Perceptions of reentry: the role of postincarceration policy in accessing physical health, mental health, and substance use services post release for people with substance use disorder within 30 days of leaving prison

Abstract

The US criminal justice system holds more than 2.3 million people, with approximately 641,000 being released back into the community each year (Carson & Anderson, 2016). One in five of those incarcerated in 2015 were convicted of a drug related offense (Carson & Anderson, 2016). With a specific focus on how the formerly incarcerated with substance use disorders reenter the community from prison, this dissertation examines the role of postincarceration policy, as well as other factors, that impact the use of physical, mental, and substance use services in the community post release. Study 1 is a critical policy analysis, arguing that in addition to postincarceration policies being punitive, they result in significant social, financial, educational, housing, and health care barriers to reentry and reintegration of prisoners into their communities as productive citizens. This article describes the types of postincarceration policies in place in the US currently and provides implications for future postincarceration policy development, program implementation, and research. Study 2 is a qualitative pilot study, presenting descriptive results from in-person semi-structured interviews with reentry clients (n=10) and reentry staff (n=10). Both clients and reentry staff view client’s mental health needs as priority at reentry. For clients, enabling factors included remaining abstinent from drugs or alcohol, informal support from family and friends, as well as professional support from agencies and barriers included long wait times for services, issues with their insurance coverage, stigma related to their drug use and time spent incarcerated. Staff, meanwhile, described systems level factors as facilitating or enabling, such as postincarceration policies limiting those with incarceration histories in accessing basic necessities and health services. Study 3 aims to expand on the Study 2 pilot with a larger, in-person interview study featuring 100 clients. Results also show high levels of chronic medical problems, clinical PTSD diagnoses, experiences of both physical and sexual abuse, and injection drug use. Additionally, signaling need for mental health service, less substance use related issues in the past 30 days, and being male all predicted service need.