Locked In Limbo: Jail-based Competency Restoration

In Texas, legislators and advocates are working to address mental health concerns for individuals entering or in the criminal justice system. For those already in jail, telepsychiatry is being offered to help rehabilitate inmates. For those just entering the system, a mental health court in Travis County has been developed to connect people with needed mental health services so that they can stand trial and even have their cases dismissed.

In response to the dangerous gap in health services that incarcerated people face upon release, California and 26 other states have implemented Medicaid waivers allowing coverage to begin up to 90 days before release and continue for up to a year afterward. The program connects inmates with case managers, medications, housing assistance, and mental health care before they walk out the door. California's program has already enrolled more than 50,000 incarcerated people in prerelease services since January 2023.

Chesterfield County, Virginia implemented a multi-faceted response to the opioid crisis, including a jail-based recovery program, Helping Addicts Recover Progressively (HARP), that brings people in recovery to the local jail to talk about addiction and treatment resources. Combined with other efforts, overdose deaths have dropped by half in a single year, and around 4,000 people have participated in HARP.

Research has found that providing medications for opioid use disorder can help prevent overdoses after release from prison. The state’s Department of Adult Correction recently launched a pilot program to test this theory. 229 of the 287 participants received treatment, several of whom said the access to the medications helped save their lives.

With the new statewide Medicaid expansion, the Department of Adult Correction is working to ensure fewer people reenter society after incarceration and enter a healthcare coverage gap by helping people apply for Medicaid before release. With the Medicaid expansion, 80% of the 15,000 people released from prison each year are now eligible for coverage, and prison staff submit about 100 Medicaid applications each week.

At the Los Angeles County Jail, two men incarcerated on pending murder charges created a homegrown approach to improving the care and conditions of confinement for people with serious mental illness. Their approach is simple: showing love and care for people whose illness makes them feel like outcasts. By helping fellow incarcerated men attend counseling and other programs, and by tending to their personal needs, the initiative has contributed to a significant drop in people harming themselves. Fewer restraints are needed, and the pods where the program operates are notably cleaner and calmer than before.

The Michigan Prison Doula Initiative seeks to provide pregnant women experiencing incarceration the support and care they need to maintain physical and mental health before, during, and after giving birth. The initiative has partnered with the Michigan Department of Corrections to start work in one prison – with the hopes of expanding to others – by providing prenatal counseling, support during birth, and postpartum visits.

Among the challenges for HIV-positive inmates are lack of food that meets their dietary needs and susceptibility to tuberculosis. The support groups, part of an HIV prevention and care program active in all the nation’s prisons, mitigate those challenges and create awareness about HIV prevention and care.

Alabama’s Tutwiler Prison for women, once found to be one of the worst prisons for women in the country, has undergone major reforms to change its once-abusive culture. A key part of this has been a focus on pregnant women who are experiencing incarceration, focusing more on rehabilitation than punitive measures by offering peer support groups and substance abuse programming. Tutwiler has also brought in the Alabama Prison Birth Project, offering childbirth education and doula services if desired.

New York-based nonprofit, Rehabilitation Through the Arts (RTA), runs theater programs for individuals experiencing incarceration as a way of improving mental health and reducing recidivism. While the United States’ criminal justice system has been focused on punitive measures, there’s been a trend toward rehabilitation across the country in recent years. Participants in RTA have shown a rate of recidivism of just 5% – compared to a 60% national average – but funding and sustainability remain a consistent hurdle.