The Centers for Disease Control and Prevention (1999a) defines barrier as "anything that can prevent a patient from being able to adhere to a treatment regimen" (p. 2). One could argue that the increasingly large number of inmates being discharged unconditionally without any community supervision constitutes such a barrier. According to the Bureau of Justice Statistics, "about 112,000 state prisoners were released unconditionally through an expiration of their sentence in 2000, up from 51,288 in 1990" (Hughes & Wilson, 2005). State prisoners being discharged for "maxing out" their sentence now represent approximately 20% of those who are released (Travis, 2005). Jails are even more problematic, with the overwhelming majority of inmates receiving no community supervision. This means that many discharged inmates cannot rely on parole officers to refer them to health and behavioral services to support their reintegration into society. Even when under supervision, enormous caseloads are leaving parole officers stressed and overwhelmed and, consequently, they are not often able to give adequate attention to each and every parolee. In his study which examined the availability and accessibility of resources for ex-inmates, Helfgott (1997) found that inmates often felt that there was nobody to help them. They often did not know what was available, or how to find out.
The fact that so many released prisoners receive no prerelease preparation further supports the creation of written discharge materials, because a pamphlet or a comprehensive resource guide may be the only information on which they can rely. The parallels to the medical field are surprisingly similar. Makaryus and Friedman (2005) note that "after being carefully supervised in the hospital, patients at discharge assume the former responsibilities of the health care team for their own health care" (p. 991). The same can be said for the majority of inmates. However, unlike most patients, inmates must also start from the beginning in finding employment, housing, food, clothing and the development of strong social networks to increase their chance of succeeding in the community. Many times the inmate's family is not there to support him, having given up on the inmate for his past transgressions. The inmate is in a situation where with limited help he has to locate and obtain identification, health care and ongoing treatment for substance abuse, mental illness, and chronic and/or communicable diseases. Written information given to an inmate prior to release may be the only assistance for returning to the community that they receive.
Currently, only a small minority of state prisoners released each year experience a multisession, formalized prerelease program. Angiello (2005) reports that only 10% of prisoners discharged in 1997 were offered any prerelease programs. Also, the majority of the state prison prerelease programs are voluntary, and are available primarily in minimum-secure facilities (Austin, 2001). Furthermore, prisoners with serious mental health issues, gang membership, who are maxing out and who are seriously violent are exempted from participation in specific prerelease programs (Corrections Compendium, 2004). Services are even more limited for the jail population.
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