Does Dually-based Medical and Mental Health Care at a County Jail Reduce Recidivism for HIV+ Individuals?

The importance of continuity of health care between corrections and community has been increasingly recognized, including its heightened prominence in the 2008 National Commission on Correctional Health Care standards In Hampden County, MA, HIV+ jail patients are assigned to health center teams based on zip codes where “dually-based” physicians work with patients in both the jail and continue the care after return to the community. Integrating this primary health care model with mental health and substance abuse disorders treatment has not typically been realized.

Mental Health As a New Continuity Enhancement (MHANCE) redresses this situation through a collaboration with a community mental health organization that provides mental health care within the jail and courts. With MHANCE, two mental health clinicians and supportive case management have been added to the team of dually-based health providers.

MHANCE is one of 10 jail sites in the Enhancing Linkages to HIV Primary Care and Services in Jail Settings Initiative of the Special Projects of National Significance (SPNS) authorized by the Ryan White Care Act-- a 5-year demonstration project that identifies HIV-infected individuals in jails and assists them in securing HIV primary care and social support services when transitioning back to the community. MHANCE is the only site focused on mental health care in a community-integrated model.

This presentation describes our experience adding “dually-based” mental health care and supportive case management to the existing system of care at Hampden County for HIV+ inmates. This presentation also reports on an analysis of recidivism, comparing non-MHANCE inmates with similar chronic illness, mainly Hepatitis C, with MHANCE inmates post 6 months of release. Using factorial MANOVA, outcome variables from jail records were compared between a control group (N = 40), matched for ethnicity, gender, number of previous incarcerations, LSI score, classification, previous technical violations, type of crime, gang affiliation, presence of juvenile history, site of release, and substance use disorder, and MHANCE clients (N = 40) who have also been released at least 6 months prior. Our hypothesis is that individuals in care with MHANCE were more likely than individuals who were out of care to stay in the community and less likely to recidivate or to delay the time before re-incarceration.