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Jails have mix of pretrial detainees, misdemeanants & paro

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Title: Jails have mix of pretrial detainees, misdemeanants & paro


1
  • Access to Federal Benefits
  • for People with Mental Illnesses
  • Leaving Jail or Prison
  • Presentation by
  • Elaine Alfano, Policy Analyst
  • Bazelon Center for Mental Health Law
  • 11/27/07

2
Why Focus on Re-Entry?
Individuals with mental illnesses leaving jail
or prison without sufficient supplies of
medication, connections to mental health and
other support services and housing are almost
certain to decompensate, which in turn will
likely result in behavior that constitutes a
technical violation of release conditions or a
new crime. Council of State Governments,
Criminal Justice-Mental Health Consensus Project
3
Clinical Data about Inmates
  • 8-16 have a MI
  • 2-4 times more likely to have SMI than general
    population
  • Inmates with MI 72 have co-occurring substance
    use disorder
  • 60 of inmate w/ MI were using drugs/alcohol when
    committed their offense

4
2006 US Department of Justice Study
  • 43 in jail and 32 in state prison had symptoms
    of mental illness
  • 21 in jail 24 in prison were assessed by
    professional as having a mental health problem in
    year before arrest
  • 24 of jail inmates and over 15 of state prison
    inmates had experienced psychotic symptoms in the
    last 12 months

5
Causes of Rising Imprisonment Rates
  • Percentage of inmates with the most serious
    disorders - not changed since 1950
  • Numbers with SMI has risen at the same rate as
    the incarcerated population overall.
  • The problem is length of stay - NOT caused by
    closing of mental hospitals.

6
Mental Health Problems Unidentified
  • Only 23 of inmates reporting MH problems
    received treatment for problems in the year
    before arrest
  • Many inmates receive an assessment of SMI for the
    first time when they are incarcerated

7
Histories of Incarcerated People with Mental
Health Problems
  • More likely to have a history of physical or
    sexual abuse
  • More likely to have lived in foster care while
    growing up
  • More likely to be homeless and unemployed in the
    year prior to arrest

8
Greater Trouble Inside
  • 58 of prison inmates with MI are charged with
    rules violation vs. 43 of those without
  • 20 of prison inmates with a MH problem are
    injured in fight vs. 10 of those without.
  • Study in NYS - 23 in solitary confinement have a
    mental illness. Sensory deprivation, social
    isolation and idleness worsen condition.

9
Length of Incarceration
  • In 2000, 27 of inmates with mental illnesses
    released into the community had served their
    maximum sentence vs. 16 of the general prison
    population
  • Among those diagnosed with serious mental
    illness, 50 served their maximum sentences.

10
Recidivism Rates
  • 64 of released inmates with mental illnesses
    were rearrested and 48 were hospitalized after
    18 months.
  • 47 of prison inmates with a mental health
    problem have served 3 or more sentences (vs. 39
    without).
  • 81 of prison inmates with mental illness had
    prior convictions compared with 79 of other
    inmates.

11
Costs to Society
  • US has highest incaceration rates 737 per
    100,000 people
  • 2nd highest, Russia, is 581 per 100,000
  • Over 60 billion spent annually on corrections
  • About 2/3 of prison admissions related to
    probation/parole violations - ½ are technical
    violations, not new crimes
  • Source Open Society Institute

12
Aims of a Benefits Initiative
  • Through pre-release planning, individual leaves
    facility with
  • Benefits bridge assistance
  • Identity documents
  • Connection to community services supports

13
Benefits Provide Safety Net
  • Medicaid
  • Medicare
  • SSI/SSDI
  • Veterans Benefits
  • TANF
  • Food Stamps
  • Housing asst.
  • General Assistance

14
Bazelon Work on Benefits
  • Consensus Project
  • Publications
  • Model law and policy
  • 3-state project -MN,MD,VT
  • Federal legislation

15
Jail and Prison Differentiation
  • Jails have mix of pre-trial detainees,
    misdemeanants parole violators. Short stays,
    generally less than 1 year
  • Prisons have people already sentenced
  • Jails under local or county govt. Policies,
    practices, resources vary by locality
  • Prisons governed by state

16
SSI/SSDI Income-Support Programs
  • SSI (Supplemental Security Income) is paid to
    low-income, disabled individuals
  • SSDI (Social Security Disability Insurance) is
    for disabled workers who have paid Social
    Security taxes for a minimum number of years

17
SSI Benefits
  • After 1 full calendar mo., SSI suspended
  • 12 months, re-apply and new disability
    determination needed
  • SSI key for income support Medicaid

18
Restoring SSI
  • Suspended benefits can be re-instated prior to
    release, payable upon release.
  • New applications for SSI may be filed while the
    individual is in jail or prison.
  • New benefits are payable back to the date of
    application (or in the case of a person in jail
    or prison, back to the date of release).

19
SSI New Application
  • Need to provide evidence of disability and low
    income and resources.
  • Medical documentation requires a physicians or
    clinical psychologists report.
  • Application may take 3 or more months for review.
    Important to begin process well in advance of
    release.

20
Pre-Release Agreements with SSA
  • SSA encourages local SSA offices to enter into
    Pre-Release Agreements.
  • Facility agrees to
  • Designate a facility-liaison to work with SSA
  • Provide needed medical/non-medical info to
    support claim.
  • Provide anticipated release date and notify SSA
    if anticipated release date changes.

21
Social Security Disability Insurance (SSDI)
  • SSDI monthly benefits, based on past earnings.
  • Automatically eligible for Medicare 2 years after
    they qualify for SSDI.
  • Cash payments are suspended one month after a
    conviction benefits can resume on release
  • New applications for SSDI can be timed so inmate
    receives payment upon release.

22
Medicaid
  • Benefits vary by state, but all states cover
    outpatient services for mental illness.
  • Medicaid will not pay health care of individuals
    who are incarcerated, but (at state option)
    individuals can retain Medicaid eligibility while
    incarcerated.
  • Qualified individuals are eligible for benefits
    immediately upon release.

23
Medicare
  • Federal SSDI linked to eligibility for Medicare?
    subject 2-year waiting period.
  • Inmates 65 or older also eligible.
  • Does not pay for health care in CJ facility.
  • Can resume upon release but the individual will
    need Medicare card.

24
Restoring Medicare
  • Part A (hospital) restored at release
  • Outpatient medication (Parts B D) end if no
    premiums are paid
  • Failure to pay premiums Will have to wait to
    re-enroll during general enrollment period
    (annually Jan. - March) pay higher premium
  • If incarceration will be 90 days, inmate should
    contact SSA

25
Veterans Benefits
  • Disability payments can resume upon release with
    timely notification to VA
  • Service-connected disability payment reduced 60
    days after felony conviction
  • Non-service-connected disability stops 60 days
    post-convictionfelony misdemeanor

26
VA Benefits
  • Veterans cash health benefits can re-start if
    timely notice is provided to VA.
  • Prior to release, veterans should contact the VA
    to request benefit restoration.
  • To reinstate benefits, the VA needs written
    confirmation that the individual has been
    released.

27
Temporary Assistance to Needy Families (TANF)
  • TANF cash assistance/services for needy families
    w/ dependent children in the home.
  • Cash assistance is only paid to a custodian of
    dependent children
  • TANF-funded services can go to non-custodial
    parent, but only if related to economic
    self-sufficiency
  • TANF recipients are also eligible for Medicaid.

28
TANF Applications
  • Information individuals need to know in order to
    apply for TANF
  • A recent income history is required in all
    applications.
  • Individuals with incomes that are considered too
    high may not eligible for a TANF cash payment but
    may still be eligible for
  • Services
  • Medicaid

29
Food Stamps
  • For low-income, based on income and assets
  • Work requirement waived for caretaker of child
    under 6 or person w/disability.
  • Federal law bans Food Stamps for life for people
    convicted of drug felonies, although states can
    opt out

30
Federal Food Stamp Rules
  • Applications for Food Stamps can be submitted
    with an application to reinstate or apply for SSI
  • The Social Security Administration will then
    process the Food Stamp application.
  • Federal funds are available (50-50 match) for
    outreach services.
  • Jails/prisons could use these funds to provide
    information to inmates so they can apply while
    incarcerated.

31
Identity Documents
  • Social Security card, birth certificate,
    citizenship documents, Medicare card
  • Ensure that valid IDs held by facility are
    returned upon release or
  • Can be held in trust by a community agency.
  • Held by a family member the inmate trusts.

32
New Identification Documents
  • Establish process so inmates obtain official,
    photo ID upon release. Most state DMVs provide
    official photo-IDs for non-drivers.
  • Interagency agreements and planning needed to
    achieve aim.

33
Getting Started
  • Research
  • Outreach to key informants and likely advocacy
    partners
  • Outreach to state and local officials
  • Assessing interest and buy-in interagency
    leadership
  • Legislation, admin policy, executive orders are
    the vehicles for making needed policy changes

34
Partnerships and Coalitions
  • Include partners that collectively have the range
    of knowledge/sphere of influence needed
  • Interagency planning, leadership and sustained
    commitment needed
  • More complex undertaking than it would seem

35
Major Planning Decisions
  • Where to start pilot vs. statewide?
  • Prison/jails?
  • Population only those with SMI?
  • Eligibility criteria
  • Lead agency
  • Who does benefits counseling?

36
Other Key Decisions
  • Resource needs
  • Training needs
  • Monitoring
  • Documentation
  • Outcome Measures
  • Intake screening
  • Eligibility tracking
  • Re-entry planning
  • Sustainability of initiative

37
Benefits Counseling Options
  • Local community mental health agency case
    managers
  • State eligibility workers
  • Specially-trained corrections staff
  • Community health center out-stationed eligibility
    workers
  • Community Action Agencies, homeless programs,
    often also have eligibility specialists.

38
What is Needed?
  • The right partners
  • MOUs, interagency collaborative agreements
  • Training and leadership
  • Systematic planning implementation

39
Summary of Core Elements
  • Screen for mental illness
  • Screen for benefits, IDs, and need for
  • medical records
  • ? If possible, suspend not terminate
  • Application assistance in facility
  • Expedited review of applications
  • Interagency agreements
  • Coordination of release planning

40
Interagency Agreements
  • Medicaid, Corrections, Health, Social Welf.
    Econ.Services, MH/SA, DMV, VR
  • Fed. Agencies - SSA, VA pre-release agreements
  • Health Care for Homeless, Comm. Health Centers,
    Community Action

41
Release Planning - Best Practices
  • Medicaid, Corrections, Health, Economic Services,
    Mental Health, SSA, VA, DMV, consumer reps in
    work group planning effort
  • Start at intake screen for benefits
  • Start prep work applications ASAP

42
Best Practices
  • On-going training for staff
  • Document steps
  • Develop forms, checklists, protocols to
    operationalize process
  • On-going monitoring feedback

43
Best Practices
  • Collect process outcome indicators
  • Stay involved. Keep champions involved/informed
  • Use success for new re-entry efforts

44
Priorities Identified
  • Support for CMHC in-reach
  • Focus on housing
  • Peer support/mentoring
  • Focus on state psychiatric institutions

45
Contact Info
  • Elaine Alfano, Policy Analyst
  • Bazelon Center for Mental Health Law
  • 1101 15th Street, NW, Suite 1212
  • Washington, DC 20005-5002
  • Phone 202 467-5730, ext. 123
  • E-mail elaine_at_bazelon.org
  • Website www.bazelon.org
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