Community Reentry. MLCHC Conference, May 7, 2013

Size: px

Start display at page:

Download "Community Reentry. MLCHC Conference, May 7, 2013"

Elaine Gilbert
5 years ago
Views:

1 Community Reentry Warren J. Ferguson, MD Professor and Vice Chair Department of Family Medicine and Community Health University of Massachusetts Medical School MLCHC Conference, May 7, 2013

2 Objectives 1. Briefly frame the scope of incarceration in the U.S. 2. Discuss public health problems as a result of hurdles faced upon community reentry 3. Detail MA releases and recidivism 4. DOC and MassHealth efforts to improve insurance status upon release 5. UMass Health and Criminal Justice efforts to improve link to health care upon release

3 Scope of Incarceration in U.S. Over 2.3 million incarcerated on any given day U.S. incarcerates far more individuals than any other country One in nine black men are incarcerated on any given day and 1 in 3 lifetime risk of incarceration Juvenile justice detainees have a risk of violent death 10x that of other juveniles 15% of detainees have serious mental illness Disproportionate rates of chronic infections, substance abuse and traumatic brain injury 95% of inmates are released

4 What happens upon release? Barriers to public housing, employment, driver s license, medical and behavioral health treatment High prevalence of PTSD from incarceration Three year recidivism rates in MA at 50% Adjusted risk of death upon release in first two weeks is 12 times that of other citizens Risk of death from overdose 129 times that of others in first two weeks after release Suicide, homicide and cardiovascular disease also prominent causes of death

5 Massachusetts Prison Data

6 800 Criminally Sentenced Releases each Quarter

7 Nearly 1200 Pre-Trial Releases Each Quarter

8 Civil Admissions Each Quarter

9 Top 10 municipalities only account for half of release addresses

10 Summary of MA Release Data Roughly 2,600 Releases from MA DOC facilities each quarter or 865 per month About 40% have very rapid turnover in the system as pre-trial detainees Growing trend that supervised pre-trial detainees moved from County facilities to DOC facilities Boston, Springfield and Worcester account for a third of released persons addresses Half of released inmates reside in top 10 municipalities There are two medical discharge planners in the entire state

11 Reentry Initiatives

12 MassHealth Initiative DOC, MassHealth and UMMS partnered in 2006 to maximize disability determination and MassHealth insurance enrollment effective on day of release 90% of inmates leaving with health insurance 6-month cohort study of released inmates

13 Conclusions to Study Pilot project has succeeded in providing access to full spectrum of care Fewer episodic emergency department visits than anticipated High consumption of substance abuse and mental health care consistent with the prevalence of these disorders in the population

14 Important Reentry Initiatives Foundation-funded initiatives COCHES (RWJF) Transition Clinics (Langeloth) Now catapulted to major initiative through CMMI BHHCH one of the sites as is MGH-Charlestown UMMS-MLCHC collaboration MOU between UMMS and 13 MA CHCs to accept patients ACA- a game-changer for those states who sign on as most released detainees will have insurance

15 Case Presentation

16 Providing support and hope MG is a 50 year old Latino male released from MA DOC 3.5 years ago. He had a substance abuse disorder, was convicted of a crime and spent 20 years in a maximum security prison in MA. He suffers from moderate to severe persistent asthma and is disabled due to ADHD. His mother has very serious COPD and he committed himself to stay sober upon release so that he would be able to take care of her.

17 Speed bumps and Milestones: Money Leaves MA DOC with MassHealth and federal disability reinstated Has some source of revenue on which to live

18 Speed Bumps and Milestones: Addiction Relying on exercise to stay healthy and sober Period of stress leads to addictive behavior Treated by PCP with buprenorphine and stabilized his situation, likely averting relapse and downstream criminal activity

19 Speed Bumps and Milestones: Housing Living with girlfriend who is bipolar. Big fights and gets kicked out, now homeless. Lives in truck for winter and sneaks up to mom s subsidized housing to get warm 1am-6am. I write letter to housing describing two-year sobriety and his personal responsibility. He is accepted into public housing and is on wait list

20 Speed bumps and Milestones: Medical Illness Asthma gets severe. Difficulty with exercise, one of his key coping mechanisms Educate him on controller medicines and give him access to prednisone to start on his own with asthma action plan. Now exercising regularly again

21 Speed bumps and Milestones: Tragedy and Grief In fight with girlfriend, his cherished pet pitbull attacks his girlfriend. She ends up with 100 sutures on face. He intervenes with hand and dog s bit breaks his thumb requiring surgery. Not treated for pain due to stereotyping post-op. Given acute pain relief and again avoid addiction relapse. Dog is put down and he suffers tremendous grief over loss. Supportive counseling over loss of dog. Again avoids relapse.

22 Speed bumps and Milestones: Transportation Was driving truck illegally without a license. Has saved some money via disability pay and work under the table. Able to pay RMV fines and now has his license.

23 Summary In consideration of the disruption of social determinants of health and overrepresentation of minority individuals in prison and jail, no worse health disparity than incarceration. Community reentry is a key point to intervene to avert reincarceration. Academic and community partnerships are critical.

A Call to Action: The Role of Community Health Centers in the Era of Mass Incarceration

A Call to Action: The Role of Community Health Centers in the Era of Mass Incarceration Warren J. Ferguson, MD Professor and Vice Chair, Department of Family Medicine and Community Health Director of Academic