Securing Mental Health Services and Benefits for Reentering Offenders

By Lia Gormsen

On May 12, ACA co-sponsored a congressional briefing on Capitol Hill called “Breaking the Cycle of Recidivism: The Case for Timely Federal Benefits Assistance Upon Reentry.” The hearing was in support of a piece of legislation proposed by Rep. Andre Carson, D-Ind., that addresses the gap in mental health services for offenders. The Recidivism Reduction Act seeks to ensure prompt access to federal supplemental security income and Medicaid benefits for ex-offenders reentering society. Moderating the event was Laurel Stine, director of federal relations for the Bazelon Center for Mental Health Law. She emphasized how crucial the passage of this legislation is to not only help mentally ill offenders reintegrating, but for families, taxpayers and the communities to which the offenders are being released. 

First to speak was Fred Osher, M.D. As director of health systems and services policy for the Council of State Governments Justice Center, Osher is familiar with the ways in which the mentally ill are — and are not — provided for by the federal government. He spoke about how caring for the population of reentering offenders with mental illness is complex, but ultimately manageable. He conducted a study of the prevalence of serious mental illness among jail inmates in facilities in Maryland and New York, and found several reasons why mental illness occurs with more frequency for incarcerated individuals. For one, mental illness often co-occurs with substance abuse, a criminalized action. The homeless are more likely to suffer from mental illness, as well as to be incarcerated. And because those with mental illness are more likely to be homeless, they often have no homes to return to when they are due to be released. Ex-offenders with mental illness are also likely to be sentenced to under-funded community programs that are not able to support their housing needs. And often, imprisonment exacerbates mental illness, leading to behavioral problems that warrant longer stays in jails and prisons.

To combat these problems, Osher recommended that Congress increase appropriations for the Mentally Ill Offender Treatment and Crime Reduction Act, as well as the Second Chance Act. Osher also touched on two topics that were elaborated on by the second two speakers at the briefing. One recommendation was the need for alternatives to booking that law enforcement can use on the front end, when they are confronted with criminalized behavior on the streets that could be the result of mental illness. Another was the need for immediate access to income support from the federal government for reentering offenders with mental illness — a topic that the next speaker, Yvonne M. Perret, discussed in greater detail. Perret, a psychological social worker, serves as executive director for the SOAR (SSI/SSDI Outreach, Access and Recovery) Technical Assistance Center. In this role, Perret facilitates access to supplemental security income (SSI) and Social Security disability insurance (SSDI) benefits for inmates being released from prisons and jails in several states. She explained to the audience, comprised of congressional staffers and local organizations representing corrections, mental health and homelessness, the strict standards under which one must fall to qualify for SSI and SSDI benefits. Then, once candidates do qualify for SSI/SSDI benefits, Perret said it can take an additional two years in most states for Medicaid to kick in.

In addition to the strict set of standards that participants must meet, other barriers to receiving these benefits include lengthy and confusing application procedures. This is made especially challenging for incarcerated individuals, because the application processes are meant to be completed online, and secure facilities do not allow inmates Internet access. Moving release dates also pose a problem for the implementation of these benefits to incarcerated individuals. In some instances, Medicaid can be suspended during a person’s incarceration, but when suspension occurs, participants must have their statuses updated to keep their Medicaid accounts active, which often cannot be done in prison. Sometimes medical vendors in prisons will not release medical records to inmates upon release, which poses another barrier to Medicaid application. When inmates are released to halfway houses, they sometimes remain ineligible to begin receiving benefits because halfway houses are considered under the purview of the department of corrections.

Like Osher, Perret had many ideas for ways Congress could ease barriers for reentering offenders, allowing easier access to benefits, and therefore, easier and more successful reintegrations. She too touted greater flexibility for police officers to not arrest individuals who may be acting in a manner that warrants arrest because of their mental illness. She called for overturning legislation that criminalizes homelessness, and for a Social Security prerelease agreement template to be made for all states to use. Perret said criminal justice professionals should receive training on the types of trauma that often precede homelessness and how retraumatizations can occur during incarceration. To help with benefits applications, Perret also said that there must be funding for staff training and to help inmates and those serving in the community with benefit applications. “And to do this well,” Perret said, “is a labor intensive effort that really requires maintaining relationships and developing clinical information.” Perret also called for changes to the SSI legislation, specifically that suspension regulations be relaxed for those sentenced to less than one month in jail.

Last to speak was Warden Robert Green of the Montgomery County (Md.) Correctional Facility. He illustrated the difficulties of assisting inmates with reentry by telling the story of Montgomery County inmate “Danny.” Danny was in and out of Green’s facility multiple times before Green finally decided to set Danny up with a reentry plan. But, even with a plan in place, Danny landed himself back in prison within a few days, despite Green’s efforts. The problems were in the details: a bus pass with insufficient funds to get him to the correct stop; inventory day at the Salvation Army that prevented him from picking up clothing; and crowding at the shelter that meant nowhere for Danny to sleep. What appeared to be minor setbacks on the surface, ultimately led to Danny’s reincarceration — and the realization that Green would need to employ a full-time “eligibility worker” at his facility to avert missteps like those Danny encountered. This position, funded in part by the Montgomery County Department of Health and Human Services, serves as a sort of reentry specialist in Green’s facility, aiding inmates with benefits applications and securing housing and medical services. Though Green is proud of the work this position and his facility is doing to optimize services and resources for its reentering population, barriers exist at the legal level that continue to impede successful reintegration.

“I truly believe that we are on the edge of a very perfect storm in corrections,” Green said. “Reentry should not be an add-on to corrections … If we are taking someone’s freedom away, if we are taking them out of society, we should be as much interested in putting them back.” For this to be accomplished, he called for laws to be changed, processes to be streamlined and policies to be standardized. “We need your help now,” Green said. “We need to look at reentry as a national policy. …We need to get unnecessary barriers out of the way.” It begs the question, “who doesn’t think this is a good idea?” 

The purpose of the briefing was to gain support for the Recidivism Reduction Act (HR 2829) currently pending before the House Committee on Energy and Commerce. It would amend title XVI (Supplemental Security Income for Aged, Blind, and Disabled) (SSI) of the Social Security Act (SSA) to require the reinstatement upon release of an otherwise eligible, disabled inmate for SSI benefits, which were terminated due to the inmate’s incarceration in a jail, prison, penal institution, or correctional facility for a period of 12 or more consecutive months. The act would also require the inmate to apply for reinstatement and resumption of such benefits within 36 months after release, allow application for reinstatement before release, and permit provisional benefits to an individual until the application is acted upon. It also would amend SSA title XIX (Medicaid) to require state Medicaid plans to provide that in the case of any individual enrolled for medical assistance immediately before becoming an inmate of a public institution: 1) the enrollment shall be reinstated upon the individual's release from such institution unless and until there is a determination that the individual is no longer eligible to be so enrolled; and 2) any period of continuous eligibility in effect on the date the individual became such an inmate shall be reinstated as of the release date and the duration of such period shall be determined without regard to the period in which the individual was such an inmate.

Lia Gormsen is former assistant editor of On the Line.

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