From prison to community: An innovative discharge planning program at San Quentin State Prison

More than two million people in the United States are incarcerated, a fourfold increase since 1980. California has the distinction of having the largest incarcerated adult population nationwide. Over ninety percent of incarcerated Californians will be released to the community with sixty percent returning again to prison within 3 years - creating a revolving door between prison and the community. Former inmates have high rates of mental illness, chronic diseases, infectious diseases and substance abuse, and are 12 times more likely to die from largely preventable causes, in the first two weeks after release. There are limited discharge planning programs for inmates with chronic medical conditions, leaving returning inmates without care in the community. In order to address this discontinuity of care and its impact on chronic disease management, the Discharge Planning program was implemented at San Quentin State Prison in 2007. A collaboration between local community public health systems and the prison, the program targets paroling patients with chronic diseases and arranges primary care in the community within 30 days. Prior to the direct handoff of patients to community health systems, patients receive intensive health education and harm reduction. Medical records are transferred directly to community providers. Community health workers aid in social service referrals prior to patients' release home. The Discharge Planning program aims to lower the recidivism rate of its participants, and improve their health status whether incarcerated or free.