Providing Transition and Outpatient Services to the Mentally Ill Released from Correctional Institutions

More than a generation ago, the mentally ill began to flood our jails and prisons. Correctional institutions were not prepared for the influx of mentally disordered offenders and numerous reports have graphically detailed deficiencies in the provision of needed services (Center for Mental Health Services, 1995; National Commission on Correctional Health Care, 2002a, b; The Correctional Association of New York, 2004). However, little attention has been focused on the problems related to transitioning this population to the community and the provision of outpatient-based mental health services. Though the quality of institutional care remains woefully inadequate in many jurisdictions, it has become increasingly apparent that community-based care is an urgent necessity. Parallels between the current state of correctional mental health services and the civil public psychiatric system can be drawn. For many years, the public sector struggled with the problem of the “revolving door”: following discharge from inpatient care, many mentally ill individuals were unable to function in the community, relapsed, and were readmitted. In most jurisdictions, efforts to address this problem have relied on an increased emphasis on discharge planning for patients transitioning from state civil hospitals to community-based treatment and, once in the community, aggressive support services. There is now universal recognition that these measures are essential ingredients to maintaining many of the seriously mentally ill in the community. At present, correctional care systems have not broadly adopted such services, with predictable results. A study from the state of Washington illustrates the consequences. A cohort of mentally ill individuals convicted of felonies was followed postrelease. In the first year in the community, only 16% received any form of mental health treatment; by the end of year three, nearly 40% had been rearrested (Lovell, Gagliardi, & Peterson, 2002).