In New Hampshire jails, recovery programs are scarce

By JEREMY BLACKMAN

Monitor staff

Last modified: 7/5/2015 11:49:51 PM

The Merrimack County jail is one of the most visible battlegrounds in New Hampshire’s war on drugs. Nearly 80 percent of inmates there report histories of substance abuse. Every week, a stream of men and women in orange detention uniforms shuffle before judges in Concord for drug and drug-related crimes.



Yet, like at many county jails, recovery options are scarce, and growing scarcer.



Since the state began rolling out expanded Medicaid last year, more than 39,000 people have enrolled, offering them unprecedented access to affordable primary and preventive care, including inpatient drug treatment. But jailed addicts, many of whom are now eligible for the same services, have largely missed out.



In fact, since the New Hampshire Health Protection Program began funding inpatient treatment earlier this year, inmates across the state have lost timely access to residential programs, even when directed to them by court orders, according to substance abuse counselors, treatment providers, corrections officials, lawyers and inmates themselves.



“We have more clients in need, and fewer places that help,” said Tracy Scavarelli, managing attorney at New Hampshire Public Defender’s Concord office. Staff there have reported that incarcerated clients cleared for release to a treatment facility effectively have one option left: Farnum Center in Manchester.



Meanwhile, taxpayers are shelling out tens of thousands of dollars per year to house a single inmate.



The pinch comes at a pressing moment for the state’s criminal justice system, as it works to confront a deepening drug crisis with limited resources and relatively few community alternatives. While New Hampshire has one of the highest drug dependency rates in the country for young adults, nearly every other state ranks higher in available treatment.



For inmates in county facilities, many of whom are low-income and have experienced addiction firsthand, treatment and recovery can seem especially elusive, just at a time when they have an opportunity to get clean for good. Wait lists can be longer, case managers at times unavailable, and intensive treatment all but nonexistent in many jails.



“It is woefully inadequate in terms of access for people charged with crimes,” Merrimack County Attorney Scott Murray said.



Some see immediate solutions, by bringing intensive recovery services within the walls and expanding programs that divert first-time drug offenders directly to treatment.



Others insist that expanded Medicaid will help jailed addicts in the long run, noting that many sick and indigent inmates can now leave detention centers with access to medicine and services. Early wrinkles, they say, will eventually iron themselves out.



“It is a period of transition, and there are pieces that were in place that no longer work,” said Jacqui Abikoff, executive director of Horizons Counseling Center, an outpatient treatment facility in Gilford, and chairwoman of the New Hampshire Board of Licensing for Alcohol and Drug Use Professionals.



Less access



In the past, those who now qualify for expanded Medicaid accessed residential treatment almost exclusively through state subsidies. Since March 1, however, insurance providers have taken over the burden, a requirement of the Affordable Care Act.



The switch has been a mixed blessing for treatment centers. Managed care pays considerably better than the state, and more people are now eligible for services. Supporters also say the new model helps existing providers expand services and, over time, will lure more providers to the state, a crucial step if there is to be any hope of meeting total demand.



But there are also new hurdles. While the state paid less, it also demanded less of providers and gave them more autonomy. Now, under managed care, residential centers must prove through strict guidelines that a person actually needs inpatient care, as opposed to a cheaper, less intensive model.



Inmates in jail don’t typically meet those requirements because they’re housed in an ostensibly drug-free environment, making them less of a priority. In the past, officials said, they were admitted regardless, especially if a judge had recommended treatment.



Inmates today can still access residential care, but most residential treatment centers require that they first be evaluated by a drug and alcohol counselor, a process that can take several hours, and that neither jails nor treatment providers have the time and personnel to do.



“What happens now is somebody says you need to be accurately diagnosed,” Abikoff said, adding: “But we haven’t figured out who’s going to do that assessment or who’s going to pay for it.”



Without the evaluations, there is a risk that inmates who need intensive treatment will slip through the cracks.



Some, including Doug Iosue, a social worker at the Cheshire County jail, see benefits in the shift to stricter admission criteria.



“Mostly this is a good thing,” he said. “We overused residential treatment because it was easy. . . . For a lot of people who have been in jail for a month or three months and have physically removed themselves from their environment, (that) does interrupt the cycle of using.”



But Iosue noted that treatment providers have applied the standards differently. While Farnum Center only requires a phone interview, he said, others like Phoenix House, Keystone and Friendship House are now extremely difficult to get into from jail because they require added assessments or in-person interviews.



In an email this spring to attorneys, Iosue wrote that he had recently referred a person to Friendship House in Bethlehem, but it had been four weeks since her phone interview and the program still had yet to schedule a face-to-face meeting.



Looking ahead



Corrections officials like Ross Cunningham, assistant superintendent at the Merrimack County jail, are pushing for changes from within. Before arriving in Boscawen last fall, Cunningham spent seven years at the Sullivan County jail, where he created an intensive re-entry program for low-level, nonviolent offenders.



The program, launched in 2010 and paid for by the county, lasts three months and includes full- and half-day treatment, after which participants are released into the community and monitored for a year. Cunningham said the program has so far been a success; the facility’s recidivism rate has dropped to about 17 percent.



The program follows a path that treatment professionals often recommend for severe addicts: months of intensive treatment followed by extended transitional living. That rarely happens in New Hampshire, Cunningham noted.



“We are so broken that the fact is, you have to be incarcerated to get a treatment model like that,” he said.



Cunningham hopes to develop a similar program in Merrimack County, though funding for it could be a challenge. Part of his leverage in Sullivan County came from savings he made by ditching plans for a new $42 million jail.



But treating addicts in jail has its drawbacks. In a community-based program, they can keep a job and their insurance. Once they are incarcerated, Medicaid is immediately suspended. Plus they have to deal with an environment where drugs are readily available.



“We could do treatment – mental health and substance abuse – all day long, but it’s not the function of a jail,” Iosue said. “Jail,” he added, “is so much different than the place where you are living your life.”



Others want counties to introduce or expand their diversion programs for first-time offenders. Superior Court Chief Justice Tina Nadeau has become a vocal advocate of drug courts and similar alternative sentencing programs, including New Hope, a cheaper, less rigorous model used in Merrimack County.



“It still boils down to the community piece,” Cunningham said. “Where in each community do you have catchments for these people to seek treatment? There’s very little or none, so they end up here.”







(Jeremy Blackman can be reached at 369-3319 or jblackman@cmonitor.com or on Twitter @JBlackmanCM.)





