This story was first published online at North Carolina Health News.

When Jeff Walker came out of incarceration, all he had were the clothes on his back. He was directionless, stigmatized. He didn’t have support. He didn’t have anything. 

That was five years ago.

People leaving jails and prisons and reentering society during the COVID-19 pandemic face the same stigma, the same lack of direction—all while attempting to navigate a global pandemic.

For those leaving prison, vital in-person connection is hard to come by, even in regular times. Finding a job has proven more difficult due to the pandemic-generated lag times for identification and Social Security cards, not to mention broadband disparities that make WiFi moot in some rural areas.

Walker gets those struggles. After re-entering society but still experiencing substance use issues, he was able to find solace in transitional housing and the connections he made there five years ago.

Now, he works to give other formerly incarcerated people another chance as the program manager for Wilkes Recovery Revolution in North Wilkesboro and a member of the Peer Justice Initiative, a group of formerly incarcerated people who advocate for others re-entering society and within the jail and prison systems.

Returning in a pandemic

Personal connections are very important for those returning to society after a period of incarceration. Peer-to-peer support is what Walker and others in the Peer Justice Initiative are all about.

But as the COVID-19 virus claimed the lives of thousands in the state, businesses and nonprofits closed their doors and most North Carolinians stayed in their homes. Peer support was hard to find.

The pandemic forced many support groups and mental health services to shift to online. After re-emerging into society after years behind bars, some formerly incarcerated people reentering society don’t know how to use the technology that has been vital to pandemic-era communication, such as cellphones and computers.

On top of that, people released without IDs or social security numbers were unable to work for weeks after reentering society, Walker said, especially at the height of the pandemic when the Department of Motor Vehicles was shut down.

Existing inequities such as spotty broadband access were also thrown into high relief during the pandemic, said Philip Cooper, economic and workforce development at YMI Cultural Center in Asheville and a member of the Peer Justice Initiative.

“I was recommending to people: don’t go back to your rural counties right now, go somewhere else,” Cooper said.

People leaving jails and prisons were left feeling directionless — and that can be deadly. One study from the University of North Carolina at Chapel Hill found that formerly incarcerated people were 40 times more likely to die of an overdose in their first two weeks after release than someone in the general population.

Many formerly incarcerated people say their drug or alcohol use ultimately landed them in jail or prison, said Walker.

“[If] individuals don’t have some kind of support when they’re being released to do something different,” Walker said, “then they’re gonna go back to doing what they know how to do.”

In North Carolina, some 98 percent of people currently incarcerated will eventually be released back into society, according to the North Carolina Department of Public Safety. Reentry is still a challenge for many formerly incarcerated people battling both physical and mental illnesses.

Health problems

Reentering society after a long jail or prison sentence is already an anxiety-inducing experience, Cooper said. They are worried about where they will live and find work.

Additionally, they aren’t linked to the substance use treatment or mental health services that so many justice-involved people need. In 2017, DPS found that 71 percent of inmates screened for substance use disorder needed long-term treatment. At that time, 17 percent of the prison population had a mental health diagnosis, many had more than one.

“A lot of times these guys don’t even properly get engaged for substance use and mental health treatment,” Cooper said.

He said the often formerly incarcerated people don’t trust the counselor or social worker they have been connected with because they view that person as working for the system.

“And they already got this distrust with the system,” he said.

By the time they come home, the combined anxiety and unstable plans could lead them to self-medicate with drugs or alcohol, Cooper said.

Incarceration may be the place where someone starts using substances for the first time, said Earl Owens II, a peer support specialist in Mecklenburg County, and a member of the Peer Justice Initiative.

“I know it’s hard for people to believe, but sometimes people go to prison and create a drug habit. One that they didn’t have before they were incarcerated,” said Owens, who called substance use and mental health issues “collateral consequences” of incarceration.

In addition to mental health problems and substance use disorders, people in prison have higher rates of chronic diseases like diabetes and hypertension and communicable diseases such as hepatitis C and HIV, according to the American Academy of Family Physicians.

Reducing recidivism

In an attempt to combat recidivism rates and ease the transition of prisoners back into society, Gov. Roy Cooper established the state’s Reentry Action Plan in 2018.

“North Carolina is a better and safer place when those who take responsibility for and learn from their mistakes can get another chance to live productive, purposeful lives,” Cooper said at the time. “ … We owe it to everyone to make sure they’re successful.”

The plan established State Reentry Council Collaborative workgroups, which include stakeholders such as businesses, faith-based agencies, and representatives of state agencies, across the state. The plan also encouraged local reentry councils and formal partnerships with community organizations doing the work on the ground.

“[If] individuals don’t have some kind of support when they’re being released to do something different, then they’re gonna go back to doing what they know how to do.”

The Guilford County Local Reentry Council is one of those local groups. While the program has been around for years, it opened its physical Reentry Center in June. Edward “Chap” Williams, reentry director at the center, said it gives people the ability to “change their narrative, their story,” as he peered at the Wall of Fame at the center during an Open House in June.

With the help of reentry programs, Williams said formerly incarcerated people can fight the narratives in their heads, such as “You’ll never be anything” or “You’ll be just like your mom or dad.”

“Now they have some substantial things, some information,” Williams said. “They have a job, they’re able to pay their rent. Their self-esteem has increased, and for me, that’s one of the biggest to see—a man or a woman feel like a man or a woman.”

Co-director KJ Powe said she has seen how incarceration can be a “generational thing,” through her experience as a detention officer. While experts debate some research that points to a higher risk of incarceration for children of incarcerated parents, children of incarcerated parents may also face stigma and are more likely to experience mental health problems, such as anxiety disorders.

“I got to see firsthand the revolving door of how people will come in and out constantly because they didn’t know,” Powe said. “They didn’t have the skills that nobody ever told them there’s something different.”

Many returning citizens also need a medical reentry plan, whether it be for physical health conditions, drug addiction, or mental illness. Some 80 percent of formerly incarcerated people reenter society without health insurance, according to Health Affairs.

While people have access to health care in prison, since many formerly incarcerated people don’t have their own insurance or qualify for Medicaid once they’re released, they end up on their own.

A medical reentry plan

Evan Ashkin, the director of North Carolina Formerly Incarcerated Transition Program (NC FIT) said he initially made the “incorrect assumption” that prisoners would be linked to medical care upon release.

“Even if you didn’t care about the person, from a fiscal standpoint, diabetes, hypertension, you’re going to wind up in an emergency room with terrible complications,” said Ashkin, who is also a professor at the UNC-Chapel Hill School of Medicine,

“However, that is exactly the case.”

In order to prevent formerly incarcerated people from going without necessary medicine upon their release — which could lead to worsening illness — NC FIT’s Community Health Workers, who have a lived experience of incarceration, connect people with health resources upon their release.

NC FIT is a partnership between UNC Family Medicine, the North Carolina Department of Public Safety, the North Carolina Community Health Center Association, federally qualified health centers, county departments of public health, and community-based reentry programs and councils.

The program has sites in Durham, Orange, Wake, Mecklenburg, and Guilford counties, according to its website, but it still “cannot even come close to meeting the need,” Ashkin said.

Ashkin estimated that about 80 percent of people who participate in NC FIT are uninsured and uninsurable. Because North Carolina has yet to expand Medicaid, people who earn more than about $6,400 and less than $14,500 a year fall in the Medicaid “coverage gap,” and are ineligible for either Medicaid or Affordable Care Act subsidies.

NC FIT is able to fundraise to get its clients into primary care, but it does not have the funds to get those with serious medical conditions into specialty care.

“Medicaid expansion would be enormously impactful to the quality of their lives, to them getting the appropriate medical care that anybody else is entitled to who has chronic disease, and for prevention,” Ashkin said.

Because of the pandemic, the prison system released some people who were medically vulnerable early, so they could stay with family or in a transition home, to be at less risk of contracting COVID-19. But Ashkin pointed out a related problem, namely, that these medically vulnerable people lacked access to care.

“I know there’s no connections to health care,” he said. “How are they getting their meds? Follow up? Everything is closed.”

NC FIT’s solution was FIT Connect, a program that got the medical records from people who were released early, so they could connect them to an appointment at a federally qualified health center in the state, using a network of agencies the program made.

“It’s been tricky,” Ashkin said. “It’s hard to track down people, and we certainly haven’t been 100 percent successful. We have gotten hundreds of people appointments, so that’s good, but paying for it is very challenging.”

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