To the Editor: I appreciated the focus on correctional psychiatry in the June 2006 issue of Psychiatric Services, as it highlighted an increasingly important part of public-sector psychiatry. Wilson and Draine (1) conducted an admirably thorough survey of existing reentry programs for prisoners with mental illness and accurately focused on the importance of public safety. However, I believe they did not sufficiently emphasize a critical reason for the development of such programs: saving money by prevention of return to prison.
The commissioner of the Indiana Department of Corrections (DOC) has explicitly stated that his support for improving prisoner reentry is motivated by budget concerns: "If we can reduce our rate of recidivism by 5%, we save over 80 million dollars for the taxpayers of Indiana. That is our goal" (2). Indiana, with six other states, has adopted the Transition From Prison to Community Initiative (TPCI) model, proposed by the National Institute of Corrections and Abt Associates (3). This model requires states to restructure the reentry process and implement evidence-based practices in order to reduce recidivism; it includes mental health problems among the important dynamic factors that can influence the risk of recidivism.
As part of the TPCI implementation in Indiana, DOC invited representatives from Indiana Medicaid, the Department of Family and Children, and the Division of Mental Health and Addiction to join a workgroup on the reentry of offenders with mental illness. This workgroup quickly focused on the critical importance of reinstatement of Medicaid benefits to a smooth transition from prison to community care for people with severe mental illness, which was noted by Morrissey and colleagues (4) in the June issue of Psychiatric Services. Medicaid benefits are routinely terminated for virtually all offenders who are sent to prison, because the length of stay is almost always longer than one year—in contrast to the shorter stays for jail detainees, also noted by Morrissey and colleagues (5) in a second article in the June issue. Although no new programs are currently envisioned in Indiana, the process of Medicaid reinstatement should become much more efficient for all Medicaid-eligible offenders currently in state prison, as the process will begin before release from prison. In addition, communication between DOC personnel and local mental health providers is expected to improve.
Mental health advocates should never underestimate the power of the budget to influence policy decisions. In this time of tightened budgets, we must be alert to opportunities that will support the practice of good psychiatry and we must partner with the agencies that play an important role in the lives of people with severe mental illness, including Medicaid and correctional authorities.
Dr. Parker is associate professor of clinical psychiatry and director of forensic psychiatry, Indiana University School of Medicine, Indianapolis.
Wilson AB, Draine J: Collaborations between criminal justice and mental health systems for prisoner reentry. Psychiatric Services 57:875-878, 2006
Donahue JD: Paving a Path to Successful Prisoner Re-entry. Indianapolis, Indiana Department of Corrections, Project Profile, July 2006. Available at www.in.gov/indcorrection/reentry/pdfs/JDProjProfile.pdf
Mitchell C, Parent DG, Barnett L: Transition From Prison to Community Initiative. Washington, DC, National Institute of Corrections, Abt Associates. Available at www.nicic.org/webpage_222.htm
Morrissey JP, Steadman HJ, Dalton KM, et al: Medicaid enrollment and mental health service use following release of jail detainees with severe mental illness. Psychiatric Services 57:809-815, 2006
Morrissey JP, Dalton KM, Steadman HJ, et al: Assessing gaps between policy and practice in Medicaid disenrollment of jail detainees with severe mental illness. Psychiatric Services 57:803-808, 2006