A Holistic Approach

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By Jesse Duthrie

Dan Abreau is the Associate Director of the SAMHSA National GAINS Center in Delmar, New York. The GAINS Center is a national agency focused at expanding access to community-based services for adults with co-occurring mental illness and substance use disorders in connection with the justice system. The GAINS Center is operated by Policy Research Associates. Dan Abreau has worked in correctional facilities since the 1970’s, and now works to strengthen the resources and success of reentry programs on a national level.

Jesse Duthrie: What are the major projects you are working on with your agency?

Dan Abreau: Most of the work that we do is funded by SAMSHA. The work focuses more on jail diversion. The work we do takes place before reentry. Since 2002 we’ve been the technical provider for around 40 to 50 cases around jail diversion. Perhaps the most related publication we have around reentry is called the Assessment Planning and Identification Coordination (APIC) model. It’s a model that helps jails and prisons in a timely way identify people with mental illness, assess their needs, and identify the appropriate providers for their needs for when they get out.

Companion to the APIC model is a reentry checklist that was developed. This checklist has 10 domains that reflect different needs that the reentry population has so that people working at those sites can easily look at those needs and whether or not they’re met. If they’re not, they can develop a plan so they can be.

JD: Of those 10 domains, what would you say are the most pressing for offenders with mental illness returning home from prison?

DA: Here’s the issue with that question. Reentry planning is a little like putting up Christmas tree lights: if one lights goes out they all go out. For example, if you have everything handled but a person doesn’t get their medication when they get out, well then the person decompensate and they end up in the hospital. Or say they get everything handled but they don’t get adequate housing and they end up in a shelter where there’s a lot of fragmented services and it’s harder to get the multiple types of services they need. Maybe the person has co-occurring disorders and they’re being treated for the mental illness but not adequate attention to the substance abuse, so the plan falls apart.

You really have to look at this holistically, and sometimes you can’t get all the needs fulfilled for people getting out of prison. But it’s important to be aware of what those things are once you’re released, where the providers are or the community supervision people. We need to figure out alternate plans to making those referrals so we can move beyond the inadequacy.

JD: What it sounds like is each person has their own set of criteria that they’re going to have to deal with when they are released from prison. How do you guys provide that one-on-one attention for a massive returning population?

DA: We’re not the only technical assistance provider. One of the issues prison systems around the country face, and some are better than others, is having the resources to do this work. It really is a specialty type of resource that’s required and a lot of state prisons still don’t have the resources still to devote to make these reentry plans work well. So first off there is a resource issue.

Then you have to remember that in most states, with maybe Rhode Island and Connecticut being an exception, those prisoners aren’t located anywhere near where people live. So you’re doing the reentry planning from a remote location, trying to get services in a number of communities across your state. And in many states you have multiples prisons, so you’ve got multiple referrals, multiple communities, and it gets to be a pretty resource intensive process.

JD: Are there any particular instances where you’ve seen the work you’ve been doing has been incredibly effective? What caused it to work so well?

DA: I’ll give you an example that is directly tied to the APIC model. Alaska did use the APIC model to educate their legislature about reentry planning and the need for dedicated resources. Not only did that include prison-based resources, but also transition resources and community resources. They used the APIC model to get additional resources that could include reentry planning. This included things like finding health benefits prior to release and making referrals to providers before release.

Case managers came into the prisons to either provide transportations for the prison back to the community- you’d be surprised how many people get lost on a bus ride- and to provide that direct kind of service right from prison back into the community. Then there was an increase in available funding so Medicaid gets approved, and some payment to providers to treat people immediately upon release so that there is no reason why anybody should get lost among the population if they have a serious mental illness.

Payment of services upon that critical time of reentry became another important push. Reentry got APIC legislation passed in Alaska to fund those last pieces of service. They’ve done a really nice job with it.

JD: How long have you been working in the field of mental health and prisoner reentry?

DA: Mental health and prisoner reentry and mental health since I started my career in the early 70s, which was when de-institutionalization was just starting. I’ve always worked in prisons, and I eventually became an administrator and with the last 10 years of my career I worked with reentry. I retired and came to work at the Gaines Center in 2005.

JD: Seeing as you’ve been involved within prison systems since the 1970s, how have you seen the chance in attitudes and stigmas within the system towards offenders with mental health issues?

DA: Back in the ‘70s nobody was prepared for how complex it was going to be for people with mental illness to return to the communities. There were issues in every community. It wasn’t just de-institutionalization, it was change in mental health laws, which made it harder to lock people up because of a mental health problems and granted people with mental illness a full range of civil liberties. It wasn’t just public policy; it was the way the laws changed.

And then there was the issue of having co-occurring disorders and how that complicates recovery for people with mental illness. Then there was an issue of resources. I still think we haven’t reached a point yet where community mental health treatment is adequately funded. So that’s one issue, but there are improvements. Now there’s targeted grant programs to help agencies do a better job and they have invested millions of dollars, but in the end it’s still a very complicated thing.

JD: Where do you see the future of this mental health issue going, and what changes needed to be made in order to reduce recidivism in the long run?

DA: If you look state level and then service level, a lot of people got caught up in the war with drugs. People with mental illness, like people without mental illness, use drugs. There was a pretty broad net and people with mental illness got caught up in that. So that’s one issue that states are beginning to address.

Another problem is the three strikes laws. We’ve gone through a couple of decades now with different approaches to crimes. States cannot afford the level of incarceration that they’ve legislated any more. You’ve got multiple funding streams to address these issues: Department of Corrections, Department of Community Supervision Agency, The Office of Mental Health Agencies, and The Substance Abuse Agencies. In some states these agencies can be badly coordinated.

JD: If you had anything to add to the readers of RELEASE who might not be familiar with this issue, what would you add?

DA: Connecticut, across the justice and mental health system, is doing a lot of these things that we’ve talked about. It’s not just because it’s a small state. There really are a lot of quality people there. Trauma is a huge issue that gets overlooked; I think Connecticut is one of the leading states in looking at issues of trauma and incarceration, whether it’s dealing with veterans or mental illness. There are actually higher rates of incarcerated people that have experienced trauma than mental illness. Connecticut’s done a lot of training and is one of the top states in preventing and treating trauma.

I think that people understand that it’s important to be holistic in the approach, it’s important to establish partnerships, and that additional funding may be required but it’s kind of a “pay me out, pay me later” situation because people we’re talking about are high users of expensive services: emergency room services, cycling through jail, etc. These people are going to cost money, but by working in an organized way it may be more cost effective in the long run.

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