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Safe Reentry From Jail Presented at:
Criminal Justice – Behavioral Health: Partnerships Promoting Integrated Healthcare San Antonio, Texas January 2017
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Substance use and mental illness are driving factors in justice-system involvement
56% 64% 16% 17% 53% 68% 19% 4% 9% GenERAL State Prison Local population Jail General State Prison Local population Jail General State Prison Local Population Jail ANY MENTAL HEALTH PROBLEM SERIOUS MENTAL ILLNESS SUBSTANCE USE DISORDER 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
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Prevalence of Chronic Illness
Local Jail Population General Population Hypertension 26% 14% HIV 1.3% 0.3% Hepatitis B or C 6.5% 0.9% Asthma 20% 11% Substance Use Disorder 68% 9% Mental Illness 64% 10% Source: Marcuschak, LM, Berzofsky, M. Medical Problems of State and Federal Prisoners and Jail Inmates, US Department of Justice February, 2015.
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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
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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
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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
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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
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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
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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
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What’s Going On Around the County?
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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
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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
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Seattle WA Major Familiar Faces initiative
Engaging Medicaid managed care companies to work within their jail pre-release
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Maureen McDonnell Director for Business and Healthcare Strategy Development
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