Focus Area: Mental and Physical Health

A significant share of individuals confined in correctional institutions experience severe mental illnesses; of those, many have co-occurring physical health and substance use issues. These individuals do not always receive needed treatment or medication to address their mental health needs, either inside or outside the correctional institution. The barriers they must overcome in order to access care are significant and can present serious consequences. For instance, a period of incarceration may result in suspension or loss of Medicaid eligibility, and restoring eligibility can take several months. This can result in an interruption in receiving prescriptions and put a person at a higher risk of relapse and recidivism.

This section provides an overview and examination of key evaluative research related to mental and physical health programming for incarcerated populations and those recently released from prison. Below are the results and conclusions of health research that met the criteria for methodological rigor. These studies provide a basis for comparing and discussing effective strategies currently practiced in the reentry field for both overcoming barriers to access to health care and treating mental and physical health problems.

From a thorough review of the literature in 2010, researchers identified 43 reentry studies that examined mental health programming. Of these 43 studies, 11 programs met the evidentiary criteria for inclusion. Four of those programs met a high standard of evidence, while seven are categorized as meeting the basic level of evidence. An updated search was completed in the fall of 2015 and researchers identified 52 additional reentry studies that examined health programming. Of those, five programs met the criteria for inclusion, four of which were rated at basic methodological rigor.

The programs span a wide spectrum of health-related reentry interventions—from programs in which agencies collaborated with correctional institutions with the purpose of increasing access to services and continuity of care, to those providing social therapy, psycho-education, violence prevention training, and transcendental meditation.

What the Research Says about Mental and Physical Health Programs

Comprehensive Programs Providing Continuity of Care

Broadly speaking, programs that use a continuity of care approach provide participants intensive case management while the individual is incarcerated, refer him or her to outside service providers prior to release, and continue to offer post-release case management and other services in the community. In four of the five studies of reentry programs falling into this category, researchers found significant reductions in recidivism among program participants, suggesting these types of programs are likely to be effective at reducing recidivism. Programs falling under this area include the Mental Health Services Continuum Program, Dangerous Mentally Ill Offender Program, Mentally Ill Offender Community Transition Program, Connections Program, and the Alameda County Integrated Dual Disorders Treatment Program.

Curriculum-Based Programs

At this point, three curriculum-based programs are included, although more will be added over time. These programs are not necessarily designed for those with a diagnosed mental illness; rather, they aim to improve reentry outcomes for a more general population of inmates by focusing on cognition and mental well-being. The Lifestyle Change Program, which was found to have a beneficial impact on recidivism, features 70 weeks of classes (including a phase that incorporates a cognitive-behavioral approach). Classes focus on problem solving, goal setting, managing stress and fear, and improving cognitive skills. Another program, Moving On, was also associated with reductions in recidivism. Two separate studies of this program implemented and evaluated in two different prisons both found evidence of a reduction in recidivism for female participants. However, a third program - the Violence Prevention Program - was not found to have significant effects on recidivism.

Other Programs

Six interventions were identified that did not fall into either of the preceding categories. A Transcendental Meditation program, which focused on decreasing mental and physical stress through daily meditation, was associated with reductions in recidivism. An evaluation of the effects of Medicaid benefits for severely mentally ill individuals returning from jail likewise found beneficial effects on recidivism. And, a therapeutic community operated in a maximum security institution in Canada demonstrated some effectiveness in reducing recidivism for residents with severe mental health disorders who were not diagnosed as psychopathic. However, an evaluation of the Minnesota Department of Corrections release planning services for serious and persistently mentally ill individuals leaving the state’s prisons found no evidence of effectiveness in reducing recidivism. Similarly, the Transitions Clinic, a primary care-based, complex care management program did not reduce recidivism. Finally, a study of individuals incarcerated in social therapy institutions in Germany did not find evidence of reduced recidivism; unfortunately, the study provided very limited information about the nature of the intervention studied.

Future Areas of Research

Though many evaluations have been conducted to investigate the effects of mental and physical health programs on people returning from prison and jail, few of these evaluations’ research designs met the criteria for methodological rigor. For example, while many studies of Transcendental Meditation have been conducted, only one was determined to be sufficiently rigorous to allow for drawing conclusions about the program's effectiveness. The field could greatly benefit from more studies of sufficient methodological rigor that focus on the wide array of health interventions available to the reentry population. In order to identify the most effective programs aimed at increasing service provision and continuity of care for individuals with mental illnesses after release, evaluators should examine implementation fidelity (the degree to which a program adheres to its initial design) more closely. These types of programs may also vary in effectiveness because of differences in the quantity and variety of services that are available in any given jurisdiction. Researchers may look to these characteristics in future research to help the field understand which programs that provide continuity of care are most appropriate and impactful for a given setting.

Summary of Evaluations and Outcomes

Rigor Evaluation Recidivism Employment Substance Abuse
High Rigor Bleick & Abrams; Rainforth et al. 1987 (not evaluated) (not evaluated)
High Rigor Burke & Keaton 2004 (not evaluated) (not evaluated)
Basic Rigor Chandler & Spicer 2006 (not evaluated) (not evaluated)
High Rigor Cortoni, Nunes, & Latendresse 2006 (not evaluated) (not evaluated)
Basic Rigor Duwe & Clark, 2015 (not evaluated) (not evaluated)
Basic Rigor Duwe 2015 (not evaluated) (not evaluated)
High Rigor Farabee, Bennett, Garcia, Warda, & Yang 2006 (not evaluated) (not evaluated)
Basic Rigor Gehring, Van Voorhis, & Bell 2010 (not evaluated) (not evaluated)
Basic Rigor Liau; Shively; Horn; Landau; Barrida; and Gibbs 2004 (not evaluated) (not evaluated)
Basic Rigor Lovell, Gagliardi, & Phipps; Mayfield 2005, 2007 (not evaluated) (not evaluated)
Basic Rigor Morrissey 2004 (not evaluated) (not evaluated)
High Rigor Nyamathi et al. 2015
Basic Rigor Ortmann 2000 (not evaluated) (not evaluated)
Basic Rigor Rice et al. 1992 (not evaluated) (not evaluated)
Basic Rigor Sacks et al., 2012 (not evaluated) (not evaluated)
Basic Rigor Theurer & Lovell 2008 (not evaluated) (not evaluated)
Basic Rigor Walters 1999, 2005 (not evaluated) (not evaluated)
High Rigor Wang et al. 2012 (not evaluated) (not evaluated)