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Health and Prisoner Reentry

How Physical, Mental, and Substance Abuse Conditions Shape the Process of Reintegration

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Document date: February 15, 2008
Released online: February 26, 2008

The nonpartisan Urban Institute publishes studies, reports, and books on timely topics worthy of public consideration. The views expressed are those of the authors and should not be attributed to the Urban Institute, its trustees, or its funders.

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More than 8 in 10 returning prisoners have chronic physical, mental, or substance abuse conditions. This research report demonstrates how each of these health conditions is associated with distinct reentry challenges and service needs. Using a representative sample of men and women from the Urban Institute’s multistate Returning Home study, we assessed health status at release and gathered data on reintegration experiences through multiple postrelease interviews. We present typologies of reentry experiences by health status, detailing individuals' success finding housing and employment, reconnecting with family, abstaining from substance use and crime, and avoiding reincarceration. Using these typologies, we conclude with targeted strategies to improve service delivery and reentry outcomes.


Each year, nearly 700,000 men and women are released from prison into communities across the United States (Sabol, Minton, and Harrison 2007). Many do not make a successful transition: two-thirds are arrested within three years and one-half are returned to prison, either for parole violations or new crimes (Langan and Levin 2002). This revolving door phenomenon is costly in terms of criminal justice system expenditures, not to mention the human and social costs borne by crime victims, returning prisoners, their families, and the communities in which they reside. Since 2001, the Urban Institute has been conducting research to understand the process of prisoner reentry and identify factors associated with reentry success and failure, with the goal of informing policy and practice. This study, Returning Home: Understanding the Challenges of Prisoner Reentry, provides a rich description of the reentry process through a longitudinal series of interviews with a representative sample of returning prisoners before and after their release (see Methodology section for details). In this report we describe the health status of returning men and women and examine the role that health problems and health treatment play in shaping reentry outcomes. This study takes a wide view of “health” and includes physical health problems, mental illness, and substance abuse in the analysis.

 The results presented here corroborate other research documenting high rates of physical health conditions, mental illness, and substance abuse in correctional populations (National Commission on Correctional Health Care [NCCHC] 2002). Returning Home respondents typically had one or more chronic health conditions at the time of their release. The majority of men and women in the study sample had chronic physical and mental health conditions at the time of their release from prison. About 7 in 10 also reported levels of preprison substance use consistent with abuse and dependence. Including substance abuse under the rubric of health, we found almost none without health concerns: more than 4 out of 5 men and women had at least one physical health, mental health, or substance abuse problem at the time of their release. Available treatment, however, did not match the level of need in prison, and treatment rates declined once individuals were released to the community.

This report describes the ways in which returning prisoners with physical health conditions, mental health conditions, and substance abuse problems navigated the first year after release and demonstrates the distinct challenges they faced with regard to finding housing and employment, reconnecting with family members, abstaining from substance use and crime, and avoiding a return to prison. Anecdotal evidence suggests several reasons why prisoners with health problems often have a more difficult reentry process than others (Travis 2005). Returning prisoners face multiple, often simultaneous tasks as they embark on the process of reestablishing their lives outside prison—finding housing, getting a job, having enough money to live on, reconnecting with children and family—and these intermediary steps influence the ability to live a drug-free and crime-free life. Unresolved health and substance use problems often complicate an already challenging transition. Returning prisoners with health problems may be unable to engage in work or other activities because of pain or sickness, and their families may be unwilling or unable to serve as a fallback support. They are additionally confronted with the tasks of managing their health problems, such as accessing health care and keeping up with medications or appointments. Those with severe or unmanaged health problems face an increased risk of adverse outcomes, including physical illness, relapse into drug use or, particularly in the case of mental illness, inappropriate behavior that provokes a police response. It stands to reason that successful treatment of returning prisoners’ health conditions could increase their chances of reentry success by improving their ability to work, support themselves, and abstain from substance use, all of which have been shown to contribute to desistance from criminal activity.

Addressing the health problems of returning prisoners has the potential to improve individual health and reentry outcomes. The benefits may also extend beyond the individual to the communities in which returning prisoners reside. Released prisoners return in relatively high concentrations to a small number of socioeconomically disadvantaged communities in America’s urban centers (Lynch and Sabol 2001). For example, Houston received one-quarter of all persons returning from Texas prisons, and 25 percent of those returned to just seven neighborhoods (Watson, Solomon, La Vigne and Travis 2004). Given the extent to which many individuals cycle in and out of correctional facilities, former prisoners comprise a respectable share of the population in certain communities. This concentration in some of the most disadvantaged urban areas has created a public health opportunity whereby attending to the health needs of prisoners and former prisoners may affect the course of a number of epidemics. Research has shown that sizeable portions of the total number of Americans with HIV, tuberculosis, and hepatitis, for example, serve time in correctional facilities each year (NCCHC 2002). If individuals are engaged in treatment, either in prison or after release, there is the potential to reduce the burden of illness and prevent further disease transmission.

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Topics/Tags: | Crime/Justice | Health/Healthcare

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