The Promise of Healthcare Reform in Transforming Services for Jail Detainees

Chronic behavioral health conditions, such as psychiatric and substance use disorders, affect at least half of all arrestees, with two-thirds suffering from at least one chronic medical disorder. These conditions contribute to their criminal behaviors and propensities to recycle through the criminal justice system (Binswanger et al. Journal of Urban Health 89:183-190, 2012). Despite their limited resources, jails have nonetheless become de facto settings for the delivery of healthcare services. With the passage of the Affordable Care Act (ACA) of 2010, jail releasees will become eligible for government-subsidized healthcare coverage in 2014. The widespread availability of integrated healthcare services for the released jail population is likely to reduce criminal behavior, which is often associated with psychiatric and substance use disorders and their co-occurrence. This article provides an overview of behavioral healthcare services available to jail releasees. We discuss the evolving landscape of substance use and mental health interventions under healthcare reform, including anticipated changes in funding infrastructures and streams for treatment services. We examine the financial and practical implications of these changes for the criminal justice system, particularly for the nation’s jails