Today’s post is coauthored with Jason Schnittker for the Robert Wood Johnson Foundation Human Capital blog. 

More than 650,000 inmates are released from prison every year.[i]  Although their debt to society may be paid, their struggles have just begun.  Reentry is not easy.  Former inmates need to find a place to live.  They need to find a job.  And many need to support families.  All told, 4 million people in the U.S. are dealing with the “mark” of a prison record and its consequences for their work and personal lives.[ii]  Most will struggle for years following their release.

Given all these difficulties, it’s hard to imagine health being a major part of their struggle.  After all, many former inmates are still quite young and, for that reason, unlikely to suffer from major health problems.  Mental health is part of the picture, but usually considered through a different lens:  policy-makers ask how mental illness affects criminal offending—that is, what leads to prison in the first place—but rarely consider the pivotal role of mental health in making a successful return to the community.

Yet the role of mental illness is just as relevant after release as before.[iii]

Many former inmates suffer from poor mental health.  And these problems often get worse following release, given the many disadvantages they face.  Former inmates suffer from many of the same disorders as other people, including depression and anxiety, albeit at higher rates. We know that substance disorders and psychosis are related to criminal offending, but former inmates suffer from mood and anxiety disorders too, and these conditions have received far less attention.  Our own research suggests that depression plays an especially powerful role in shaping the reentry prospects of former inmates.[iv]

Insofar as we demand that former inmates become productive and responsible members of society, we may need to provide them with a little more help.  Reintegration requires persistence, motivation, and a strong social network, all of which are undermined by mental health problems.  Mood and anxiety disorders, in particular, can rob individuals of motivation and initiative and undermine their relationships.  Psychosis and substance abuse are, of course, important as well, especially in preventing new offending.  But good health is more than the absence of these particular conditions, just as reintegration is more than the absence of particular criminal behaviors. Reintegration also implies successful adjustment to challenging work and family situations — and good overall health fortifies us all in meeting such challenges.

To date, enthusiasm for better mental health treatment among former inmates has been limited.  From a cost-benefit perspective, the role of treatment in reducing crime is inconclusive.[v]  But evidence on the effectiveness of mental health treatment for other outcomes, including employment, is more favorable.[vi]  The Affordable Care Act will help.[vii]  A robust safety net of low cost service providers will help too.  But true reform requires something more ambitious:  the recognition that good health is a precondition to getting back on your feet.

Jason Schnittker, PhD, and Chris Uggen, PhD, both recipients of Robert Wood Johnson Foundation (RWJF) Investigator Awards in Health Policy Research, recently published a study in the Journal of Health and Social Behavior on incarceration and psychiatric disorders. They found that incarceration increases the risk of mood disorders after release and that these disorders increase disability. Schnittker is an associate professor in the Department of Sociology at the University of Pennsylvania. Uggen is the Distinguished McKnight Professor in the Department of Sociology at the University of Minnesota.