WASHINGTON, D.C., March 18, 2005—Former prisoners with serious physical or mental health problems and health care and social service providers in the Cincinnati area agree: a seamless transition from care inside the prison walls to care on the outside must take place if released prisoners are to make it back in society.
The challenge is considerable for Cincinnati and other Ohio cities. A 2004 survey by the nonpartisan Urban Institute found that one-quarter of the men released from Ohio prisons were on medication and one-third wanted counseling, mental health treatment, or substance abuse treatment. In the year ending last June, 28,571 men and women left Ohio prisons.
"An adequate service safety net requires extensive prerelease planning and close collaboration among many people," says Christy Visher, coauthor of "In Need of Help: Experiences of Seriously Ill Prisoners Returning to Cincinnati," a new exploratory study from the Urban Institute.
"These include health care providers, substance abuse counselors, and case managers inside the prison and their counterparts in the community, as well as parole officers and social service workers. Also vital are local, state, and federal agency staffs that determine eligibility for such programs as Medicaid, Social Security, food stamps, housing assistance, and veterans' benefits."
Ohio is at the forefront of the states developing innovative approaches to preparing prisoners for reentry. In fall 2002, Ohio launched "The Ohio Plan" to ready all prisoners for release and connect them to community services. The plan is being rolled out over five years and initially focuses on former prisoners with the greatest need for help.
"In Need of Help"
In late 2003 and early 2004, Urban Institute researchers interviewed 81 male prisoners with serious mental or physical health problems as they prepared for release and sought health care upon their return to Cincinnati. Focus groups were also conducted with about two dozen health care and social service providers serving former prisoners in Cincinnati.
Fifty-two percent of the former prisoners were contending with depression, 30 percent suffered from hypertension, 27 percent had asthma, 26 percent experienced back pain, and 25 percent had arthritis. These problems were often intertwined with extensive histories of substance use: 62 percent smoked daily before incarceration, 37 percent smoked marijuana a few times a week or daily, 31 percent were drunk a few times a week or daily, and 28 percent reported similar use of cocaine.
Among the study's key findings were the following:
- Most ex-prisoners said mental health care in prison was generally available when needed, but few were satisfied with the quality and availability of medical and dental care.
- Prisoners reported long waits to see a prison doctor and insensitive, uncaring treatment from many of the doctors and nurses.
- The lack of information before release about community services-where to go, how to get them, whom to talk to-was a major obstacle to obtaining care after incarceration.
- Former prisoners reported they often had to rely on family, friends, and the local hospital's emergency room for help obtaining medication after release.
- Community service providers praised the Ohio Plan, but said prisoners' medical needs required more attention during release preparation.
- Health care providers recommended that former prisoners have a single place to go for comprehensive information about health care and other services after their release.
- Lack of resources, limitations local funders place on grants, and intense competition for funding struck community workers as the most significant impediments to aiding former prisoners, especially those with the most serious health needs.
Back in the community, ex-prisoners were asked what assistance or services they needed most. Topping the list were financial support, mentioned by 75 percent of respondents, followed by health insurance, 58 percent; a job, 48 percent; housing, 46 percent; and education, 33 percent.
The prisoners' experiences and the insights of the service providers, Visher says, suggest special attention and resources be applied to
- improving the prison-to-community transition for seriously ill prisoners—whether or not they will be supervised after their release—including plans for continuing treatment, medication, housing, and other essential services;
- enhancing communities' capacity to treat former prisoners who need mental health and substance abuse treatment;
- developing mechanisms for prisoners to obtain legal identification and apply for state and federal benefits before release; and
- establishing universal mental health screening for soon-to-be-released prisoners, including those who will not be under a parole officer's supervision.
"In Need of Help: Experiences of Seriously Ill Prisoners Returning to Cincinnati," by Christy A. Visher, Rebecca L. Naser, Demelza Baer, and Jesse Jannetta, was funded by The Health Foundation of Greater Cincinnati. Available at http://www.urban.org/url.cfm?ID=311155, it is part of Returning Home: Understanding the Challenges of Prisoner Reentry, the Urban Institute's three-year study of prisoner reentry in Maryland, Illinois, Ohio, and Texas.
The Urban Institute is a nonprofit, nonpartisan policy research and educational organization that examines the social, economic, and governance challenges facing the nation.
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