Formerly incarcerated individuals face many challenges as they re-enter their communities, and chief among these is finding and securing housing. Due to a variety of causes, including a lack of affordable housing, limited work histories, and resistance by landlords and community residents, such individuals struggle to find places to live. For those with mental illness, these challenges increase. In the past it was believed that a person with mental illness who is homeless first needed to obtain treatment for the illness and address any substance use disorders before moving into housing. Now, however, many entities, including the California Legislature, have adopted a “housing first” model, which recognizes that a person with mental illness who is homeless needs a safe, decent place to live in order to stabilize and improve his or her health.
The California Department of Corrections and Rehabilitation (Corrections) has been operating the Integrated Services for Mentally Ill Parolees program (program) to provide services to parolees who are seriously mentally ill and homeless as they re-enter their communities during parole. The program is administered by the Division of Adult Parole Operations (parole division). According to a January 2020 policy brief from Corrections, 29 percent of its incarcerated population have a serious mental illness and 70 percent have a substance use disorder. In 2007 the Legislature authorized Corrections to obtain day treatment and crisis care services for parolees who have a mental illness, and by 2009 Corrections had begun contracting with public and private providers to offer these services. In 2012, the Legislature added a focus on housing to the program’s scope, with a twofold goal of providing short-term housing during parole and helping program participants secure long-term housing after their parole term. The Legislature’s stated intent in enacting the program was to integrate those transitioning off parole into the community more successfully and to increase public safety. The Legislature also intended the program to help reduce state costs by lowering the rates of recidivism, that is, the rates at which individuals are reincarcerated. Figure 1 presents a timeline of efforts by the Legislature and Corrections to study and modify the program to accomplish the stated goals.
History of the Integrated Services Program
Source: Analysis of state laws enacted and introduced, and various documents from Corrections.
State law outlines certain requirements for participation in the integrated services program. Corrections can identify an individual as eligible either while he or she is still incarcerated or during parole. To qualify, an individual needs to have a serious mental disorder, and Corrections has to have treated that disorder either in prison or at a parole outpatient clinic. These clinics, located in parole offices, provide mental health treatment and services to parolees. If identified as having a serious mental disorder while still in prison, the individual needs to be likely to become homeless upon release to be eligible for the program; if already on parole, the individual needs to be currently homeless. Corrections’ parole agents and mental health clinicians identify potential candidates and then refer them to Corrections’ senior psychologists, who make the final eligibility determination. An individual’s participation in the program is voluntary.
Although Corrections screens individuals for eligibility for the program, it contracts for program services. As of June 2020, Corrections had contracts with five providers: two public and three private. As Figure 2 shows, the counties of San Francisco and Santa Clara operate programs, and three private providers operate programs in six other counties: Sacramento, Fresno, Kern, Los Angeles, San Bernardino, and San Diego. Each location offers placements for a certain number of participants at one time; in total, they manage 615 placements. From fiscal years 2014–15 through 2019–20, the program’s budget averaged $14 million per year and Corrections’ expenditures on its program contracts averaged $10 million per year. We discuss the program’s budget and expenditures in more detail in the Audit Results.
Corrections oversees the integrated services program with a small staff. A program administrator located in the parole division has primary oversight of the program; the administrator also has other responsibilities not related to the program. As of June 2020, Corrections had a program manager reporting to that program administrator whose assigned duties include receiving and reviewing monthly invoices from the providers, assembling annual reports on the program, and conducting on-site reviews of the providers. Also as of June 2020, five senior psychologists located in the parole division were providing support for the program; they are responsible for screening individuals for eligibility and participating in meetings with the providers to assess participants’ progress.
Program Locations of the Five Program Providers With Contracts in Fiscal Year 2019–2020
Source: Corrections’ contracts with providers, fiscal year 2019–20.
While enrolled in the program, participants receive help with meeting immediate needs and with planning for transitioning to long-term resources. Figure 3 shows the intended progression of participants in the program and depicts some possible goals of program participants. Ideally, a participant completes the program within 12 to 14 months. When a participant first enters the program, a case manager works with him or her to determine goals for the program from among a list of what are termed presenting needs. These needs include food, clothing, income, medical and dental services, and shelter, among others. The provider also uses a housing subsidy to place the participant in housing while he or she is in the program, which often consists of a sober-living home that provides supportive services to its residents, such as a 12-step program to address substance use disorders. Both Corrections and the providers monitor participants’ progress through the program. When a participant has met his or her goals for at least six presenting needs, he or she works with the provider to transition out of the program and into community services, usually county mental health services and other county or community programs.
The program participants also have access to many other provider and county-based services. For example, most providers must maintain a drop-in center with on-site amenities and support, such as a recreation room, a computer lab, bathrooms, and a dining area. All providers must also maintain a 24-hour crisis hotline. Although the providers connect participants to medical care, the providers themselves do not administer medical treatment, and participants generally need to have health insurance or other financial resources for health care treatment. Changes to California Medical Assistance Program (Medi-Cal) in 2014 increased the number of formerly incarcerated persons eligible to sign up for that health insurance; thus, many participants are likely eligible for Medi-Cal. Similarly, in 2019 the Legislature amended the Mental Health Services Act to allow counties to use funding from that act to provide services to parolees who have mental health disabilities. The amended law took effect January 1, 2020.
Program Funding Halted
Corrections has not been able to demonstrate the program’s effectiveness at reducing recidivism. Two studies between 2013 and 2017, which are both reflected in Figure 1, did not show convincingly that the program significantly reduced the rate of arrest and reincarceration for participants. In 2013 Corrections’ office of research issued a report concluding that when controlling for factors such as age and release date, the program reduced the rate of reincarceration within one year of release from prison for some program participants. The study showed that participants with severe mental illness diagnoses had a reduced recidivism rate, but those participants with less severe mental illness diagnoses did not. A subsequent 2017 study that the University of California, Los Angeles, published also reported mixed results stating that, although the program appeared to reduce participants’ rate of return to prison in the first year after release, it did not significantly reduce their rate of arrest and conviction in that time frame. Ultimately, the study concluded that there was no strong evidence that the program reduced subsequent criminal involvement.
Example of a Participant’s Progression Through the Program
Source: Analysis of provider contracts.
In June 2020 the Legislature and the Governor chose to eliminate funding for the program. The Governor stated that Corrections will connect the population the program has been serving to county resources. The Governor’s fiscal year 2020–21 May revision to the budget summary cited the program’s limited effectiveness at reducing recidivism as one justification for eliminating funding for the program. It also noted that because this population tends to qualify for Medi-Cal or other insurance under the Affordable Care Act, most parolees now have access to mental health services and community resources, which ultimately provide a better long-term continuity of care. The approved budget for the 2020–21 fiscal year appropriates half of the integrated services program’s budget for fiscal year 2020–21 and eliminates all funding in fiscal year 2021–22. Additional legislation eliminates the law that added housing to the program’s focus. According to the program’s administrator, Corrections will phase out the program by informing the providers that it will end in December 2020, halfway through the fiscal year. In response to the program’s loss of funding, the executive officer of Corrections’ Council on Criminal Justice and Behavioral Health, which promotes strategies to end the criminalization of individuals with mental illness, stated that finding housing for these individuals was now an urgent concern.
All California counties offer programs that provide mental health and housing services. Parolees with mental illness in the 50 counties that do not currently have a provider offering the integrated services program may, with the help of their parole agents, sign up for and take advantage of these county services. Thus, similar to other county residents, parolees must learn to navigate the service systems to have their needs met. They must also compete for finite services and, like other county residents, could face long wait times for services or be denied services because of limited program capacities. They may also face additional constraints. For example, we are aware of at least two differences between the housing services in the integrated services program and those in county services. First, county housing programs may not be designed to serve individuals on parole who have committed certain criminal offenses, such as those that require registration as a sex offender. Their housing must be situated outside of allowed boundaries from schools and parks, and the housing provider may bar individuals who have committed such offenses. Second, county housing subsidies may be short-term, a maximum of 90 days, for example, and they may require repayment. Although the integrated services program generally limits housing to nine months, Corrections does not require program participants to repay the housing subsidy. In the last section of the report, we discuss the various options for replacing key services the program provides, and the risks and weaknesses associated with these options.