This week in Realignment: August 2, 2013

150 150 Christopher Nelson

As anyone with any experience in government knows, alphabet soup is constantly on the menu. The worlds of public safety and health care are certainly not immune to the establishment’s undying love for acronyms.

When California Forward’s Partnership for Community Excellence sponsors regional convenings such as that which took place in Santa Barbara on Wednesday, it can quickly become overwhelming with the ACAs, MAAs, CBOs, LIPs, DSHs, CCPs and on and on.

What can sometimes get lost in why the Affordable Care Act (ACA, or “Obamacare” to most in the media) will be such a huge benefit to the California criminal justice system is the human element.

Of course, there are cost savings for counties. They are astronomical with 100 percent Federal reimbursement for the first three years and 90 percent in the following years through 2020 on a massively expanded field of eligible inmates and convicted/sentenced individuals. Treatment options for drug addicted and mentally ill individuals who are convicted, sentenced, jailed or on parole or probation will get a serious shot in the arm. 

The rationale is simple: If we attack the source of an individual’s criminal behavior rather than locking them up and hoping it will resolve itself, they are less likely to commit more crime and less likely to return to a $55,000 a year bed in jail.

But what came to light in Santa Barbara during a spirited question and answer interlude with Community Oriented Correctional Health Services (COCHS) President Steven Rosenberg was the psychological aspect the ACA provides with inmates and keeping them from returning to jail once they are out.

The sentiment was first expressed by California Forward Action Fund member Juan Arambula to kick off the convening by talking about how backward the old world mentality of incarceration is.

“They were coming out worse than when they went in. We were getting sued for inadequate levels of medical care. The idea of putting people in the farthest, most remote corners of California and then giving them $200 and a bus ticket and hoping they somehow get their lives together just wasn’t working,” he said.

It was truly hammered home when Steve Devore from Kern County’s Department of Mental Health made a point no one had brought up yet here or in Riverside earlier in the week. 

“People are not prepared to treat this kind of population who have been incarcerated for a long period of time, who know how to manipulate and how to terrorize clinicians on their first visit,” Devore said. He went on to recount a story where the first words out of an inmates mouth when he sat down with a nurse were “The only reason you’re alive is because I’m letting you live.”

When trying to convince medical care providers to sign up to treating this population, it’s a completely new consideration that never comes into play when treating the general public. The intimidation, the threats and even the physical violence.

Rosenberg quickly jumped in. 

“The Affordable Care Act creates entitlement for folks that they have never had before. They’ve never been able to sit at the lunch counter and now they are,” he said. “Up until now, we have left this population out and made them feel both powerless and disempowered.”

He went on to explain that the type of threats mentioned above are the only way in which they have ever been able to exert any power over any situation.

The challenge is this: What happens psychologically to these people when all of a sudden they are told they are told that they are entitled to the same level of care that you and I are? How we drive home the point that society is recognizing that they have value as a human? 

It’s equally as important a dynamic to consider as the number crunching and the massive process of getting people enrolled who have been trained their whole lives to avoid a system that they don’t trust and that has never helped them before.

The Partnership’s Kathy Jett touched on “churners,” or “people who were doing a life sentence on the installment plan” who are so afraid of functioning in normal society and have become more comfortable within the prison system.

“Obviously some people just belong in prison, but there’s a majority of them that have no help re-entering,” Jett said.

It was refreshing to see the enthusiasm in the room in Santa Barbara at addressing this angle and others among Kern, Santa Barbara, Ventura and San Luis Obispo county reps from corrections and health care. Not only did they appreciate the psychological opportunities, but many of them came in with strong personal relationships and infrastructure already built around communication and shared goals between agencies.

After two breakout sessions, all four counties came back with highly actionable plans to begin the long slog of getting individuals enrolled to take advantage of the reimbursement that begins January 1, 2014.

For those who have been stuck in the revolving door in California corrections with little to no recognition of the problems that keep them in the vicious cycle, it will represent a turning point in how our society views them. For the rest of us, it is our responsibility to make sure as many people as possible fall into that bracket.


Christopher Nelson

All stories by: Christopher Nelson