The U.S. Justice Department made headlines in October when it announced it would release some 6,000 inmates early from federal prisons. The move was designed to reduce overcrowding and retroactively address the harsh sentences that many drug offenders have received over the last three decades.
Unfortunately, the odds are long for those inmates, and for many thousands more who will eventually leave prison and return to society.
Almost one of every 100 American adults is living behind bars — about 2.2 million people, according to a 2014 report by the National Research Council. The vast majority will eventually be released. Yet many won't stay out for long. A report from the U.S. Bureau of Justice Statistics estimates that three-quarters of prisoners released in 2005 were arrested for a new crime within five years. More than half had been arrested by the end of the first year.
People leaving prison face a host of challenges, from untreated mental illness and substance abuse disorders to unemployment and lack of housing. "There doesn't tend to be a good handoff for individuals leaving the prison system," says Roger H. Peters, PhD, a professor of mental health law and policy at the University of South Florida. "Reentry is always going to be a challenge."
Despite the challenge, reentry is an issue the nation can no longer afford to ignore. Over the past two decades, state and federal spending on corrections increased by more than 300 percent, to about $52 billion annually, according to a 2011 Pew Center on the States report. Corrections is the second fastest-growing area of state budgets, after Medicaid.
"Policymakers and criminal justice professionals are recognizing that simply releasing someone into the community and expecting them to be successful is not a recipe for success," says Robert Morgan, PhD, a psychologist who studies correctional mental health at Texas Tech University.
Increasingly, states are experimenting with new ways to address the complicated and costly problem of recidivism, or relapse into criminal behavior. And psychologists are among the scientists and clinicians best suited to design, test and deliver those interventions.
An uphill climb
The list of obstacles is long for people released from prison. Offenders often return to communities that are highly distressed, with few employment options, high rates of violence and easy access to drugs. They may have nowhere to stay and no way to earn a living legally.
"Even if they have support, they are faced with the same risk factors they had coming in," says Nancy Wolff, PhD, an economist at Rutgers University who has studied trauma and addiction among incarcerated men and women. "And now they have one more: a felony label attached to them."
Many inmates face additional difficulties that go beyond criminal behavior. Both mental health and substance use disorders are widespread in the nation's jails and prisons, and often co-occur, as Peters and colleagues describe in a recent editorial in Psychiatric Rehabilitation Journal (2015).
More than two-thirds of jail detainees and half of prison inmates have a substance use disorder, Peters and colleagues note, compared with 9 percent of the general population. Rates of serious mental illness, including major depression and bipolar disorder, are three to four times higher in prisons, and four to six times higher in jails, than in the general population.
"The correctional system has become our de facto mental health system," says June Tangney, PhD, a clinical psychologist at George Mason University who studies interventions for jail inmates. "It is one of our silent shames."
Yet a minority of people with mental health and substance abuse disorders receive adequate treatment while in jail or prison, Tangney and Peters say. Treatment that does take place might not be intensive enough or last long enough to make a significant difference. "We have people in crisis and often ready for change, and really severely limited resources for treatment of any kind," Tangney says.
When inmates do receive treatment during their incarceration, it's often difficult to maintain those services once they are released. "If individuals can't connect with mental health services on the outside, we lose a lot of the health gain that correctional settings were able to provide," Wolff says.
On the other hand, mental illness is not the only factor worth paying attention to. "There has been a lot of attention paid over the past decade or so to offenders with mental illness, and there are a lot of misconceptions about that group," says Jennifer Eno Louden, PhD, a psychologist who studies criminal justice and mental health at the University of Texas at El Paso. "There's a sense that these folks are extremely high risk, which isn't necessarily true, but also that mental health treatment is the only service they need," she says. "Mental health is only part of the picture. We have to focus on their other needs as well."
While mental health treatments are certainly important for improving mental health outcomes, interventions must also attend to the other risk factors that predispose a person to engage in criminal activity, agrees Joel Dvoskin, PhD, a forensic and clinical psychologist at the University of Arizona who has consulted with state and local governments nationwide. Offenders both with and without mental illness benefit from interventions that attend to what sociologists have dubbed "criminogenic needs," the variables strongly associated with crime and violence. (See "Criminogenic needs" below.)
Though social scientists call them "needs," these factors also include personality traits, social relationships and situations that increase the risk of criminal behavior, such as impulsivity, poor family support and lack of employment. "Those are the things we need to invest in if we're going to have a fighting chance," Dvoskin says.
Risk and need
To best target criminogenic needs, the Risk-Need-Responsivity (RNR) Model has emerged over the last few decades as the leading tool for changing criminal behavior. The model was developed largely from work by the late psychologist Donald A. Andrews, PhD, of Carleton University in Ottawa, and colleagues.
The RNR Model's first principle — risk — is to identify offenders at the highest risk of recidivism, and provide them with the most intensive services. Low-risk offenders should receive little or no treatment. The second principle — need — is to assess inmates for the eight broad criminogenic needs associated with crime and violence. The third principle is to respond to the specific needs identified for a given offender. An offender with an impulsive personality and criminal attitudes might be best served by a cognitive-behavioral therapy program to change attitudes and behaviors, for instance, while someone with an alcohol use disorder would be better served by addiction treatment.
The RNR Model ensures that offenders with the greatest risk will receive the intensive services that have the best chance of helping them. It also benefits low-risk offenders by staying out of their way, says Jennifer L. Skeem, PhD, a clinical psychologist at the University of California, Berkeley. Providing services to people who don't really need them can be harmful, she says. It's not helpful if a former inmate has to leave work to attend appointments, or to sit in the waiting room of a community mental health center with higher-risk counterparts. "Over-programming their lives may interfere with their work, their social networks and other protective factors they would otherwise have in place," Skeem says.
Increasingly, prisons are using risk-and-needs assessments to help them decide which services will best benefit which inmates, says Kirk Heilbrun, PhD, a clinical psychologist at Drexel University who studies criminal offenders and forensic evaluation. Several standard assessments exist to measure risk and need, and take no more than an hour or two to complete, he says. "Some people need a good bit of support. Some need relatively little. But we can tell the difference without too much time and effort put in."
Yet while correctional systems are getting better at assessing inmates, there's still a gap between knowing what offenders need to be successful, and making sure they get it. "The problem is people often just stop at risk assessment, and don't use the results to inform service provision," says Skeem.
Often, that gap can be traced to scarce resources, Morgan says. "We're doing a pretty good job of identifying needs offenders have as they're trying to re-enter society. It's just a matter of how many of those needs can be met and for how many offenders."
And while it's important to address criminogenic needs, it's nearly impossible to do so without first dealing with the more immediate, basic requirements of everyday life. Morgan recalls a colleague trying to help a former inmate set goals to avoid antisocial acquaintances and address his criminogenic thinking. But the former inmate only wanted to talk about the bedbugs keeping him awake in the rundown motel where he was forced to stay after being released from prison. "Criminogenic needs is a big part of it, but that's secondary to making sure folks have their daily needs met," Morgan says.
Second chances
Despite such barriers to success, former inmates are often released back into their communities with minimal assistance or support. "The mandate of state correctional systems is to protect public safety, and that charge is frequently perceived as ending when someone is released from prison," Peters says. "There often aren't built-in mechanisms or incentives for state correctional systems to work carefully with social services, particularly behavioral health services."
As states have begun to recognize the scope of the recidivism problem, however, some have taken steps to tackle it. From 1999 to 2004, for example, Oregon's recidivism rate dropped almost 32 percent, according to the Pew report. In Oregon prisons, inmates receive targeted case management during incarceration, and detailed reenty planning beginning six months before they are released. In 2003, a bill was passed by the state legislature requiring correctional programs that receive state money to be evidence-based.
The federal government has also taken steps to address recidivism. In 2008, Congress passed the Second Chance Act, a program that provides federal grants to government agencies and nonprofit organizations that provide support and services to people returning from prisons, jails and juvenile detention facilities. Programs funded by the grant include career training, mentoring, substance abuse and mental health treatment, and evidence-based supervision strategies to improve outcomes for people on probation.
That evidence base is pretty good, many experts say, but it could be better.
"There's a fair amount of research on the things former prisoners need in order to be successful," says Eno Louden. "The real gap is in doing randomized clinical trials of specific programs to really isolate the mechanisms of effectiveness."
For example, jobs skills programs can reduce recidivism. But is it skills, such as welding or machine repair, that are helpful? Or is it the habits gained through the process of employment, such as showing up and getting along with your boss? Similarly, researchers have yet to fully parse which interventions work best for specific populations, such as juvenile offenders or sex offenders.
Meanwhile, there are opportunities for clinicians, as well as researchers, to get involved in improving the odds for criminal offenders. Some of that can be done through "in-reach," says Dvoskin, where community mental health center employees begin meeting with prisoners before they are released.
"When inmates have met clinicians, the chances of them showing up for their first appointment [after release] are much higher," he says. "It doesn't happen as often as it should, but it's tremendously helpful."
Some mental health professionals shy away from providing treatment to former inmates, adds Eno Louden. "It can be very challenging for a clinician to do mental health or substance abuse treatment for clients who are mandated — it changes the relationship between the client and clinician when it's not voluntary," she says. But there is great need for such services, she adds, and psychologists have a lot to offer, both in treating mental illness and helping reduce criminogenic behaviors with approaches such as cognitive behavioral therapy.
Providing more mental health and reentry services to criminal offenders is only part of the picture. Virtually everyone interested in corrections, on both ends of the political spectrum, agrees that broad reforms are necessary to repair the nation's unwieldy and ineffective criminal justice system.
"People are starting to realize that we're pouring bad money after bad money into prisons. It isn't doing what we were promised, and it's costing a fortune," says Dvoskin. "I think there's increasing pressure to spend this money more wisely, and quit trying to build our way out of this mess."
Criminogenic needs
Social scientists have identified eight broad "criminogenic needs" that are strongly associated with crime and violence:
- Antisocial behavior
- Impulsivity
- Criminal attitudes and values
- Criminal friends and associates
- Dysfunctional family relationships
- Poor investment in school or work
- Lack of legitimate leisure activities
- Substance abuse
Incarceration and mental health
- Almost one of every 100 American adults is living behind bars, a total of about 2.2 million people, according to a 2014 report by the National Research Council.
- An estimated three-quarters of prisoners released in 2005 were arrested for a new crime within five years, according to the U.S. Bureau of Justice Statistics. More than half had been arrested by the end of the first year.
- More than two-thirds of jail detainees and half of prison inmates have a substance use disorder.
- Rates of serious mental illness, including major depression and bipolar disorder, are three to four times higher in prisons, and four to six times higher in jails, than in the general population.