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Each year, more than 10 million people enter US jails, most returning home within a few weeks. Because jails concentrate people with infectious and chronic diseases, substance abuse, and mental health problems, and reentry policies often exacerbate these problems, the experiences of people leaving jail may contribute to health inequities in the low-income communities to which they return. Our study of the experiences in the year after release of 491 adolescent males and 476 adult women returning home from New York City jails shows that both populations have low employment rates and incomes and high rearrest rates. Few received services in jail. However, overall drug use and illegal activity declined significantly in the year after release. Postrelease employment and health insurance were associated with lower rearrest rates and drug use. Public policies on employment, drug treatment, housing, and health care often blocked successful reentry into society from jail, suggesting the need for new policies that support successful reentry into society.

Most California prisoners experience discontinuity of health care upon return to the community. In January 2006, physicians working with community organizations and representatives of the San Francisco Department of Public Health's safety-net health system opened the Transitions Clinic (TC) to provide transitional and primary care as well as case management for prisoners returning to San Francisco. This article provides a complete description of TC, including an illustrative case, and reports information about the recently released individuals who participated in the program. From January 2006 to October 2007, TC saw 185 patients with chronic medical conditions. TC patients are socially and economically disenfranchised; 86% belong to ethnic minority groups and 38% are homeless. Eighty-nine percent of patients did not have a primary care provider prior to their incarceration. Preliminary findings demonstrate that a community-based model of care tailored to this disenfranchised population successfully engages them in seeking health care.

Asylums comprises the main focus of historical research on early 20th century psychiatry. To assess the characteristic of asylum transfers in a clinical population, we analyzed newly found clinical records from University of Pisa Clinic for Mental and Nervous Illness. We focused on the early years of this structure’s activities considering all admissions from 24th April 1907 to 31st January 1913. We collected demographic and clinical data from 1,068 patients performing Chi-Square Tests to study correlation between asylum transfer and diagnosis and gender difference; independent sample Student’s t-tests were also performed to compare mean Age, mean number of Days of Hospitalization and mean number of Subsequent Admissions to the Clinic observed in patients transferred to an asylum versus those who had been discharged. Multiple logistic regression model was employed to identify the best predictors of asylum transfers. Most patient were discharged, and only a third of the hospitalization led to asylum confinement. Our data outlines a peculiar discharge rationale, suggesting that the Clinic acted like a “sieve-institution” to prevent asylum overcrowding from treatable, non-chronic conditions. These data suggest that our historical view of psychiatric care is probably not complete, and that a different approach to source materials could provide new research paradigms.

The federal “Second Chance Act of 2005” calls for expanding reentry services for people leaving prison, yet existing policies restrict access to needed services for those with criminal records. We examined the interaction between individual-level characteristics and policy-level restrictions related to criminal conviction, and the likely effects on access to resources upon reentry, using a sample of prisoners with Axis I mental disorders (n=3073). We identified multiple challenges related to convictions, including restricted access to housing, public assistance, and other resources. Invisible punishments embedded within existing policies were inconsistent with the call for second chances. Without modification of federal and state policies, the ability of reentry services to foster behavioral health and community reintegration is limited.

What you need to know People in custodial settings are entitled to the same level and quality of physical and mental health services as NHS patients in the community without restrictions Perform comprehensive extended physical and mental health assessment on entry into and release from custodial settings Monitor and treat chronic health conditions for those serving custodial sentences, offer testing for infectious diseases, and explore the possibility of mental health conditions The prevalence of mental health problems among people in prison is about 10 times higher than in the general population On a person's release from a custodial sentence, primary care services should receive a structured handover of new and ongoing health problems, which can guide them as they reassume responsibility for coordinating care Compared with the general population, adults in contact with the criminal justice system have higher rates of mental and physical health problems. The Guideline Committee (GC) comprised two forensic psychiatrists, two psychologists, a probation officer, two senior managers from a prison setting, a substance misuse practitioner/psychologist, a legal services representative, a transitions expert, a nurse, a primary care representative, a carer, two service users, a police officer, and a prison officer.

Objectives. We describe behavioral health diagnoses and community release patterns among adult male and female inmates in New Jersey prisons and assess their implications for correctional health care and community reentry. Methods. We used clinical and classification data on a census of “special needs” inmates (those with behavioral health disorders) in New Jersey (n=3189) and a census of all special needs inmates released to New Jersey communities over a 12-month period (n=974). Results. Virtually all adult inmates with special needs had at least 1 Axis I mental disorder, and 68% of these had at least 1 additional Axis I mental disorder, a personality disorder, or addiction problem (67% of all male and 75% of all female special needs inmates). Of those special needs inmates released, 25% returned to the most disadvantaged counties in New Jersey (27% of all male and 18% of all female special needs inmates). Conclusions. Two types of clustering were found: gender-specific clustering of disorders among inmates and spatial clustering of ex-offenders in impoverished communities. These findings suggest a need for gendered treatment strategies within correctional settings and need for successful reentry strategies.

This article offers a comprehensive critical review of the most popular theoretical accounts on the recent processes of deinstitutionalization and reform of mental health services and their possible underlying factors, focusing in the sharp contrast between the straightforward ideas and models maintained by mainstream psychiatry and the different interpretations delivered by authors coming from the social sciences or applying conceptual tools stemming from diverse social theories. Since all these appraisals tend to illuminate only some aspects of the process while obscuring others, or do not fit at all with some important points of the actual changes, it is concluded that the quest for an adequate explanation is far from having been completed. Finally, some methodological and conceptual strategies for a renewed theoretical understanding of these significant transformations are also briefly discussed, including a comprehensive empirical evaluation of the facts, the consideration of the shifting social values and needs involved in mental health care provision and the historical analysis of deinstitutionalization policies within the framework of the broader social and cultural trends of the decades following World War II.

This study addresses mental health and, based on a conceptual review, offers considerations on the management of deinstitutionalization processes regarding individuals interned in long-stay psychiatric institutions. Elements concerning asylum formation and logic are discussed, along with the mechanisms necessary for the effective change in paradigm and practices, with deinstitutionalization and psychosocial rehabilitation as the core issues. Reflections are offered regarding management actions committed to the psychosocial model, linking such actions to the application of the components of care and going beyond the articulation of the tools of mental health policy. Theoretical reflection offers suggestions referring to the qualification processes of mental health professionals, deinstitutionalization in the management of the Unified Health System and tripartite action with co-accountability in actions and financing. The final considerations recognize the bureaucratic obstacles in the public realm and propose facing these challenges as a management challenge, along with processes of change that can radically commit to the lives of people, thereby broadening the discussion to the ethical realm.

Objectives. We analyzed whether a method for identifying latent trajectories—latent class growth analysis (LCGA)—was useful for understanding outcomes for individuals subject to an intervention. Methods. We used LCGA to reanalyze data from a published study of mentally ill homeless men in a critical time intervention (CTI) program. In that study, 96 men leaving a shelter’s onsite psychiatric program were randomly assigned to experimental and control groups. The former received CTI services and the latter usual services. Each individual’s housing circumstances were observed for 18 months after program initiation. Our outcome measure was monthly homelessness: a person was considered homeless in a month if he was homeless for even 1 night that month. Results. Four latent classes were found among the control group, but just 3 among the experimental group. Control, but not experimental, group individuals showed a small class of chronically homeless men. The size of the never-homeless class was 19 percentage points larger for the experimental than for the control group. J- and inverted-U-shaped patterns were also found among both groups, but with important differences in timing of patterns. Conclusions. Our results reveal effects not apparent in the original analysis, suggesting that latent class growth models improve intervention evaluation.

[...]in many public policy areas, including IDD services, it is neither possible, nor ethical, to randomly assign people with IDD to treatment and non-treatment groups. Today, the overwhelming majority of Medicaid funded long-term services and supports (LTSS) for people with IDD in the US are provided in community contexts. [...]since the late 1990s there has been strong growth in the numbers of people receiving IDD services and supports while living in the home of a family member or in their own home.