Whether someone is discharging from an inpatient hospital, completing residential treatment, or releasing from incarceration, the transition from a highly structured and restrictive environment to the community can be a challenging one. Each face a combination of factors that make returning to a sense of normalcy difficult. These factors may come from internal sources or their external environment and are unique to each individual.
Re-integration from hospitalization, treatment, and incarceration share several common challenges. One area of significant importance is family. Family relationships may have been strained by past failures to seek treatment, stress from dealing with the sick family member, or an individual’s criminal actions. However, there is a strong association between family ties and post-release success (Naser & Visher, 2006). Individuals who report more family acceptance endorse more success post-release. Another factor shared across circumstances is difficulty with employment. Previous research has found job skills training and full-time employment are
commonly identified as needed services by individuals returning to society (Visher & Travis, 2011). Similarly, individuals with mental health issues often encounter challenges in finding employment and maintaining employment during hospitalization. Another significant factor is access to stable housing. Access to stable housing is one of the most commonly reported barriers to transitioning (Manuel et al., 2017) and a lack of stable housing can leave individuals exposed to stressors that increase the chances of incarceration and hospitalization, as well as relapse and recidivism. For adolescents and children, reentry from hospitalization means returning to school potential stigma from peers (White et al., 2017).
There are many things that can be done to aid in the transition to the community from inpatient treatment or incarceration and help individuals remain in the community. For hospitalized individuals, identifying community resources, teaching symptom management, and focusing on medication management can be vital for long-term success (Mackain, Smith, Wallace, & Kopelowicz, 1998). If possible, breaking the transition into steps can also be beneficial. Allowing the individual out on day passes into the community or at a housing placement may ease anxiety and stress for institutionalized individuals (Bellus, Kost, & Vergo, 2000). For adolescents and children, structured academic reintegration programs that emphasize psychoeducation for coping skills can assist students in returning to a regular classroom (White et al., 2017). For those transitioning from drug treatment programs, creating new daily routines high in structure can be beneficial. Filling time with positive activities, such as exercise and spending time with family can help individuals from falling back into old, unhealthy habits (Melemis, 2015). Enrolling in self-help groups such as Alcoholics Anonymous, SMART
recovery, and other self-help groups can aid individuals in not feeling isolated in their recovery and gives them a safe place to discuss issues without judgment.
When considering placement, attention should be given to proximity to transportation, follow-up services, and support systems. Adequate transportation and access to public transportation should be considered when determining follow-up services (Mackain, Smith, Wallace, & Kopelowicz, 1998). Another consideration is the area to which an individual is going. Placing previously incarcerated individuals in areas with high crime, antisocial peers, and few job prospects lowers their chances of succeeding in the community. Attention should also be given to the types of re-entry programs someone is referred to. Programs beginning in prison that address substance use, vocational training, and use Cognitive Behavioral Therapy as a basis have been found to produce the best outcomes (Visher & Travis, 2011).
Regardless of the circumstance, it is important to remember that re entry is a process. Services and support that are long-term and foster self-efficacy provide the best chance for success.
Citations
Bellus, S. B., Kost, P. P., & Vergo, J. G. (2000). Preparing long-term inpatients for community re-entry. Psychiatric Rehabilitation Journal, 23(4), 359–363. doi:10.1037/h0095143
Mackain, S. J., Smith, T. E., Wallace, C. W., & Kopelowicz, A. (2009). Evaluation of a community re-entry program. International Review of Psychiatry, 10(1), 76-83. doi: 10.1080/09540269875159
Melemis S. M. (2015). Relapse Prevention and the Five Rules of Recovery. The Yale journal of biology and medicine, 88(3), 325–332.
Naser, R. L., & Visher, C. A. (2006). Family Members’ Experience with incarceration and reentry. Western Criminology Review, 7(2), 20-31.
Visher, C. A., & Travis, J. (2011). Life on the Outside: Returning Home after Incarceration. The Prison Journal, 91(3), 102S-119S. doi: 10.1177/0032885511415228
White, H., LaFleur, J., Houle, K., Hyry-Dermith, P., & Blake, S.M. (2017) Evaluation of a school based transition program designed to facilitate school reentry following a mental health crisis or psychiatric hospitalization. Psychology in the Schools,54(8), 868-882. doi: 10.1002/pits.22036
