Care Coordination in Correctional Health

Momentum around mental health reform was formalized with the Affordable Care Act improving access to mental health coverage; however, discussions around current voids and further improvements continue to progress. A number of recent conversations have highlighted the unique mental health problems continuing to face those involved within our criminal justice system.

Incarceration has largely replaced hospitalization for thousands of individuals with serious mental illnesses in the U.S., with state prisons and county jails holding as many as 10 times more of these individuals than state psychiatric hospitals. Because individuals with serious mental illnesses are predisposed to committing minor crimes due to their illnesses, many end up being detained in county jails for short periods of time with limited or no mental health treatment until a state hospital bed becomes available for them or they are improperly diagnosed and released back into the community. In this update, we are reminded of a previous discussion on the matter here, but have found the issue to have continually grown and evolved. Those in jail settings have been found to have mental illnesses at alarmingly high rates for what are believed to be a host of reasons. A recent survey by the Hennepin County (MN) Sheriff’s Office found that 52% of the total inmate population shows indications of mental illness. Other studies have found the inmate populations to display characteristics of mental illness at a rate of 64%. The magnitude of these matters has been raised by groups such as the World Health Organization, and is an anticipated topic during the post-election Congressional sessions where pending legislation would build on the improvement in funding and healthcare access for mentally ill and drug addicted patients under the Affordable Care Act.

High rates of mental illness in incarcerated populations are attributed to a number of factors, including:

• Poor diagnosis of mental health conditions upon admission to a correctional facility
• Inappropriate or inadequate treatment during previous tenures in the jail setting
• Social challenges presented by the frequent entry to and discharge from the criminal justice system
• Inconsistencies in Medicaid coverage throughout the inmate and post-discharge continuum, including varying suspension and termination policies across states where Medicaid coverage is prohibited for inmates of public institutions
• Higher rates of low income and uninsured individuals entering jails

The above problems may largely be counteracted by significant improvements in care coordination across the relevant settings. A particular pain point is at the state and local level, where state-administered jails have been found to encounter an estimated 60% weekly inmate turnover. This population churn stems from an estimated 6 in 10 not being convicted, or the misdemeanor nature of the convicted resulting in shorter sentences. As a result of this frequent turnover, the provision of care is disrupted, and one study found that 8 in 10 individuals were without health insurance 16 months after returning to the community. The mental health of incarcerated populations continues to be critically in need of improved service and coordination, despite recent efforts.

TripleTree has observed a number of companies having a meaningful impact in this space. CoCentrix, recently acquired by Harris’ US Healthcare group in August 2016, offers a multi-disciplinary platform across the criminal justice continuum. Specifically, CoCentrix highlights the importance of coordination around societal re-entry in avoiding what it terms a ‘revolving-door cycle.’ Corizon Health, a combination of America Service Group and Valitas Health Services, provides care services that identify inmates at risk, treating them in the incarcerated setting while building relationships with community-based healthcare providers to ensure continuity of care upon societal re-entry. These examples serve as interesting beginnings in addressing a large, ongoing issue while the market for additional and expanded solutions remains.

We continue to monitor this space and would like to know what you think.