Jeff Mellow

Aging in Correctional Custody: Setting a Policy Agenda for Older Prisoner Health Care

An exponential rise in the number of older prisoners is creating new and costly challenges for the criminal justice system, state economies, and communities to which older former prisoners return. We convened a meeting of 29 national experts in correctional health care, academic medicine, nursing, and civil rights to identify knowledge gaps and to propose a policy agenda to improve the care of older prisoners. The group identified 9 priority areas to be addressed: definition of the older prisoner, correctional staff training, definition of functional impairment in prison, recognition and assessment of dementia, recognition of the special needs of older women prisoners, geriatric housing units, issues for older adults upon release, medical early release, and prison-based palliative medicine programs.

Parole revocation among prison inmates with psychiatric and substance use disorders.

OBJECTIVE This retrospective cohort study examined the association between co-occurring serious mental illness and substance use disorders and parole revocation among inmates from the Texas Department of Criminal Justice, the nations largest state prison system. METHODS The study population included all 8,149 inmates who were released under parole supervision between September 1, 2006, and November 31, 2006. An electronic database was used to identify inmates whose parole was revoked within 12 months of their release. The independent risk of parole revocation attributable to psychiatric disorders, substance use disorders, and other covariates was assessed with logistic regression analysis. RESULTS Parolees with a dual diagnosis of a major psychiatric disorder (major depressive disorder, bipolar disorder, schizophrenia, or other psychotic disorder) and a substance use disorder had a substantially increased risk of having their parole revoked because of either a technical violation (adjusted odds ratio [OR]=1.7, 95% confidence interval [CI]=1.4-2.4) or commission of a new criminal offense (OR=2.8, 95% CI=1.7-4.5) in the 12 months after their release. However, parolees with a diagnosis of either a major psychiatric disorder alone or a substance use disorder alone demonstrated no such increased risk. CONCLUSIONS These findings highlight the need for future investigations of specific social, behavioral, and other factors that underlie higher rates of parole revocation among individuals with co-occurring serious mental illness and substance use disorders.

Exploring Inmate Reentry in a Local Jail Setting Implications for Outreach, Service Use, and Recidivism

Although prisoner reentry has taken center stage in correctional research and policy discussions, there has been little emphasis on reentry among jail populations. This paper examines a jail-based reentry program in New York City that begins while individuals are incarcerated and includes 90 days of postrelease services. This article explores these assumptions through an evaluation of a jail-based reentry program in New York City that begins while individuals are incarcerated and includes 90 days of postrelease services. To determine program impact, the authors compare samples of participants with nonparticipants and program completers with noncompleters. The groups are matched using developmental trajectories derived from group-based trajectory modeling, in addition to propensity score matching. Findings show that participants perform no better than nonparticipants over a 1-year follow-up, but those who stay engaged for at least 90 days of postrelease services experience significantly fewer (and slower) returns to jail. The findings regarding program completion are tempered by several methodological concerns, however. The article concludes with a discussion of how the study may offer insights for program implementation and operation with this target population.

Successful Reentry: The Perspective of Private Correctional Health Care Providers

Due to public health and safety concerns, discharge planning is increasingly prioritized by correctional systems when preparing prisoners for their reintegration into the community. Annually, private correctional health care vendors provide

The Elusive Data on Supermax Confinement

3 billion of health care services to inmates in correctional facilities throughout the U.S., but rarely are contracted to provide transitional health care. A discussion with 12 people representing five private nationwide correctional health care providers highlighted the barriers they face when implementing transitional health care and what templates of services health care companies could provide to state and counties to enhance the reentry process.

Substance Abuse Treatment Gap Among Adult Parolees: Prevalence, Correlates, and Barriers

This exploratory research examines supermax confinement in the United States. An examination of counts of supermax institutions and inmates from 2001-2004 produced by the American Correctional Association and an examination of Criminal Justice Institute data found that different procedures made it difficult to compare numbers across states. Certain states produced incorrect figures about the number of supermax prisons and inmates because of reporting and/or recording errors. This study found, in short, that disagreements about definitions, changing policies and court decisions, reporting and recording errors, and different counting procedures have led to a lack of reliable and valid data on supermax issues. These findings indicate that researchers attempting to examine, or collect data on, supermax issues on the macrolevel (e.g., across states) face important difficulties. This article accounts for this confusion, discusses policy implications that may result from this confusion, and concludes with suggestions for future research.

Patient safety: moving the bar in prison health care standards.

Each year 700,000 prisoners are released back into the community, and substance abuse poses an enormous threat to their successful reentry. Using data from the 2006 National Survey on Drug Use and Health, this study reports on drug use and treatment exposure, prevalence of unmet treatment needs, psychosocial risks, and barriers to treatment among recent and current parolees. Findings show that whereas substance problems are higher among parolees than the general public, the former are more likely to receive treatment for their problems. Substance-abusing parolees who did not receive treatment often experienced multiple psychosocial challenges. Lack of health care coverage, lack of transportation, and lack of readiness for change were identified as major treatment barriers. Policy implications are discussed.

Transitioning Offenders to the Community: A Content Analysis of Reentry Guides

Improvements in community health care quality through error reduction have been slow to transfer to correctional settings. We convened a panel of correctional experts, which recommended 60 patient safety standards focusing on such issues as creating safety cultures at organizational, supervisory, and staff levels through changes to policy and training and by ensuring staff competency, reducing medication errors, encouraging the seamless transfer of information between and within practice settings, and developing mechanisms to detect errors or near misses and to shift the emphasis from blaming staff to fixing systems. To our knowledge, this is the first published set of standards focusing on patient safety in prisons, adapted from the emerging literature on quality improvement in the community.

Jail Inmates with Co-Occurring Mental Health and Substance Use Problems: Correlates and Service Needs

ABSTRACT The need for strong discharge planning materials which includes reentry guides assumes increasing importance with the large numbers of prisoners being discharged. They return to their communities and need to secure housing, find employment, obtain health care, and in many instances, on-going treatment for substance abuse and mental illness. The purpose of this study was to evaluate the content, readability and interactive nature of 13 reentry guides given to prisoners after release. This study suggests that many components of current reentry guides need to be reevaluated and redesigned in order to maximize their effectiveness with prisoners returning to the community.

Halfway Back: An Alternative to Revocation for Technical Parole Violators

The confluence of the deinstitutionalization of people with mental illness and the massive incarceration of drug offenders has dramatically raised the number of substance abusers with mental illness in American jails. This study sought to identify correlates of comorbidity and service gaps among jail inmates using data from the 2002 Survey of Inmates in Local Jails. Results suggest that offenders with comorbidity can be satisfactorily identified according to their past exposure to certain risk factors. One third of the jail population met the comorbidity criteria and 64% of them did not receive any treatment or counseling service while incarcerated. Policy implications are discussed.