Recidivism and mental illness: Iowa’s Central Pharmacy Pilot Project is an elegantly simple way to help keep mentally ill ex-cons out of prison.

An Obvious Way to Help Keep Ex-Cons Out of Prison That Pays for Itself

An Obvious Way to Help Keep Ex-Cons Out of Prison That Pays for Itself

Who's winning, who's losing, and why.
Sept. 18 2014 6:20 PM

How to Fix America’s Recidivism Crisis

It could be as simple as providing ex-cons with the medication they need.

Photo by Andrew Burton/Getty Images
Offenders who need meds don’t just need them when they’re on the inside.

Photo by Andrew Burton/Getty Images

IOWA CITY, Iowa—This year more than 650,000 inmates will be released from American prisons, a figure that breaks down to about 75 newly minted ex-cons every hour of every day. Within three years, the federal government estimates, roughly four in 10 of those former prisoners will be back behind bars, either because they committed a new crime or violated the conditions of their release.

Josh Voorhees Josh Voorhees

Josh Voorhees is a Slate senior writer. He lives in Iowa City. 

The reasons for this huge recidivism rate are myriad and interconnected. But chief among the many challenges ex-cons face are finding places to live and work—two tasks required under most rules of release and ones made all the more difficult when they have criminal records. Researchers at Princeton University have found that having a criminal record in New York City, for example, can cut the chances of a black applicant landing a job by as much as 57 percent. (The drop for white ex-cons is 35 percent.) Add to those challenges weak personal support networks and the fact that the phrase correctional system is more aspirational than apt in America, and it’s no wonder that many released inmates find themselves back behind bars.

The federal government has tried to address the recidivism crisis. In 2008, George W. Bush signed the bipartisan Second Chance Act into law, providing millions of dollars for states, local governments, and nonprofits to help ex-cons get on their feet. It has been at the state and local level where the lion’s share of innovation has happened: promising initiatives that provide substance abuse help, job training, and housing assistance. But in addition to the more comprehensive programs in places like Colorado and Hawaii, a more pinpointed effort is underway here in Iowa that could provide a blueprint for the rest of the nation.

Advertisement

The latest government figures suggest that more than half of all jail and prison inmates have mental health issues, a trend that holds true in Iowa. Much has been written about how our justice system fails the mentally ill, from how the police interact with mentally ill people in the first place to how they’re treated while in prison. The mentally ill also face daunting problems upon their immediate release. Consider: A typical inmate who is being treated for mental illness is given a limited supply of medication upon leaving prison, typically between three and 30 days’ worth. Even the 30-day prescription an inmate receives in states like Iowa won’t buy nearly enough time for an ex-con to jump through all the necessary hoops to get a new prescription once he’s on the other side of the prison walls. The average waiting time to see a behavior health provider in Polk County, Iowa’s most populous county, is about three months, and the wait is likely longer for those who live in rural areas with fewer medical resources.

To address this glaring problem, Iowa is experimenting with an elegantly simple solution. Under the Central Pharmacy Pilot Project, an inmate is still given his 30-day supply of medication upon his release but is also handed prescriptions for an additional 60 days of medication. Those prescriptions—for everything from thiothixene for schizophrenia to hydroxyzine for anxiety—can be filled at one of 320 participating pharmacies around the state, at no cost to the inmate. “We found that [the former inmates] were really struggling to get access,” says Jon-Michael Rosmann, the executive director of the Iowa Prescription Drug Corp., a nonprofit that partnered with the state to launch the program. “There are just a lot of things that have to occur. They have to find a place to live, find financial assistance, start a job search—and without access to their medication, the likelihood that all those will occur is incredibly low.”

The logic is obvious. A newly released inmate is more likely to succeed in society if he doesn’t have to make the transition without his meds. By extending the prescription, the government gives the former inmate the time he needs to secure his own medical care—either with the help of a re-entry program or on his own—and a better chance at making the difficult move back into society. (As an added bonus, the Iowa program also helps participants navigate the health care system so they have less to worry about once their 90-day medication supply is up.)

The pilot program has been running for less than two years, but the early returns are promising. Through the program’s first nine months—the last time the stats were compiled—none of the 165 participants had been charged with a violent crime in the first 90 days after his release, compared to 1.6 percent of a similar population of severely mentally ill former inmates who were not in the program. The gains were even more pronounced when it came to the type of smaller violations that can land an ex-con back in prison for violating the conditions of his release. Less than 3 percent of participants suffering from less severe but still chronic mental illnesses had their releases revoked, compared with 11.3 percent of nonparticipants with similar conditions. This is obviously a small population, in which a few cases could potentially skew the results. But it’s a promising start, one that lines up with our intuition that providing medication to people who need it is good public policy.

State spending on corrections quadrupled over the last two decades, making it the fastest-growing area of state budgets other than Medicaid, according to the Pew Center on the States. Together, states are spending more than $50 billion a year on their corrections systems, the bulk of which is funneled to prisons. It costs an average of about $33,000 a year to incarcerate someone in Iowa—that’s $90.81 per day. Given that the state has spent an average of just $93.85 per participant in the pilot program, the initiative seems like a no-brainer, an outlay that will pay for itself if it keeps even a tiny percentage of inmates from reoffending. “It’s such a small investment with such huge returns,” says Rosmann. “And, obviously, it’s the right thing to do.”

The pilot program—originally launched with cash the state Attorney General’s Office won in a pair of class-action suits against two large pharmacy benefit managers, and continued with a settlement from a different suit against a major drugmaker—is set to run for at least another three years. If its early success continues, there’s no reason why other states shouldn’t follow Iowa’s lead. State governments might also consider making a relatively small investment upfront in the form of permanently free prescriptions for mentally ill ex-inmates. Sure, that would cost more than providing medication for 30 or 90 days. But that sort of expenditure would also help a lot of people, and it could help cut down on potentially huge prison bills at the same time.