Recommendations for Implementation

State statutes and administrative orders, usually in the form of structured parole release guidelines, generally frame the parole board members' decision-making process.  Such guidelines typically address the general offender population only, however, without recognizing the special needs of offenders with mental illness.  For example, a person whose mental illness is particularly serious may have been unable to participate in

job-training classes or other inmate programming opportunities that would improve the likelihood of the inmate's timely release.  Existing guidelines, however, typically emphasize participation in such programs as nearly essential for release.

Many states are beginning to employ validated risk assessment instruments that can help guide their estimation of the potential risk offenders pose to the community upon release.  As with structured parole release guidelines, however, employing risk assessment instruments designed for the general offender population may not adequately take into account the circumstances of offenders with mental illness.  In fact, no known risk assessment instrument has been validated by research to predict accurately the nexus between mental illness and risk.[4]

Until corrections systems develop or replicate such an instrument, they should rely on mental health experts to evaluate the instruments they are currently using to ensure that they take into account mental health issues appropriately.  In addition, releasing authorities should engage appropriate mental health professionals to assess on a case-by-case basis offenders' mental health and potential risk.  At least four states (Washington, Florida, Kansas, and Nebraska) require, by statute, evaluation of the mental health status of all inmates prior to release to the community.  Three of these states further require the development of individualized treatment plans and the identification of programs and resources in the community to carry out such plans.

Releasing authorities should enlist the support of a mental health professional to assist in conducting the hearing, reviewing the inmate's medical history within the institution, assessing the specific challenges he or she will face when returning to the community, and identifying community resources to help address the offender's needs.

Example:  Pre-Release Risk Assessment, the National Parole Boardof Canada

The National Parole Board of Canada incorporates psychological and psychiatric assessments into its risk assessment procedure, when appropriate, for all offenders being considered for parole.  Certain categories of offenders receive mandatory prerelease psychological assessments, including those who have exhibited persistent or gratuitous violence or those serving indeterminate of life sentences.  Offenders who have undergone treatment while incarcerated are required to have a post-treatment report completed by a psychologist, case manager, or program officer to address any changes of risk. A supplemental prerelease assessment is required only if the post-treatment report is considered insufficient to address the offender's progress.  Psychiatric assessments are required for any offender with a life or indeterminate sentence seeking parole.   Other issues that the parole board considers include the effects of any current medications prescribed, the risk if the medication is no longer used, and the programs and interventions in the community that will help the offender have a successful reintegration.

Example:  Contract for Risk Assessment Services, Missouri Parole Board

The Missouri Parole Board contracts for independent mental health assessment services to assist in identifying risk associated with the release of persons with mental illness.  The contract includes provision for the board to consult in person with psychiatrists when seeking information on particular cases, should they desire to do so.

The value of risk assessments for inmates with mental illness depends on the quality of information regarding an offender's mental illness and the assistance of a clinician to evaluate and interpret that information for a releasing authority.  Nevertheless, releasing authorities (especially parole boards) report considerable difficulty in gaining access to this information or mental health expertise.

Parole officials typically rely on correctional health officials for information regarding an offender's mental health.  Such information, however, is often dated and incomplete.  Mental health information from community-based treatment agencies and providers would provide releasing authorities with a greater understanding of the inmate's mental health history.  To that end, releasing authorities should enter into agreements with mental health organizations to ensure the confidential and appropriate sharing of information regarding a person's mental illness.

Several state parole boards have addressed these issues by collaborating with their counterparts in the state mental health agencies.

Example:  Memorandum of Understanding Between the New York State Office of Mental Health and New York State Division of Parole

In 1994, the New York State Office of Mental Health and the New York State Division of Parole signed a Memorandum of Understanding (MOU) to identify and better serve people with mental illness.  The MOU enhanced coordination of mental health evaluations for the board of parole; increased discharge planning for inmates with serious mental illness; implemented mental health training for parole officers; and established a Dedicated Parole Caseload initiative.

Example:  Multidisciplinary Team, Missouri Parole Board

The Missouri Parole Board employs a specially trained staff person who sits on a team with institutional staff to develop a continued-care plan for inmates with mental illness. The continued-care plan is holistic, addressing all areas of the offenders' life connected to his/her success in the community.  The program consists of both an institutional and a community release center phase.  The institutional phase lasts for four months and selected inmates spend two months in the community phase for a combined minimum of six months.  The program is used by the parole board as a pre-release planning mechanism, as well as an alternative to revocation for those who are parole violators.

Example:  Forensic Mental Health Coordinating Council (UT)

In 2002, the Utah legislature expanded the membership and scope of the Mental Health and Corrections Advisory Council and renamed it the Forensic Mental Health Coordinating Council.  The Forensic Mental Health Coordinating Council includes representatives from the Department of Human Services Division of Mental Health, the State Hospital, the Board of Pardons and Parole, the Attorney General's Office, Department of Corrections (DOC), Services for People with Disabilities, community mental health agencies, Division of Youth Corrections, and the state court administrator's office.  The council was formed to develop policies for coordination between the Division of Mental Health and the Department of Corrections, advise the DOC on care for inmates with mental illness, promote interagency communication around issues of mental illness and mental retardation, address civil commitment issues, and oversee coordination of services and placement options for particular individuals.

Example:  Texas Council on Offenders with Mental Impairments (TCOMI), Texas Department of Criminal Justice (TDCJ)

The TCOMI's Continuity of Care (COC) program provides a pre- and postrelease aftercare system for all offenders with special needs released from TDCJ jails and prisons.  By identifying offenders prerelease who will need aftercare treatment, the chances for a more successful reintegration into the community are improved. When these offenders areidentified prior to release, conditions may be imposed by the parole board or the courts that require mandatory participation in mental health treatment or other similar rehabilitative programs. TCOMI has set up a regionalized continuity of care system. Now, instead of a worker having to make repeated trips across the state, his/her counterpart in that area conducts the prerelease activities. This strategy is being implemented on a statewide basis. The majority of offenders released from TDCJ facilities are returned to communities where TCOMI and, in some cases, parole jointly operate community-based treatment programs. As a result, offenders are immediately enrolled in treatment services that are targeted exclusively for them, thus eliminating service delays. This approach, which was centrally developed but regionally implemented in association with community-based service providers, exemplifies what can be accomplished when interagency partnerships and cooperation are established at both the state and local levels.

Conditions of parole are the centerpiece of the release plan for a person reentering the community from prison under supervised release.  It is essential, especially when the parolee has a mental illness, that these conditions of release be tailored to the risks and needs that the individual presents.  A parolee should not be set up for failure:  the conditions of release must be realistic and enforceable.  If the parolee has a mental illness, board members must confirm that the services can be made available before imposing conditions of release that require participation in certain community-based programs or treatment, and that the parolee can meet those conditions.

While release conditions will vary depending on the risks/needs of the individual parolee, outpatient and inpatient treatment, and methods to assure that any necessary medications are taken should be requirements of any release plan for parolees with mental illness.

Example:  Medically Recommended Intensive Supervision Program, Texas Parole Board

The Texas Parole Board works in conjunction with the Texas Council on Offenders with Mental Impairments (TCOMI) to identify offenders who are eligible for the Medically Recommended Intensive Supervision Program.  A special mental health panel, comprised of three members, considers special release conditions for these offenders.  The conditions are imposed when the board determines that a mental impairment contributed to the commission of the instant offense(s) or may adversely affect a parolee's potential for success after release.  The components of the conditions call for the parolee to participate in psychological or psychiatric evaluation, participate in mental health treatment, and use medication as proscribed by the attending physician or psychiatrist.

In some jurisdictions, parole boards have the discretion to refer offenders with mental illness for assessment, treatment and hospitalization.  State law in Utah authorizes the Utah Parole Board to place parolees with mental illness in state hospitals for treatment as a condition of release if deemed medically necessary.

Access to income through a job or benefit program and to housing are other key factors that should be reflected in the conditions of release. (See Policy Statement 36: Integration of Services and Policy Statement 38: Housing, for further discussion of employment and housing programs for people with mental illness.)

Lack of resources in the community is a major obstacle in addressing the special needs of this group of offenders.  When asked, "What community resource is most lacking in regard to placing parolees back into the community?" state parole directors polled in the year 2000 identified the inadequacy of services for people with mental illness.  The two resources they identified most frequently -  housing and licensed substance abuse treatment - are key to successful community reintegration for parolees with mental illness.[5]

For instance, paroling authorities are put in a difficult position when prerelease program staff at the prison recommend specific conditions of release that are difficult to implement or enforce, given limited resources available.  In these situations, the releasing authority may be understandably reluctant to approve the inmate's release.  In some cases, the inmate's release is delayed due to the lack of an appropriate placement plan until they have completed their sentence, causing them to return to the community without any structured plan or supervision.  Such delays serve neither the offender's treatment needs nor the interests of justice.

Before placing an individual in the community, parole board members need to be assured that the services required for the successful reintegration of the offender with mental illness are available in the communities to which they return.  Most jurisdictions engage staff or consultants to the parole board to investigate and report to the board the existence and adequacy of local services.  Boards need this assistance to help them know and understand the degree of mental illness, needed elements of a release plan to the community, and alternatives to revocation.

Example:  Forensic Community Re-entry and Rehabilitation for Female Prison Inmates with Mental Illness, Mental Retardation, and Co-occurring Disorders, Pennsylvania Department of Corrections

Due to the lack of sufficient community-based mental health services and adequate housing, inmates with mental illness in Pennsylvania state prisons are significantly more likely than other inmates to serve their maximum sentence.  In response to this problem, the Pennsylvania Department of Corrections (DOC) developed the Forensic Community Re-entry and Rehabilitation program, which is a collaborative effort between the DOC, the, Pennsylvania Board of Probation and Parole (PBPP), and the Pennsylvania Community Providers Association (PCPA).  The program will employ a community placement specialist to develop, in conjunction with the parole board and community-based providers, comprehensive transition plans and conduct follow up for program participants.  When necessary, the program will provide transitional housing for up to 60 days.  Once the offender is paroled, the placement specialist will conduct follow up interviews with community-based providers to monitor the offender's progress.

The program will be launched in May 2002.

Parole board members should have some familiarity with the nature and types of mental illness, and how these disorders can be diagnosed and treated.  Training curricula should be developed and, depending on the jurisdiction, tailored for individuals appointed to serve as parole board members, both for new appointees as well as on an annual or on-going basis for all members. (See Policy Statement 30: Training for Corrections Personnel, for discussion and examples of training for parole boards and parole officers.)