June 11, 2009
Inmates released from California prisons have a high need for drug treatment, health care and mental health services, but they face barriers to accessing such aid because many return to communities where health care services are severely strained, according to a new RAND Corporation report.
Parolees must navigate a patchwork of service providers to receive help, relying upon nonprofit clinics, county hospitals and clinics, and a few specialized programs to meet their substantial health care needs, according to the study.
"California has one of the nation's largest prison populations, but the state has not made as much progress as other states in funding re-entry health care and other services for parolees," said Lois Davis, the study's lead author and a senior policy researcher at RAND, a nonprofit research organization.
To address the challenge, policymakers need to better understand the health care needs of those returning from prison, which communities are disproportionately impacted by re-entry, and the capacity of the health care safety net in those communities to handle parolees, Davis said.
The RAND study, funded by The California Endowment, was designed to better understand the public health implications of prisoner re-entry. The issue has gained added timeliness as result of a proposal by Governor Arnold Schwarzenegger to release 38,000 prisoners early from California's prisons as one response to the state's fiscal crisis.
"This is coming at a time when the state and other funders are reducing support for the state's health care infrastructure and safety net—this is the system that serves both parolees and others who need help," Davis said. "Not only will more individuals be returning from prison in need of services, but they will be competing with other individuals who have recently lost insurance coverage and all of them will be seeing providers who are being squeezed financially."
On average, prisoners are sicker than the general population, suffering from higher rates of infectious diseases, serious mental illnesses, and drug abuse and dependence disorders. As California's prison population has risen sharply over the past two decades, the number of parolees returning to the community has risen as well.
RAND researchers analyzed California-specific data from a national survey of prison inmates, used California corrections data to examine the geographic distribution of parolees across the state, and assessed parolees' potential access to services in four representative counties—Los Angeles, San Diego, Alameda and Kern.
Researchers found that California prison inmates have a high burden of chronic illness such as asthma and hypertension, and infectious diseases like hepatitis and tuberculosis that require regular medical help.
About two-thirds of California inmates reported having a drug abuse or dependence problem, yet only 22 percent said they had received treatment since being sent to prison, according to researchers. That treatment rate is lower than what was reported by state prisoners nationally.
Half of prisoners report having a mental health problem, yet only half report receiving treatment while incarcerated—about the same rate reported for state prisoners nationally.
An analysis of the geographic distribution of parolees in the four counties showed that each has distinct clusters of parolees. The finding suggests it will be important to target re-entry resources to communities and neighborhoods within a county that are disproportionately impacted by re-entry.
In the three urban counties studied, most parolees resided in areas with the lowest access to general acute care hospitals. Some of the most prominent geographic gaps in access to health care for parolees appeared in Los Angeles County, particularly in South Los Angeles where the number of parolees is high and access to services is poor.
Access to health care, mental health services and substance abuse treatment varies across California counties and within each county, including differences by race and ethnicity. Researchers found that parolees in San Diego and Kern counties resided in areas with lower access to mental health services and drug treatment than their peers in Los Angeles and Alameda counties.
In terms of differences by race and ethnicity, a larger share of African-American and Latino parolees in Los Angeles and Alameda counties resided in areas with lower access to mental health services than white parolees.
Past research has shown that drug and property offenses contribute to recidivism rates in California. Investing in improved access to drug treatment for parolees may improve their transition back into society and reduce the chance they are sent back to prison, according to the report.
The report, "Understanding the Health Implications of Prisoner Reentry in California," is available at www.rand.org. Other authors of the study are Nancy Nicosia, Adrian Overton, Lisa Miyashiro, Kathryn Pitkin Derose, Terry Fain, Susan Turner, Paul Steinberg and Eugene Williams III.
The work was done within the Health Promotion and Disease Prevention Program of RAND Health and the Safety and Justice Program of RAND Infrastructure, Safety and Environment.