Fresh from lockup and battling a host of health problems -- including chronic illness, addiction and mental illness -- a majority of California parolees wind up in a handful of cities like Los Angeles, Oakland and San Diego.
But here's the rub: Parolees often can't get the services they need because they're going back to low-income communities where health services are "severely strained," according to a recent RAND Corporation study.
The study also says that access to care for minority parolees also tends to be uneven. For example, African Americans living in Los Angeles and Alameda counties had less access to hospitals than Latino or white parolees, while in Kern and San Diego counties, Latino parolees had the least access.
I spoke with Lois Davis, the lead researcher on the RAND study, which mapped where parolees go after they're released, and analyzed -- for the first time -- California's safety net of medical, mental health and addiction services available to parolees in their communities.
Bernice Yeung: Why should we care about the health of parolees?
Lois Davis: A lot of people ask that question--why does this matter?--and they are usually fairly unsympathetic. But California is in the top five states in terms of the sheer number of prisoners and the truth is, they all return to communities.
[T]hey should care because [parolees] become a part of a larger set of public health and social problems that California will have to deal with. They become part of the medically indigent population, those suffering from mental illness, homelessness and those having drug problems.
It has affects on our public safety, since those conditions can be associated with property crimes. This population also brings with them infectious diseases, which can have an impact on the communities that they're returning to. So policy makers need to make sure that they are getting the service and the medications that they need.
How would you summarize the major findings of this study?
Certain California counties and communities are disproportionately impacted by reentry. They are often returning to disadvantaged communities where the medical and health safety nets are already restrained and where they have limited resources to help those individuals returning from prison. So some communities are disproportionately impacted.
Also, these individual tend to be in poorer health. They have higher rates of chronic health conditions such as asthma and hypertension, higher rates of infectious diseases and conditions that require rigorous use of health care to keep them in check. Two-thirds of California inmates report having drug-abuse or -dependency problems, and one-third report having mental health problems. So they are disproportionately sicker than the average citizen in California.
The key message is that certain counties and communities are disproportionately affected by reentry and if we want to think about how to target resources, we should take that into account.
How is this study unique?
The innovation of this study is not in mapping where parolees return to and the location of healthcare facilities; it's in trying to define, for the first time, the safety net for these individuals and figuring out what the capacity of that system is in terms of being able to meet the needs of these individuals.
We are beginning to recognize that access to services varies from community to community and it varies in terms of types of service. And this impacts parolees by race and ethnicity--it's important for people to understand that mental health services for African Americans and Latinos in Los Angeles or Alameda County, for example, reside in areas with lower access to these services ...
What was surprising to me was that in the mental health area, there is a patchwork of two small networks for parolees. But in truth, they need to rely on country resources [Something we'll explore in future posts--Ed.]. It's often hard for parolees and their advocates to navigate this patchwork.
We need, fundamentally, for policy makers to ask themselves about what reentry looks like in their community. What capacity do they have to meet the health care needs of people returning from prison? As reentry plans are getting more attention, how do we design strategies to target the resources to these individuals?
What policy recommendations would you make based on your research?
My specific recommendations are that policymakers have to realize that nonprofit community organizations--in Los Angles they're called public-private partnership clinics--fill an important role in the medical safety net. So if a county is thinking about how to target their resources, they should think about the possibility of funding more of these clinics in places where there are gaps in services for this population.
They also need to look at the patchwork of mental health and drug treatment for parolees because this is an area where parolees have the greatest need, and it will have an impact on whether they reoffend or violate their parole, whether they can find housing or a job. There is a real need to look at how we can better rationalize these services so that people have better access to the resources that they need.
Is California somehow different in terms of reentry and health care?
We have to recognize that we are one of the states with a large number of people coming out of prison, so this is not an issue that we can ignore. The sheer size of the prison population is not trivial in terms of the public health and public safety impacts.
And as the state is trying to find reductions in health care and corrections costs, they are considering cutting out rehabilitative services in prisons. For example, they are thinking of cutting substance-abuse counseling unless it is court ordered, or they are thinking of releasing individuals without parole. So we could have more people coming back out but at the same time, rehabilitative services are potentially being cut while they are incarcerated. And the state is also trying to trim funding to the medical and mental health safety net when they come out. What does this mean for the medically indigent? This population will essentially push the costs to a local level. So there are impacts of reentry on public health.
Why is health not often been discussed in terms of reentry?
We know that this population is sicker on average, but when people think of people that are coming out of prison, they think about how they need housing and a job. And they do. But what some people do not appreciate is the impact that health has on the ability of people to do these things.
This population has a higher burden of disease, whether you're talking about mental health, drug abuse or chronic illness. And the public-health community has not traditionally seen prisoners, or those returning from prison, as important when they're dealing with things like infectious diseases. But [it] does have a role to play in meeting these individuals needs; these individuals are part of the population that they need to worry about ...
We need to understand this population as part of the homeless and medically indigent population, which often needs alcohol and drug treatment.
As Jeremy Travis, the former director of the National Institute of Justice, said, "They all come back," and that's true. This is not an issue that we can ignore. And this impacts certain communities in a profound way. This goes back to the question of why we should care.