Ten Men

Background and Purpose: The process of leaving prison is among the most dangerous processes imposed by law and society. The death rates for people living prison are as much as 12 times as high as general populations in weeks following. Furthermore, prisoners are entering in younger years and serving sentences into adulthood and older age with greater frequency, and with continued surveillance after release through parole. As part of our aim to support Healthy Development for Youth, we take a life span approach to life in prison and the dangers faced by prisoners who aim to return to their communities. Ten deaths of prisoners in our RCT of Critical Time Intervention for Men with Mental Illnesses leaving prison are examined as a set of linked case studies to draw and develop themes for how policy and practice impact these risks for men with mental illnesses leaving prison.

Methods:  Data for this study was extracted from a study of 216 men with mental illness incarcerated in the New Jersey state prison system, who participated in an NIMH-funded randomized controlled trial of Critical Time Intervention for men leaving prison between 2007 and 2012. The population of ten who died over the course of this CTI study represent the universe of deaths over the course of the project. While it is relatively high rate of mortality for a study of 216 men, it falls within an expected range for people with mental illnesses, with substance use disorders, and with other health conditions. What is the context for this high rate of death? What can we learn from these deaths to create a more humane, respectful departure from life inside prison?

We examined the records available from all the men. These include interviews completed while the men were still alive, our available records that were used for maintaining contact with the men as research participants, and data from health records during the time that participants were being served by the people delivering intervention conditions in this study. Content analysis of these records were used to develop themes regarding the experiences of these men as prisoners and in being released from prison. Repeated comparison across investigator-generated themes was documented to strengthen validity of the findings.

Results: Analyses revealed a sporadically responsive health system given that nearly all men had multiple, potentially fatal health conditions and addictions. The experiences of the men were characterized by habitual exclusion from resources and ordinary comforts of life and health.

Conclusions and Implications: Structural violence shapes the experience of men leaving prisons and systematically withholds resources and compassion from men undergoing the very stressful experience of prison release and “reentry” into community settings. Greater awareness of the stress and despair of this process may lead to more effective and compassionate responses of those providing services, including social workers.