Drawing the System

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By Jesse Duthrie

When Loel Meckel explains the prison reentry process, he works best with a pen in hand and blank paper at his disposal. He’s free to illustrate the process aesthetically rather than orally. It’s complex, he says, and after the first page is filled with branched titles and acronyms for state agencies, it’s hard to remember where it first started: the word “arrest.”

Loel Meckel is the Assistant Director of the Division of Forensic Sciences for the Department of Mental Health and Addiction Services (DHMAS). He’s tall, thin, and with his horn rimmed glasses he radiates an air of calm intelligence; somebody working within a challenging program with the patience and ability to explain his work clearly.

Meckel’s office looks archaic: it’s old tan stone is weathered and gothic entrance indicates that prior to becoming the head offices of the Department of Mental Health and Addiction Services (DHMAS), it could have been used for Masonic meet ups or old Catholic institutions.

Beyond the heavy steel doors, on the second floor, Meckel works with a team of men and women targeting offenders with mental illness or addiction whose risk of recidivism can be reduced by providing appropriate community services.

“Tell me about the issues men and women with mental illness face upon release from prison,” I ask Loel.

“Well first, Jesse, do you know how the incarceration process works?”

I pause. I’m caught off guard.

“Sure. A man or woman is arrested, then they are brought into court where they can either post bail or are kept in custody. Then, depending on their circumstances, are brought back to court for a hearing-“

“I think I should show you how it works a little clearer. It’s a very complex process.”

He pulls out his pen and begins the first of several drawings. Starting with “arrest,” he makes a line down to “court.” “Court” then splits to “jail” and “diversion.” Jail is tracked down with several arrows, indicating an ambiguous amount of time between jail and sentencing. Next written is “sentenced to incarceration.” Finally, another arrow and underneath, the word “release.”

By the time he arrives at release, the process is lengthy yet manageable to comprehend. But when he shifts the discussion to mental health reentry services, the process grows significantly more complex.

Upon entrance to incarceration, men and women are given mental health screening. They are given a Mental Health Care Need (MH) rating between 1 and 5; 1 indicates no mental health history of current need and may be characterized as emotinoally stable, 2-4 represent little to some mental illness severity, and 5 indicates crisis level mental disorder (acute conditions, temporary classification) that requires 24 hour nursing care.

“These numbers don’t necessarily represent the type of mental illness a man or woman has upon entering prison,” Loel explains. “Say a person with no history of mental illness commits a serious crime and comes into prison with serious distress or depression, he or she may be given a 4 or 5 MH rating. On the other hand, a person with history of schizophrenia may be relatively calm when they enter a corrections facility, and even though there’s a history of mental illness, they may not require the more intensive mental health services provided by Department of Corrections.”

Prior to release, inmates are given the opportunity to receive reentry aid from the University of Connecticut Health Center’s prison-based Correctional Managed Health Care Services, and DHMAS. This planning stage gives men and women extended medication after release, as well as counseling, psychiatric services, and discharge planning. Because the therapeutic effect of psychiatric medication may diminish in as little as a few days, it’s imperative that they continue the medication they’ve been on during incarceration.

Loel explains the two types of reentry planning in the state based on presence of a Serious Mental Illness (SMI). The first is called the DMHAS-DOC Interagency Program. Within this program, incarcerated men and women with SMI are prepared three to six months prior to release through a referral system which includes DHMAS, UCONN’s Health Center’s prison-based Correctional Managed Health Care Services, and DMHAS-funded Local Mental Health Authorities (LMHA).

It’s impressive to see the amount of agencies working together to help these men and women being released.

The second planning set is called Connecticut Offender Reentry Program (CORP). CORP also provides services for men and women returning from prison with serious mental illness but is much more intensive than the DMHAS-DOC Interagency Program. The aim of CORP is primarily to maximize the chance of successful reentry to the community and secondarily to reduce recidivism by helping those with severe mental health needs. Using extensive resources inside and outside of incarceration, men and women are given intensive case management, integrated mental health and substance abuse services, and linkages to supportive men and women in their communities. The DHMAS website adds that men and women are given “pre-release assessment and skills building programs including the development of a community support network.”

Loel explains to me that men and women coming out of the DMHAS-DOC Interagency Program have a recidivism rate around 50% after a year of release. When I ask what the CORP recidivism rate is, he blows me away.

“Somewhere around 18%. But that number is not exact.”

How is it, then, that two programs targeted at the same objective have such greatly contrasting effects on recidivism? I trace my mind back a few weeks to a phone interview I conducted with Dan Abreau of the GAINS Center in New York. [Insert Link for Q&A with Dan Abreau]. In our conversation, Dan frequently stressed that the greatest factor to providing adequate care for returning men and women is to give them the appropriate amount of resources to have a successful transition process from prison to community.

Of course, there is the issue of funding for reentry programs. Where the standard DMHAS-DOC Interagency Program utilizes resources from several agencies, the level of involvement is lessened potentially due to cost. It seems that CORP, with a greatly significant percentage of recidivism rates, uses a larger margin of resources, which comes at a cost to the state. Yet the two program use the same number of agencies but with CORP the LMHAs have CORP staff who only serve CORP clients, so the intensity of services is higher than for the DMHAS-DOC Interagency Program.

When I asked Loel to explain why there isn’t more investing into the expansion of CORP programs, the answer comes back the same as any other state agencies: the funding is not there. Grants are dispersed at the capitol and programs more or less have to make do with what they are given.

This isn’t the first time I’ve encountered reentry programs facing this same issue. In Waterbury, the CT Renaissance House’s dual-diagnosis program showed how successful reentry programs can be for people with both mental illness and substance abuse treatment; however, the CT Renaissance House was only one of two dual-diagnosis programs in the state. All of the academic research that had been conducted within the psychology and sociology fields has proven that duel-diagnostic treatment is the next step in the advancement of reducing recidivism and providing adequate treatment. I can remember being in the offices, seeing the long list of counseling services, and asking why there weren’t more of these programs in the state. Again, it was a problem of finance.

Loel hurries to his computer to print out info graphics from the GAINS Center. He prints out an info graphic similar to the one he’s drawn out short hand, except this one is vastly more intricate. Then he prints out the DHMAS list of services for mental health release programs in Connecticut.

It’s as confusing as it is complex. As we go through the info graphs, names of state and national agencies like the Substance Abuse and Mental Health Services Administration (SAMHSA) pop up. While there was once funding from naitonal agencies, Loel explains how DHMAS has been able to run its programs solely off of state funding. But after awhile it’s hard to keep up with the money trail- specifically who’s receiving the money and what it’s being used for.

The process is not streamline, I deduce, and vast array of financiers and recipients makes it complex to track how the process itself works. I look down at the papers Loel has printed, and the white computer paper he’s drawn several illustrations on. I remember the first thing he said when he started to discuss the mental health reentry process: “It’s more complicated then you think.”

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