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Current thinking suggests that specialized services are needed for the successful community reintegration of ex-inmates with psychiatric disabilities (Hartwell & Orr (1999). Psychiatric Services, 50, 1220–1222; Healey (1999). National Institute of Justice, February; Hartwell, Friedman, & Orr (2001). New England Journal of Public Policy, 19, 73–82). Nevertheless, stable community re-entry after criminal incarceration involves the response of multiple organizations due to the complexity of community re-entry factors. This chapter presents findings from the analysis of secondary data collected since 1998 and a qualitative interview study with ex-inmates with psychiatric disabilities that identified pathways and turning points influencing community re-entry. Using Sampson and Laub's life course theory as a framework (Sampson & Laub (1993). Crime in the making: Pathways and turning points through life. Cambridge, MA: Harward University Press.), the pathways and turning points offer a point of departure for agencies and organizations in responding to ex-inmates with psychiatric disabilities in the community. Pathways related to service needs at release include race, age, education, diagnosis, and criminal history; whether an individual is on probation or parole; and whether an individual has a history of homelessness, mental health services, and/or substance abuse. Turning points post release include institutional resource availability, living arrangements, psychotropic medication compliance, outpatient therapy and substance abuse treatment, and having entitlements and benefits in place at release.

Since 1963, the promise of the Community Mental Health Centers Construction Act (1963), the planned provision of community-based mental health services, and advances in psychotropic medication and treatment suggested that the mentally ill might be better managed and served in the community than in hospital (Bachrach & Lamb, 1989; Grob, 1991). While “dehospitalization” proceeds today (Geller, 2000), large numbers of individuals with mental illness also return to the community from correctional custody and bring with them complicated clinical profiles and service needs (Laberge & Morin, 1995; Rice & Harris, 1997; Lamb & Weinberger, 1998; Lamb et al., 1999). An increasing awareness of this phenomenon has resulted in estimates that prisons contain four to five times the rate of persons with mental illness found in the community (Morris & Tonry, 1990; Regier et al., 1990; Morris et al., 1997; Rice & Harris, 1997; Wolff et al., 1997). According to the 2000 Prison Census, about 150,900 or 1 in 10 state inmates were in mental health programs; 114,400 or 1 in 13 were receiving psychotropic medication; and 18,900 or 1 in 80 were in 24-hour psychiatric care (Bureau of Justice Statistics, 2000). While the recent estimates suggest that approximately 16% of all those incarcerated in state prisons (16% of all males and 24%of all females) have some sort of mental illness (Ditton, 1999), a meta-analysis examining the prevalence of mental disorder with a narrow criterion found that 10% of male and 18% of female inmates had an Axis I major mental disorder of thought or mood (Pinta, 2001).

Community-based service providers (such as home health agencies, rehabilitation and mental health services) have found it necessary to cope with extremely uncertain and turbulent environments due to a changing regulatory environment and restructuring of the acute health care system. This paper discusses three types of survival strategies adopted by community-care service providers in a medium-sized city in the Northeast. These agencies provide long-term social and health services to the disabled and frail elderly with chronic care needs. The implications of each strategy for service provision to people with chronic care needs are discussed.

Medical and legal records of 64 inmates receiving mental health services at a maximum-security prison located in the Northeast United States were examined to look at whether prison adjustment is impacted by housing in a mental health residential treatment unit. Inmates in the residential treatment unit, the “treatment group” had a significant decrease in hospitalizations and disciplinary reports while housed in the residential treatment unit. Inmates with a mental health history housed in the general population, the “control group,” did not show a decrease in these behaviors during a similar time period. Results find that inmates referred to the residential treatment unit seem to have high numbers of hospitalizations and segregations while housed in the general population, which level off and become similar to the control group upon entry to the residential treatment unit. Implications for future research evaluating the impact of the residential treatment unit on the behavior of the inmate after he has left the unit are discussed.

Over the past decade or so, there has been a significant renewed emphasis on community-based approaches to promoting social change and economic development, delivering services, and addressing the needs of people in poverty. One way in which such efforts strategically address this goal is by focusing on the organizational infrastructure of a community, seeking to change the ways that individual community-serving organizations relate to one another and to organizations and actors beyond the community. This paper focuses on one approach to this task: the establishment of broker organizations — local intermediaries responsible for fostering and convening partnerships and networks of relations among existing organizations. It briefly outlines the impetus and rationale for engaging in interorganizational relationships in this context, defines and explores the role of broker organizations as they have played out in a few illustrative cases, and distills some of the central issues that emerge regarding their promise and limitations.