The transition between incarceration and the community is a difficult and stressful process. This is especially true for the mentally ill inmate, who may have difficulty coping with such stress. On July 1, 1999, a new aftercare program in the Maryland Department of Public Safety and Correctional Services was implemented. In response to a variety of forces, the need for improved pre-release treatment, training and case management was recognized, and a program - the Mental Health Transitional Unit (MHTU) - was developed to meet this need. The forces prompting us to develop this program included:

The program, as it has been developed, is designed to accept all inmates with known mental illness (dual diagnosis is acceptable) approximately 6 months prior to the scheduled release date. During the inmate’s stay in the MHTU, a variety of treatment modules are offered to the inmate, targeted at a variety of issues that are likely to cause the newly released mentally ill inmate difficulty in the community. These modules include:

In addition to the training and education groups, the treatment staff of the MHTU undertakes a comprehensive re-assessment of the inmate’s psychiatric diagnosis and treatment needs. The inmate’s medication regimen is evaluated and adjusted as needed. As the date of release approaches, the MHTU staff invites the appropriate community-based case manager or other provider to the MHTU. A coordinated effort at comprehensive linkage is undertaken by this team of institutional and community providers, and includes, as needed:

Upon release, the staff of the MHTU will attempt to follow up at 14, 30 and 90 days to document successful linkage to the needed services. Although we have not developed this with any further evaluation component (e.g. a control group receiving "standard" pre-release services), we believe that this intervention has such solid face validity that such a model will not be needed.

The first 18 months of experience with this project has highlighted some difficulties related to the transition from prison to the community. Some of these problems are unique to the prison system. For example, the MHTU is currently based at the maximum security Patuxent Institution. Patuxent has certain advantages, most especially in that it is located in central Maryland, which is the ultimate home to 90% or more of the inmates in the Maryland Division of Corrections (DOC). This makes it geographically feasible for community providers to come to the MHTU, which is under an hour away from these highly populous counties. However, because Patuxent is maximum security, inmates housed in lesser security settings may elect to remain where they are, as they fear losing privileges and the ability to earn good conduct and other credits. In addition, Patuxent recently became the first non-smoking institution in the DOC, creating another disincentive.

From the standpoint of the prison-based case managers in the MHTU, the project has developed well. Although we are not satisfied with our ability to identify inmates appropriate for this program, it is clear that what we do now to help inmates with mental illness plan for their return to the community is far better than what we were able to do two years ago. Our ability to develop and foster good working relationships with providers in the community has steadily improved. However, the community providers have identified some areas of deficit. These primarily include (1) adequacy of records within the prison, and (2) availability of medications upon release. We have made efforts to improve these deficits.

Future growth areas for this program will include:

Along with our partners at the Maryland Mental Hygiene Administration, Baltimore Mental Health Systems, and the Center for Behavioral Health, Justice and Public Policy, we hope to be able to present preliminary data in the near future. We further hope that others in the correctional system will develop programs such as ours.