This chapter has highlighted and discussed interventions that increase success for people with mental disorders reentering the community after incarceration. What do these approaches look like in real life? There are many different ways these tools and strategies are employed to suit the needs of different populations. A person emerging from jail with an opioid use disorder will naturally have different support requirements than, for example, a person with a serious mental illness or a developmental disorder who is being released after years in prison.

The Felton Institute’s Success: Movement from Incarceration (SMI), is just one example of a program employing some of the approaches we have learned about in this chapter. The Felton SMI program serves people returning to the community from jail in Alameda County, California (figure 8.18), who are experiencing severe and persistent behavioral health challenges. The program receives funding from the state of California and Alameda County, as well as from private contributions. Some details of the Felton SMI program are described below. Consider how the specifics of this program strive to meet the goals discussed in the previous sections of this chapter.

Felton SMI Participants

The Felton SMI program deals with a very specific population: non-violent offenders who serve their sentences in county jails rather than prisons and are to report to county probation officers upon their release. Due to legal changes shifting this group away from prison and into county jails, a significant increase in California jail populations—and, accordingly, an increase in the number of people with mental disorders being released from jail custody—gave rise to the need for the program. The Felton Institute developed the SMI program to support this group by providing intensive psychiatric-focused case management in the Alameda County community.

Participants in the Felton SMI program are referred to the program directly by the jail or by their defense attorneys. Participants are typically on probation for a felony and are experiencing post-traumatic stress disorder (PTSD), schizophrenia, bipolar disorder, depression, and/or anxiety, often in addition to a substance use disorder. Among participants with both mental health conditions and substance use disorders, the use of methamphetamine, heroin, and/or alcohol is most common. As of April 2023, 68% of participants were male, just over half were Black or African American, 16% were White, and 8% were Asian. The program details are summarized in this section but feel free to review more specifics about the Felton SMI program in this SAMHSA publication [Website].

Felton SMI Staff

Once enrolled in the Felton SMI program, a participant is supported by a multidisciplinary team. A clinical, or mental health, case manager conducts a mental health assessment and provides counseling. Medical staff provide a medical evaluation, and a nurse practitioner provides medication, if needed. Peer support workers help participants gain social security benefits and acquire driver’s licenses or other documentation. A case manager works with participants to obtain Medicaid, secure housing, enroll in education or training, and prepare resumes.

Case managers must have a bachelor’s degree, and clinical case managers must have a master’s degree. All Felton SMI program staff are trained in cognitive behavioral therapy, trauma-informed care, cultural sensitivity, and de-escalation—among other skills. The program offers these trainings several times each month, and collaborators from the Alameda County Probation Department provide additional training on probation and compliance.

Felton SMI Approaches and Outcomes

The Felton SMI program uses wraparound services and case management to support approximately 160 participants a year through three program phases: stabilization, transition, and sustainability. During stabilization, staff assess a participant’s mental health and immediate needs, such as housing, food, vital documents, and transportation. During the transition phase, participants receive mental health treatment, substance use treatment if appropriate, and case management services. When participants are ready to be self-sufficient and transition into long-term or short-term community support, they are in the sustainability phase.

To accomplish its three phases, the Felton SMI program employs a variety of techniques, including cognitive behavioral therapy (discussed in this text in Chapter 2), to support participants’ behavioral health needs. At the same time, program staff, including peer support workers, help participants locate housing, access transportation, acquire food, secure employment, and connect to other social services. The program also helps participants with family reunification.

Felton SMI program staff (case managers, peer support workers, clinical or mental health case manager, and the program manager) visit the county jail weekly to meet with potential program participants and provide information about the program. The program manager monitors referrals daily. Once the program accepts an individual, a case manager reaches out to the person within 48 hours. If the person is unhoused upon release, the case manager will go into the community to locate the person and meet them wherever they are. Upon enrollment, program staff conduct a needs assessment and connect participants to services.

Participants typically remain in the Felton SMI program for one year. The frequency of visits varies depending on the program phase. Participants in the stabilization phase need more support, but as they become more independent during the transition phase, they require less support and fewer visits. When participants reach the sustainability phase, they are independent and connected with external services as needed. Felton SMI staff report that participants have been able to advance their education, remain employed for longer periods, and reunify with family members. By the end of the program, participants report they have gained self-agency and feel empowered.

Evaluations of the Felton SMI program identify important factors that contribute to its strength, including:

• Being participant-centered. Participants are allowed to share their needs and stay focused on their readiness for change. What worked for one participant may not work for another participant.
• Being physically present. Working with people who are reentering the community from jail and are unhoused requires outreach on the ground, and this cannot be accomplished from a distance. To engage a person in treatment, program staff must be willing to go to encampments, parks, and other locations in the community.
• Hiring staff that mirrors the participants. It is important that staff reflect participants’ race, ethnicity, gender, language, and experience. Staff with lived experience can mitigate some of the stigma associated with being incarcerated and help participants feel comfortable sharing their own lived experiences and trauma.

The information in this section comes from the federal agency SAMHSA, which holds the Felton SMI program out as an example of success (see more details in SAMHSA’s report [PDF], if you wish). More information about the Felton Institute and all of its programs is available, if you are interested, at the Felton Institute website (Felton Institute, 2024).

Licenses and Attributions for Success: Movement from Incarceration

Open Content, Shared Previously

“Success: Movement from Incarceration” is adapted from Best Practices for Successful Reentry From Criminal Justice Settings for People Living With Mental Health Conditions and/or Substance Use Disorders by Substance Abuse and Mental Health Services Administration (SAMHSA), which is in the Public Domain. Modifications, by Anne Nichol, licensed under CC BY 4.0, include condensing and revising the content.

Figure 8.18. Photo by Spencer DeMera is licensed under the Unsplash License.