Evidence-based reentry key for incarcerated population

Evidence-based reentry key for incarcerated population

By Elizabeth Thompson

At first, Tommy Green doesn’t tell his clients that he was formerly incarcerated.

As a Community Health Worker for North Carolina Formerly Incarcerated Transition Program (NC FIT) in Orange County, he connects people coming out of jails and prisons with health resources, as well as assistance with other needs, like food and transportation.

When he first meets clients, he tells them about the program, but it’s not until he says he also did time that he sees a spark in their eye.

“They look at me first like it’s just a health care worker or a health care provider or somebody in the medical field,” Green said, “but as soon as they know that I’ve been incarcerated, I’m looked at as a friend, become the big brother or uncle or father figure.”

There has been little funding directed at studying the process of reentering society after incarceration, said Evan Ashkin, professor of family medicine at the school of medicine at the University of North Carolina at Chapel Hill. However, research suggests that support from peers, people who have been through similar experiences, during reentry is beneficial for people leaving incarceration.

Ashkin, the founder of NC FIT, which connects formerly incarcerated people with health needs to health care services and other reentry resources, says employing community health workers, people with lived experience with incarceration, to help connect people to the right services is “the only reason” NC FIT works.

Reentering society after incarceration, whether it be after a week-long detainment at the local jail or over a decade in prison, can be a challenge — especially since incarcerated people are frequently sicker than the general population, with higher rates of diseases such as diabetes or hepatitis C.

Because of Green’s lived experience, he can meet clients where they are and establish a form of trust with them. They know he understands the complexities of reentry. 

While some reentry specialists without a history of incarceration might immediately point clients toward the job hunt, Green said he understands that sometimes returning citizens need to decompress and get their lives together before jumping into a job.

“If you got a job and you’re not where you need to be mentally, then you’re not gonna keep that job,” Green said. “It’s not going to work.” 

Mental illness and incarceration are often intertwined. A 2014 report from the National Research Council found that 64 percent of jail detainees, 54 of state prisoners and 45 of federal prisoners reported mental health concerns.

“We incarcerate people for the crime of mental illness and the crime of substance use disorder,” Ashkin said.

Despite the public health implications for people reentering society and the fact that 98 percent of people incarcerated in North Carolina will be released, many people reenter society feeling unsupported. 

In a recent health policy brief in Health Affairs, Ashkin made the case for more evidence-based reentry programming for formerly incarcerated people, such as medication-assisted treatment (MAT), an evidence-based approach for treating substance use disorders, and other approaches that focus on health and well-being.

A sicker population

Incarcerated people are more likely to suffer from mental health issues. As much as 85 percent of the prison population either has a substance use disorder or was arrested for crimes related to drug use. Often, these people are using substances to “self-treat” an underlying mental health disorder. 

Chronic physical health conditions, such as diabetes, and communicable diseases such as hepatitis C and HIV are also more prevalent among incarcerated people.

David Rosen, assistant professor of medicine at UNC’s medical school, said incarcerated people tend to be sicker due to a combination of things, from poverty to lack of health care.

“There is really just pervasive trauma among that population and with the trauma comes self-medication, and that’s an explanation for a lot of the substance use,” Rosen said, “And then with the substance use and with lack of access to care, people are more likely to engage in behaviors that might lead to hepatitis, HIV, STIs.”

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