What Happens when Mentally Ill Prisoners Become Mentally Ill Citizens

The Urban Institute is a think thank that was formed in 1968 as an outgrowth of President Johnson's awareness of a "need for independent nonpartisan analysis of the problems facing America's cities and residents." A listing of U.S. Think Tanks by Ideology from Spero News lists the Urban Institute as "centrist," which seems like a fair assessment, based on my admittedly surface-level inspection. If anything, a somewhat left-leaning bias might be evidenced by what they research, though now how. That is to say, they concern themselves with social issues, rather than concentrating on economics or foreign policy.

Anyhow, The Urban Institute published a report in 2008 examining health and re-entry. They looked at Physical Health, Mental Health, and Substance Abuse. They're a national think tank based in Washington, D. C, but they did their data collection in Texas (and Ohio).

The results are interesting, they're sobering, but in many respects, they're not really surprising. Here are some highlights (or lowlights):

Prevalence

• 6% of men and 18% of women had the trifecta -- a physical illness, a mental illness, AND substance abuse.
• Fifteen percent of men and 35% of women reported mental health conditions, based on self-report data. The authors of the study estimate that the actual prevalence is double that.
• About 40% of respondents did not receive any treatment for their mental illness while in prison.
• About 16% of men and 31% of women self-reported PTSD

These numbers are roughly in line with our previous research. The one number that jumps out at me as being incongruent is the 12% of female prisoners that we reported as having "Serious Mental Illness," as opposed to the Urban Institute's number of 35%. There are a couple of possible reasons for this discrepancy. The first is that the 12% number actually comes from jail detainees. Whoops -- that's an oversight on our part (and one I've noted in the earlier post). The other difference is that the 12% figure refers to serious mental illness, defined in the NIJ report as acute symptoms of schizophrenia, major depression, and/or bipolar disorder. The Urban Institute's criteria for mental illness was presumably broader. And of course, the assessment methodology was different, too. Generally speaking, research about mental illness in jails and prisons is thin on the ground, which is why we've typically pulled percentages from only one study each. It's almost surprising that our numbers match The Urban Institute's as well as they do.

The Urban Institute's report, though, isn't just about prevalence. It's concerned with the re-entry experiences of folks with mental illness (and physical illness & substance abuse). Here's what they found in that regard:

Effects of Mental Illness on Re-entry

• "Respondents with mental health conditions reported poorer outcomes in most domains." In other words, as much as it sucks when you're trying to re-integrate into society to have a physical illness or a substance abuse issue, it sucks more to have a mental illness. It's worth noting that TBI was not on the list of the Urban Institute's physical illensses.
  
• Mentally ill people of both genders had more problems finding a place to live after release than those who weren't mentally ill. Interestingly, the timing of this varied by gender -- men were more likely to be homeless 8-10 months post release, and women were more likely to be homeless 2-3 months post-release. For both, at 8-10 months post-release, the homeless rate was about 20%. It's just that for women, this was the same as folks without a mental illness. Which is chilling in its own right.
• Part of the reason for the increased homelessness is less family support for the mentally ill. And part of the reason for that is violence -- the mentally ill folks were more likely to have been the victims of violence, and to have perpetrated violence, than those who weren't mentally ill.
  
• By three months out of prison, only about 36% of mentally ill men & 26% of mentally ill women had found employment. This was much lower the the rates by non-mentally ill folks.
• And finally, mentally ill men & women were more likely to engage in post-release criminal behavior, which isn't surprising, given that they're having problems finding places to live and jobs to support themselves.

Policy Implications

The Urban Institute had a number of policy recommendations, but for the most part, it boils down to case management services, starting well before a prisoner's release date, and including linking them to support services that exist in the community, as well as things like Medicaid and SSI Disability. Sounds like a good idea to me.