Jails have mix of pretrial detainees, misdemeanants & paro

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• 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

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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
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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

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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

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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.

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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

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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

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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.

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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.

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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.

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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

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Aims of a Benefits Initiative

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

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Benefits Provide Safety Net

• Medicaid
• Medicare
• SSI/SSDI
• Veterans Benefits

• TANF
• Food Stamps
• Housing asst.
• General Assistance

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Bazelon Work on Benefits

• Consensus Project
• Publications
• Model law and policy
• 3-state project -MN,MD,VT
• Federal legislation

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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

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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

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SSI Benefits

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

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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).

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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.

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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.

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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.

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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.

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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.

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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

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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

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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.

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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.

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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

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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

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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.

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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.

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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.

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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

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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

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Major Planning Decisions

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

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Other Key Decisions

• Resource needs
• Training needs
• Monitoring
• Documentation
• Outcome Measures

• Intake screening
• Eligibility tracking
• Re-entry planning
• Sustainability of initiative

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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.

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What is Needed?

• The right partners
• MOUs, interagency collaborative agreements
• Training and leadership
• Systematic planning implementation

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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

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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

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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

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Best Practices

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

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Best Practices

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

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Priorities Identified

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

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Contact Info

• Elaine Alfano, Policy Analyst
• Bazelon Center for Mental Health Law
• 1101 15th Street, NW, Suite 1212
• Washington, DC 20005-5002
• Phone [phone], ext. 123
• E-mail elaine_at_bazelon.org
• Website www.bazelon.org