen McDonnell Director for Business and Healthcare Strategy Development mmcdonnell@tasc.org 312-573-8222