C. Health and Reentry
Released prisoners have an extremely high prevalence of mental disorders and chronic and infectious diseases— much higher than in the general population. Ex-cons face limited and insufficient access to community-based health care upon release. Further, incarceration disqualifies inmates from Medicaid eligibility, and restoring eligibility can take several months—interrupting access to prescription drugs and health care. Between 30 and 40% of released prisoners reported having a chronic physical or mental health condition—most commonly depression, asthma, and high blood pressure. In New Jersey, one third of those released in 2002 had at least one chronic or communicable medical condition. Many more released offenders report being diagnosed with a medical condition compared to those who received medication or treatment for the condition while incarcerated. Only 12% report having taken medication regularly in prison. In Ohio, over half reported depression, but only 35% reported receiving treatment or medication. While 27% reported having asthma, less than 14% received treatment for it (Lynch & Sabol, 2001).
Corrections agencies often lack discharge planning and preparation for health care needs upon release. Less than 10% of Illinois ex-cons received referrals to services in the community. Securing health care is a major concern for many released prisoners. At least 75% of those interviewed said they needed help getting health care after release. As might be expected, the vast majority of returning prisoners have no medical insurance—only 10% to 20% reported having private insurance.
D. Substance Use and Reentry
Research shows that while 83% of state prisoners have a history of drug use, only about 15% of this group receives treatment in prison, and even fewer continue to receive appropriate treatment once released. The majority of those released have extensive substance use histories. In Maryland, in the 6 months before entering prison, over 40% of offenders reported daily heroin use, while nearly 60% of returning prisoners in Texas reported daily cocaine use. Prisoners identify drug use as the primary cause of their past and current problems, but few prisoners receive drug treatment while incarcerated. In New Jersey, though 81% of inmates had drug or alcohol problems, program capacities were limited to only 6% of the state prison population. In Texas, substance abuse program capacity can only serve 5% of the potential population in need (Lynch & Sabol, 2001).
Researchers agree that in-prison treatment is much more likely to effectively sustain a decline in substance use if it is tailored to an individual’s need and level of risk, and if it is linked to drug treatment aftercare in the community. Those with substance use histories and who engage in substance use after release are very likely to reoffend.