Comparing Trauma, Physical and Behavioral Health Needs, and Service Utilization Rates of Those Who Died after Release from Prison to Those Who Did Not

Background and Purpose: Individuals leaving incarceration are 12-13 times more likely to die within two weeks of release compared to members of the general population. Few studies explore the life experiences and needs of those who die after leaving incarceration. This paper fills this gap by comparing experiences of trauma, physical and behavioral health needs, and pre-incarceration service utilization of individuals who died after release from prison to those who did not.

Methods: Data came from 1,539 individuals enrolled in an RCT of a behavioral health reentry intervention in four states. Baseline data were collected 4-6 months prior to release; death data were collected for up to 18-months post-incarceration. Pre-incarceration experiences of trauma were assessed using the Trauma History Questionnaire and the RAND 36-Item Health Survey captured emotional well-being and quality of life prior to release. Behavioral health constructs were measured prior to release using the MINI Neuropsychiatric Interview. Pre-incarceration perceived service needs and utilization were assessed using the Service Assessment for Children/Adults. Death data were collected through official record searches; researchers also learned of participants’ deaths when scheduling interviews or through local media. Overall, 24 individuals died after release (83% male, 50% White, 30% Black/African-American) with an average length of 270 days in the community prior to death. Analyses examined characteristics of those who died using frequency distributions; between-group differences in trauma, emotional well-being, overall health, behavioral health, perceived service need and utilization for individuals who died were compared to those who did not using bivariate comparisons.

Findings: Analyses from the baseline data collected prior to release suggests that those who died had experienced slightly more lifetime traumatic events (7.27 vs. 6.81) and had higher levels of major depression (39.13% vs. 28.23%) compared to those who did not die. Those who died also had higher incidence of substance use disorders (82.61% vs. 70.00%). Those who died had lower emotional well-being (69.13 vs. 75.64) and overall health (61.73 vs. 74.85) on a 0-100 scale. Fewer individuals who died identified a perceived need for mental health services (43.48% vs. 44.99%), yet they reported higher mental health service utilization (56.52% vs. 41.79%) than their counterparts. Despite having higher rates of substance use disorders, individuals who died were less likely to identify a need for treatment (39.13% vs. 45.56%) and had lower rates of treatment engagement prior to incarceration (43.47% vs. 53.57%).

Conclusion and Implications: Reentry is a high-risk time for death. Individuals leaving incarceration often have poorer health, more trauma exposure, and are more likely to have behavioral health diagnoses. Findings suggest that individuals who died during reentry are less likely to perceive a need for behavioral health services or to engage in pre-incarceration substance use disorder treatment. This gap is critical given elevated rates of death and overdose fatalities during reentry. Research is needed to identify causes of death for individuals leaving incarceration and effective preventative services. Individuals leaving incarceration will benefit from help recognizing the need for treatment, along with being connected to evidence-based community services to prevent unnecessary death.