Cook County Jail seems an unlikely place to address drug and mental health treatment, but that’s exactly what the jail is doing thanks to President Obama’s signature healthcare reform legislation.

Since April 2013, jail administrators have been screening individuals coming into the facility at 26th and California to see if they have health insurance. If not, jail administrators have been enrolling individuals, if qualified, into CountyCare, Cook County’s version of expanded Medicaid. CountyCare is now under the auspice of the state. More than 6,000 inmates have a Medicaid insurance card by starting an application in jail. Cook County Sheriff Tom Dart called it a “game changer.”

Dart has been advocating for greater services for those suffering from mental illness. A third of the jail population, or 3,000 inmates, suffer from some form of mental illness.

“We still have the issue of capacity and places for them to go [for treatment] but at least now the hurdle isn’t ‘You don’t have any insurance; we are not going to take care of you,'” Dart said.

Under Obamacare, substance abuse and mental health treatment are essential health benefits insurance providers in healthcare exchanges must now cover. Additionally, those states that expanded their Medicaid programs must also provide mental health and substance abuse treatment.

Cook County got an early jump on enrolling low-income residents into expanded Medicaid via a 2012 federal waiver given to states with large county populations. Cook County is among three other counties — in Los Angeles and New York — to get the waiver.

That allowed Chicago to begin screening and enrolling individuals in CountyCare. The CookCounty effort is a partnership between Treatment Alternatives for Safe Communities, Inc. (TASC), and Cook County Health and Hospital System.

Mental health and drug addiction

The move makes good public policy since many low-income uninsured adults are involved in the justice system, according to Sophia Ansari, spokesperson for the Cook County Sheriff’s office.

“Insurance coverage provides greater opportunity to build strong continuity of care between the jail and the community by allowing this often transient population to leverage community resources, including access to necessary medication not previously accessible,” Ansari said.

John Jay Shannon, a doctor in CookCounty’s system, agreed.

Through the system’s CermakHospital located inside the jail, those in custody receive treatment for withdrawals. They also receive counseling for those suffering from mental illness, especially if dual diagnosed with a drug addiction.

According to Cook County health data, nearly 60 percent of jail detainees suffer from alcoholism or addictions to valium-like drugs or opiates, such as heroin. Having access to medical care ensures continuum of care and treatment once released, according to Shannon.

“We can provide episodic care at the jail by stabilizing individuals and making sure they get their proper medications,” he said. “But individuals’ long term needs go far beyond the care we can administer at that facility. Now, with CountyCare coverage, when people leave the jail we have a way to ensure they have access to healthcare once they are released and re-enter the community.”

But Dart sees a greater impact with the health insurance law — that it could impact recidivism rates.

“I can’t tell you how many people I see that come into my jail who are repeat offenders, not because they are bad people but because they are mentally ill and they have nowhere to go, [or have] no treatment,” Dart said.

Access to health care, though, is not a cure all, Dart noted, adding, “but it will definitely do one of two things: some people will never come back in [and] others won’t come in as often.”

The ‘Three Components’

Health insurance is a start, says Clifton “Booney” McFowler Jr., who served 27 years for first-degree murder but now advocates against youth and gang violence. He too battled a brief addiction to heroin in 2011.

 But it doesn’t address the needs to help ex-offenders transition from “outlaw to citizen,” McFowler stressed. He currently works at BUILD, an Austin nonprofit serving at-risk youth, as a case manager working with juveniles connected with the criminal justice system.

“It’s hard coming from an outlaw to a citizen,” McFowler said. “All your life you’ve been breaking the law. Now you coming out here with no assistance to transform into a productive citizen to your community and family with no help. So you are fending for yourself.”

The formerly-incarcerated, he said, are unprotected citizens unlike other minority groups where laws prohibited discrimination in housing and employment. That’s not so for ex-offenders, McFowler argues. They struggle, he said, with getting a state ID or job-readiness skills, like setting up email or writing a resume; and they also need counseling because incarceration affects the mind.

“Criminal behavior is a mental illness too. Anybody that will do something that would put them in a cage can’t be thinking right,” McFowler said.

Policymakers, he insist, must understand the three components needed to help the formerly-incarcerated transform their lives — that’s drug treatment, mental health and re-entry services.

“If you just work one then you got the other two that’s going to take hold, and you are still going to end up with the same results,” McFowler said. “We need to have a mechanism in place to address the criminal behavior, drug addiction and mental behavior.”

The way to do that, he says, is to have resources for ex-offenders to get treatment for both substance use and mental illness, as well as job or vocational training that leads to gainful employment.

“A lot of the things that is needed is just the basics,” McFowler said. “It’s not asking that you give the formerly-incarcerated a crutch. It is just equipping them with the basic tools they need.”


Related articles:

PART II: Untangling the managed care system

PART I: Hope for substance abusers under Obamacare


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