Supporting persons with mental illness and substance use disorders in jails and prison

Jun 20, 2019

The Office of Substance Abuse and Mental Health Services (SAMHS) has a long-standing program to help persons with mental illness and co-occurring substance use disorders re-integrate into the community following discharge from incarceration.

Known as Intensive Case Managers (ICMs), this team of 18 dedicated professionals not only helps to navigate successful transitions into the community, they also have a critical role in diverting people from hospitalization by identifying appropriate levels of care in the community.  Their work includes conferences with judges, prosecutors, defense attorneys, probation and parole officers, guardians, and consumers themselves.

Nationally, approximately 700,000 individuals return home from state prisons and an additional 9 million are released from county jails annually. More than 10% of those coming in and out of prisons and jails are homeless in the months preceding and following their incarceration (Council of State Governments, 2016).

When people are incarcerated, community-based services are limited and ties with those providers often become fragmented and broken. This is where the ICM team steps in to provide essential services and follows-up post-incarceration to ensure linkages are made or restored to community-based services.   

The key components of success include housing, services, and diversion:

  • Housing: Recognizing the correlation between recidivism rates and housing stability, SAMHS has recently prioritized the Bridging Rental Assistance Program (BRAP) to include persons with mental illness being discharged from incarceration settings. BRAP subsidizes a portion of participants' rent and provides support in arranging housing. Even when the voucher is not used, participation provides a level of confidence in the housing search and much-needed support in eventual placement.
  • Services: The cornerstone of successful community placement is MaineCare enrollment and eligibility. Visiting a community mental health provider or substance use disorder clinician on the first day of release is a critical step in avoiding recidivism.  With MaineCare expansion now firmly in place, increased access to appropriate care and treatment is further anticipated. The ICM team now assists individuals with applying for MaineCare at the time of admission, rather than as discharge approaches. In up to 80% of cases, individuals with mental illness may have co-occurring Substance Use Disorder (SUD), meaning that SUD services also play a critical role in successful community placement. With Governor Mills' executive order directing immediate action on the opioid epidemic and improvements to Opioid Health Homes in the last few months, there are more treatment options available to support people with SUD coming out of Maine's jails and prisons. Combined with medication management, behavioral health homes, and community integration services, people connected to care in the community have real opportunities for success. Still, further action is needed, prompting the Department's request for additional opioid response funding and the upcoming Opioid Response Summit.
  • Diversion: An increasingly important role within the ICM team is working with the Courts on mental health dockets. ICMs have become a critical component in partnership with the Judiciary, defense attorneys, and prosecutors in helping to identify community resources necessary for appropriate and timely behavioral health care. Avoiding higher levels of care than are clinically necessary, such as inpatient hospitalization, and further incarceration, is often achieved by ICMs assigned to the jails and prison system.

On the horizon, ICMs will be increasingly involved in diversion efforts ahead of court and incarceration. We look forward to improving appropriate treatment options for all who need them statewide.