We have important tools to help reduce recidivism through rehabilitation, namely the Affordable Care Act and post-release support, such as that offered by San Francisco’s Transitions Clinic. I am highlighting this combination having listened to a news segment, titled: “Obamacare in Jail: How San Francisco Policy Helps Inmates,” filed by April Dembosky’s for KQED’s The California Report: State of Health, April 30, 2014. The whole story is encouraging, but I especially liked her coverage of what helps with rehabilitation, which, in turn, reduces recidivism, namely that those IN and LEAVING jails or prisons have:
- readily accessible mental health and/or substance use disorders treatment AND
- readily accessible transition support to acclimate “on the outside.”
The first point is a huge problem with a huge need. As The Department of Justice writes in its April 17, 2014 post, “Reentry and the Affordable Care Act,” “…men and women in this population suffer three times the rate of mental illness and four times the rate of substance abuse problems as compared to the general public.”
Substance use and mental health disorders are brain changers – in other words, they change how the brain functions. Given the brain controls everything a person thinks, feels, says and does and is in turn influenced by all that comes at it – treating these disorders requires an integrated, long-term approach to re-wiring all that goes into causing them. It also requires the two (substance use and mental health disorder) be treated concurrently if they are both present. Treating these disorders can include help with stress triggers (such as what am I going to do now!), proper diagnosis, help for the family members still involved in their lives, help with underlying childhood trauma and access to properly prescribed and monitored medications for substance use cravings and mental illnesses. And it is imperative this sort of treatment happen otherwise the brain is left to its old devices, so to speak, and the individual’s long-standing embedded brain maps will take the individual (brain) down its old road and thus it’s old behaviors. In other words, relapse.
To help with this specific need of effective mental health and substance use disorders treatment, we now have the Affordable Care Act, which requires insurance plans to provide coverage for both mental health and substance use disorders treatment and has the potential to open coverage to millions of low-income adults (like the formerly incarcerated). As 21st century brain and addiction-related research shows, integrated, co-occurring mental health and substance use treatment is key to healing the brain of both disorders and thereby helping a person change distractive behavioral patterns.
And to the second point, transition clinics, Dembosky writes about Wanda Fain, recently released after 21 years behind bars, “Fain has seizures, lymphoma, and bipolar disorder. In prison, the guards regulated all of her care for her. She wasn’t allowed to eat a meal until she took her meds. But on the outside, it’s up to her to find the right doctor, the right pharmacy –- and to figure out which four buses she needs to take to get there.
“’It’s little things like that that people think are so easy,’ she (Fain) said, shaking her head. ‘They are so overwhelming.’”
Re-entry clinics help with this and in that vein provide the missing piece in many treatment programs – long-term, continuing care (aka aftercare). As 21st century brain, mental health and substance use / addition-related research also shows, long-term aftercare (in other words, care long after detox and rehab) is also imperative. It must address the individual and be a carrying forward of that which was started during rehab: continued medications and monitoring, help with job searches, effective co-occurring disorders treatment, therapy around trauma… treatment and after care are not one-size-fits-all endeavors.
One such re-entry clinic now being held up as a model is San Francisco’s Transitions Clinic. As Dembosky writes in her article, it is “a specialized program designed for former prisoners, where doctors, psychiatrists, and social workers all consult together on the same patients. But its key staff are community health workers who have all spent time behind bars, too….”
These are exciting times when it comes to making solid inroads to reducing recidivism: Affordable Care Act + Transitions Clinics = Win Win for successful rehabilitation of the formerly incarcerated, their families and our communities.
© 2014 Lisa Frederiksen