Case Study

Helping Justice-Involved Individuals Access Better Care and Successfully Reenter Community

The United States has the highest incarceration rate in the world, with almost two million people imprisoned in a variety of facilities, including state and federal prisons, local jails, and juvenile correctional facilities, according to the Prison Policy Initiative.1 Many experts have pointed to mass incarceration as a public health crisis because its effects extend beyond the walls of the prison itself, most notably to families and communities.2

Mass incarceration disrupts social and family networks. Almost 10 million children have experienced one or both parents incarcerated at some point in their lives, which can adversely impact their educational, economic, and social opportunities. This may include an increased risk of substance use and involvement in crime as they mature. Parental incarceration also contributes to future health problems, such as chronic disease and post-traumatic stress disorder, limiting children’s opportunities for a healthy life. 3

Mass incarceration also affects economic development across the country as it consumes large portions of government budgets with negligible impact on crime rates in some states. Local, state, and federal governments spend almost $180 billion each year on corrections, policing, and criminal court systems. 4

Unfortunately, people of color are disproportionately overrepresented in the nation’s prisons and jails. Although 32% of the U.S. population is Black and Hispanic/Latino, 56% of the U.S. incarcerated population is represented by these groups.5 The Substance Abuse and Mental Health Services Administration reports that untreated substance use disorders among probationers and parolees can lead to relapse and a path toward continued criminal behavior, leading to potential probation/parole violations and an increased risk of reincarceration.6

THE CHALLENGE: Breaking the Cycle

Incarcerated individuals are ten times more likely to meet the qualifications for substance dependence or use than the general population, and approximately 25 to 45 % of them have a history of mental health conditions.7  What’s more, Black Americans with co-occurring serious mental illness and substance use disorders are 1.5 times more likely to be arrested and booked for a crime compared to white Americans with co-occurring serious mental illness and substance use disorders.8

In Massachusetts, residents with a history of incarceration are 120 times more likely to die from opioid overdose than the general population, and the risk is even greater the first month after release.9 Additionally, individuals with severe mental illness are more likely to be incarcerated than hospitalized, especially low-income people of color.10

Disproportionate rates of mental health issues, suicide, substance use disorders, disabilities, and physical disorders plague the reentry population.11 Nearly 75% of formerly incarcerated people are still unemployed a year after release. In fact, research has found that joblessness is the single most important predictor of recidivism or returning to prison.12

Emerging evidence shows that formerly incarcerated people underutilize preventive health care but are overrepresented in acute care settings like hospitals and emergency departments, often presenting with preventable or poorly managed conditions, which drives healthcare costs up and puts a further strain on the health system. 13

There is a need to disrupt the cycle of “relapse-reoffending-incarceration-release-reoffending” by connecting individuals with substance use and/or mental health conditions to appropriate health care and community services.

OUR APPROACH: Using Community Support to Provide Needed Services

In 2019, ForHealth Consulting at UMass Chan Medical School, along with a variety of community partners and sponsoring agencies,* collaborated with the Massachusetts Medicaid (MassHealth) program in the development of the MassHealth Behavioral Health Supports for Justice-Involved Individuals (BH-JI) intervention. The goals of this ongoing demonstration project are to:

  • Improve health outcomes
  • Decrease fatal overdoses
  • Increase community tenure
  • Provide effective and efficient healthcare utilization

Justice entities identified MassHealth members in two counties who had a mental health and/or substance use disorder, were being or were recently released from incarceration or are on probation or parole and were at risk for re-offending.

Once identified, eligible individuals were referred to two community-based organizations, which:

  • Conducted assessments
  • Provided in-reach support prior to the individual’s release
  • Met the individual on the day of release and maintained daily contact for the first month, then as needed, with 24-7 on-call support (most members engage for approximately six months)
  • Helped individuals develop person-centered support plans, including making and keeping appointments
  • Assisted with accessing housing, transportation, employment, social services, healthcare, and benefits
  • Supported social connectedness
  • Once a member is stabilized in the community, navigators provide a warm handoff to post BH-JI supports—a transfer of care between members of the navigator team to the individuals assisting with care for long-term stabilization. Post BH-JI supports can last from 30 days to more than a year.

OUTCOMES: Better Services for BH-JI Individuals Means Better Public Health for All

As of June 2023, 3,914 individuals have enrolled in the program, with 1,398 actively participating in BH-JI as of July 2023. Approximately two-thirds of referred individuals enroll and participate on average for six months.

The outcomes of the project have shown:

  • More effective healthcare service utilization after BH-JI enrollment compared to before enrollment.
  • Increased utilization of non-behavioral health pharmacy, professional outpatient behavioral health, and lab and radiology services.
  • Decreased inpatient behavioral health, emergency room, and emergency transportation services.
  • 67% had an outpatient behavioral health visit
  • 19% received diversionary behavioral health services, including substance abuse detoxification, clinical stabilization, and rehabilitation services
  • Enrollees’ housing stability increased 20% overall from time of enrollment to six months following enrollment
  • Employment numbers improved from 27% at enrollment to 38% after six months

The program demonstrated effective and efficient healthcare utilization for justice-involved individuals enrolled in the BH-JI program. In February 2022, the program was expanded statewide.

Programs like these promote seamless reentry into the community through successful interventions, emphasizing the continuity of patient care and social services like transportation, employment, and housing. Ultimately, the goal for ForHealth Consulting’s work with BH-JI individuals is to ensure the delivery of equitable, high-quality, and cost-effective healthcare for this complex population.



2, 3, 4, 14 Acker J, Braveman P, Arkin E, Leviton L, Parsons J, Hobor G. Mass Incarceration Threatens Health Equity in America. Princeton, NJ: Robert Wood Johnson Foundation; 2019. 










*List of sponsoring organizations in 2019: Executive Office of Health and Human Services, Massachusetts Executive Office of the Trial Court, MassHealth, Open Sky Community Services, Advocates, Massachusetts Department of Corrections, Middlesex Sherriff’s Office, Worcester County’s Sherriff’s Office, and the Massachusetts Parole Board.