For more than 40 years, case management techniques have proven effective at meeting health plan members’ complex behavioral health needs. Still, today, when it comes to case management services, individuals coming out of correctional facilities remain underserved. Many community-based health plans fail to recognize that these individuals require at least the same intensity of case management services they would need as someone who is discharged from a psychiatric hospital or detox facility.
To be sure, there are unique challenges to providing case management for individuals exiting correctional facilities. However, the principles are the same: connections, communications, continuity. And the results can be dramatic: reducing rates of recidivism, decreasing relapse in substance use, and mitigating cost of treatment while enhancing social reintegration and public safety.
To effectively serve these individuals, health plans need to gain a solid understanding of the unique issues they face in accessing care and create targeted strategies and reliable infrastructure to meet those needs.
Incarcerated individuals experience extremely high rates of chronic medical conditions, complex mental health issues, and substance use disorder (SUD).
- Half of incarcerated individuals have a chronic medical disease; approximately 60 percent have a substance use disorder, and 35-45 percent have a mental health disorder.
- People with serious mental illness are three times more likely to be incarcerated than hospitalized.
- Incarcerated individuals are ten times more likely to meet the criteria for drug dependence or abuse than the general population.
- Analysis of a Massachusetts state database found that individuals incarcerated in a state or county facility were 120 times more likely to die from an opioid overdose than individuals with no incarceration history, and the risk of death was highest in the first month after release.
Even with access to appropriate services—including case management—the prospects for success post-incarceration may be compromised by social determinants such as homelessness, joblessness, and the lack of community connections.
Fortunately, in Medicaid expansion states, the vast majority of individuals released from a correctional institution are eligible for Medicaid. And many programs establish eligibility and enroll these individuals in a Medicaid managed care plan on the day of release.
Developing a case management program for individuals with justice involvement
Building an effective case management model for individuals with Justice Involvement begins with becoming knowledgeable about the process and sequence of the criminal justice system. In this way, managed care providers can identify opportunities to introduce individuals to treatment and services at various intercepts.
Understanding the role of criminal justice professionals will help facilitate the collaboration and communication that is the foundation of effective case management, where roles, responsibilities, and treatment goals are clearly identified.
For optimal effectiveness, evidence-based behavioral health treatment programs should be tailored and employed to meet the unique cognitive, emotional, social, and coping skills of the individual.
To effectively address treatment needs for mental health and substance use disorders, case managers working with justice-involved individuals should receive training on recognizing and addressing criminogenic risk factors and conditions. Case managers should also develop plans to assist individuals in accessing stable housing, jobs, benefits, and other community resources. Coordinating services to address individuals’ physical health, behavioral health, social and criminogenic needs in an integrated way is essential for improving health outcomes for this population.
Also, incarcerated individuals have experienced higher rates of traumatic events with long-lasting negative repercussions, including sexual and physical violence, isolation, intimidation, and coercion. For this reason, case managers should ensure that service providers use trauma-informed service protocols and implement safety protocols to protect the client, other clients, and the organization’s staff.
As you begin to think about implementing Justice Involved case management in your organization, we can help. Our research-driven approach has led us to create technical, academic, and policy supports for Medicaid, community health organizations, and those in the criminal justice health field.
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Resources for more information:
- Commonwealth Medicine collaborates on Massachusetts initiative providing community-based supports for individuals with justice involvement (Commonwealth Medicine, December 17, 2019)
- Behavioral Health Initiative Enhances Connection to Community-Based Supports for Individuals Involved with the Criminal Justice System (Mass.gov, press release, July 15, 2019)
- Case Management in the Criminal Justice System (NIH Research Action, February 1999)
- Principles of Community-based Behavioral Health Services for Justice-involved individuals: A Research-based Guide—A bridge to the possible (SAMHSA)
- Chapter 2—Case Management and Accountability, Continuity of Offender Treatment for Substance Use Disorders from Institution to Community (NCBI.NIH)
- Care Management in the Correctional Setting (Care Management, April/May 2018)
- Case Management for Justice-Involved Populations: Colorado (Health Policy Center and Justice Policy Center)
- The Jail Health-Care Crisis: The opioid epidemic and other public health emergencies are being aggravated by failings in the criminal justice system (The New Yorker, February 28, 2019)
- Improving Outcomes for Justice-Involved Individuals With Lessons from Veterans Programs (Health Affairs, October 6, 2016)
- Coordinating Access to Services for Justice-Involved Populations (Milbank Memorial Fund, Issue Brief, August 2016)
- State Strategies for Establishing Connections to Healthcare for Justice-Involved Populations: The Central Role of Medicaid (The Commonwealth Fund, Issue Brief, January 11, 2019)
Data Sources
- US DOJ. “Drug Use, Dependence, and Abuse Among State Prisoners and Jail Inmates, 2007-2009.” June 2017.
- US DOJ. “Indicators of Mental Health Problems Reported by Prisoners and Jail Inmates, 2011-12.” June 2017. (includes state and federal prisoners)
- US DOJ. Medical Problems of State and Federal Prisoners and Jail Inmates, 2011–12, October 2016.
- Torrey, 2010. More Mentally Ill Persons Are in Jails and Prisons Than Hospitals: A Survey of the States
- MA DPH, “An Assessment of Fatal and Nonfatal Opioid Overdoses in Massachusetts (2011 – 2015).” August 2017. https://www.mass.gov/files/documents/2017/08/31/legislative-report-chapter-55-aug-2017.pdf