A person with mental illness who is incarcerated may or may not have a known history of mental health care and treatment. Regardless, once the need for mental health treatment is identified, the correctional setting provides an unparalleled opportunity to begin closely monitored treatment. The challenge is to treat the individual in a manner that recognizes and prepares for the likelihood of release, so as to ensure that services will continue when he or she re-enters the community. The logical way to do this is to engage the community-based mental health care system from the outset.

Upon intake to the facility, all individuals in jail or prison should be screened for mental health issues, and those who are screened as having potential challenges in this area should receive a comprehensive mental health assessment (See Policy Statement 8, Development of Intake Procedure, for more on mental health screening and assessment after admission to a correctional facility.) The first task for jail or prison health care personnel upon identification of an inmate's mental health needs is to determine whether the person has a history of treatment. Information gathering protocols should be implemented to enable cross-referencing. In many cases, the need for treatment and knowledge of a treatment history will surface at arrest or booking, so the process of establishing a treatment history and creating a linkage with the community-based system can begin even before the intake process formally starts. In such cases, law enforcement or corrections officials should be able to determine through formalized procedures whether the inmate is known to the community mental health system and, if so, what his or her treatment history reveals. The majority of inmates with mental illnesses will not have had recent contact with mental health providers. In a large number of other situations, however, the need for treatment may not become evident until some later point in the process.

Example: Data Link Project, Maricopa County Sheriff's Office and Value Options (AZ)

When individuals are booked into the county jail, their name, date of birth, social security number, and gender are electronically sent by the Maricopa County Sheriff's Office to the management information system of the Regional Behavioral Health Authority (RBHA) of Maricopa County, Value Options. The system electronically and simultaneously cross-references the demographic information with the RBHA's roster of more than 12,000 clients who receive mental health services in the area. The data link provides for continued identification of clients throughout the day, regardless of booking charge, time of booking, or current mental status. It allows RBHA access to the Maricopa County Sheriff's Office booking information in order to identify individuals who may be eligible for diversion from the criminal justice system.

In many communities, laws and/or common practice protect the confidentiality of such information. With more provisions of the federal Health Insurance Portability and Accessibility Act (HIPAA) becoming effective, confidentiality of health care information is becoming an even more complicated concept than it has been. Still, experience shows that confidentiality can be protected, even as information that will enable appropriate treatment is shared among treating professionals. Corrections and community health care providers have taken a number of different approaches to the problem of respecting confidentiality while ensuring appropriate treatment. The most foolproof appears to involve engagement of community providers in correctional settings, ensuring that information on each individual is closely held by a limited number of provider agencies. In most cases, recipients of mental health care services are willing to sign releases allowing information to be shared among the providers caring for them.

Example: Jail Health Services, San Francisco Department of Public Health (CA)

Treatment services, including psychiatric care, are provided in the San Francisco jail system by employees of the San Francisco Department of Public Health. These staff members can access electronic information (a summary record) of treatment in the public health system for each inmate identified during jail screening as having a mental illness. The Department is in the process of converting to a new electronic medical record system that will make the complete record readily available to all providers in the system, including jail-based medical staff.

Engaging the community-based system in providing mental health care services to people in jails and prisons opens the door to a smooth transition from the correctional setting to the community. It ensures that treatment planning can take into account the predictable needs of an inmate upon release and the availability of services in the community to which he or she returns. Problematic interruptions in treatment or unnecessary changes in medication can be avoided. Just as important, appropriate psychosocial supports can be developed and adjusted by a single treatment team that knows the client and understands the dynamics of re-entry.

The challenge of making connections with treatment providers that are geographically far removed from prisons remains a significant barrier to smooth transitions. Even when great distances must be overcome, however, correctional facilities and inpatient or outpatient providers can establish meaningful links. Telephone contact and more advanced forms of telemedicine can ensure that a community connection is made (see Recommendation d, below). In many states, too, it will turn out that a relatively large number of prisoners returns to an area served by a single provider. In those places, relationships between prison health providers and their community counterparts-however far away-can be developed over time to aid in smooth transitions.

In its 2003 report, the President's New Freedom Commission on Mental Health decried the fragmentation of the nation's mental health care system. The Commission recognized the particular challenges of accessing care for individuals re-entering their communities after periods of incarceration. As an important step in reducing«…such fragmentation and ensuring effective and continuous care, the Commission cited linking people with serious mental illnesses to community-based services upon their release to the community. Engaging community-based providers early, and solidifying their connection to individuals in prisons and jails, is critical to ensuring that no one with mental illness is overlooked by corrections- and community-based mental health providers.