By Rachel Crumpler
Trying to get back on one’s feet in the community after leaving prison or jail is rarely easy. People often face steep hurdles finding housing, employment and health care. For those with mental health diagnoses, the transition can be even more difficult.
But that’s the reality for roughly one-quarter of the 18,000 people released from North Carolina’s 55 state prisons each year — about 4,700 people with some type of mental health diagnosis.
Every 90 days during the last fiscal year, an average of 864 people receiving mental health services while incarcerated were released from North Carolina’s prisons. About 75 of them — every 90 days — had a severe mental illness, such as schizophrenia or bipolar disorder.
Mary Grillo, director of social work services at the N.C. Department of Adult Correction, said the period after release is a “vulnerable time.” Speaking during a panel on improving behavioral outcomes at last month’s 2026 Rehabilitation and Reentry Conference, Grillo said that in the first two weeks after release, formerly incarcerated people face 40 times the risk of overdose and more than twice the suicide mortality rate than those in the general population.
North Carolina’s mental health system can be tough to navigate. Without a direct connection to care and support, staying stable in the community can be nearly impossible. Many people end up right back in a jail, prison or the hospital in a frustrating — and costly — revolving door of recidivism. Taxpayers shoulder the bill: Incarcerating one person in a North Carolina prison costs more than $54,000 a year.
It’s a cycle state leaders are working to break with a concerted push to strengthen support for people leaving incarceration, with a goal of improving reentry success by 2030. One of the main target areas is improving access to physical and behavioral health care.
In recent months, public scrutiny and attention has intensified on the gaps between the state’s mental health and criminal justice systems. The men accused in the high-profile stabbing death of Iryna Zarutska last August in Charlotte and the killing of Wake County teacher Zoe Welsh in January have histories of serious mental illness along with criminal involvement.
Advocates for people with mental illness are quick to point to research that shows most people living with mental illnesses are far more likely to be the victim of a crime than a perpetrator. But these cases have renewed discussions and debate over how to better support people with mental illness who move between the behavioral health and carceral systems. The cases have also prompted legislative action and an executive order from the governor.
A panel discussion on behavioral health needs for people released from prison was the focus of a May 12 Joint Reentry Council meeting in Pitt County that brought together representatives from every state cabinet agency and community stakeholders.
Planning supports before release
Just 20 social workers at the Department of Adult Correction are responsible for providing aftercare planning for everyone who is on the prison system’s behavioral health caseload, Grillo told NC Health News. This planning typically starts about 90 days before release and involves social workers conducting needs assessments for housing, transportation and other supports and working with the state’s four local mental health management agencies (known as LME-MCOs) to link individuals released from prison to behavioral health care services in their communities.
Social workers also help eligible people apply for Medicaid up to 90 days before their projected release with the goal of it being active on the day they walk out the door. That gives people a way to pay for the care they need.
“We need more social workers to be able to do more of this work and to be able to start earlier,” Grillo said. “They are very busy and very stretched juggling multiple facilities and high caseloads and multiple roles.”
More extensive care coordination is provided through DAC’s High-Priority Reentry Program, which launched in 2023. The program serves adults leaving state prisons with a psychotic disorder who had been incarcerated for violent felonies or sexual offenses, or people who were taking powerful antipsychotic medications. The program emerged about a year after a case in which a man with a serious mental illness and history of violence was released and ended up killing someone in the community, Grillo said.
“If you looked at his aftercare plan, everything looked good,” Grillo said. “He had the services that he needed. He had a place to stay. He had a mental health team in the community. He had Social Security and Medicaid. So everything looked fine, but then the impetus became like, what more do we need to do? We need to be doing more specifically for this really high-needs group of individuals.”
In 2025, DAC made 149 referrals to the High-Priority Reentry Program, which is intended to serve a small group of the riskiest, high-need releases. DAC refers eligible people to local LME-MCO care coordination teams, which include peer support specialists. Those teams conduct needs assessments, create a detailed 90-day transition plan, schedule post-release psychiatric appointments and complete referrals for other necessary supports, like housing and transportation.
Connecting to care in the community
Grillo said one key to helping people’s mental health after release is providing direct, person-to-person handoffs to care in the community. Some of the best results involve “in-reach,” when behavioral health providers meet with incarcerated people before their release to build trust and familiarity so that they have a higher likelihood of going to an appointment once they’re out, she said.
One program that does this and has quickly become essential in serving people with serious mental illnesses since its launch in August 2022 is FIT Wellness, part of the North Carolina Formerly Incarcerated Transition Program. Ted Zarzar is the program’s medical director and a psychiatrist who works in the prison system and in the community. From his work in both settings, Zarzar said he’s seen how gaps in care often contribute to crises, as he sees some of the same people bounce between the community and incarceration.
“FIT Wellness … is trying to sort of jam this revolving door,” Zarzar said. “How can we disrupt this?”
Before release, eligible FIT Wellness participants have an initial video call with one of the program’s community health workers — who have their own experiences of incarceration and can relate. Those who enroll are linked to clinics that have both psychiatric and primary care staff on site in the four counties where the program currently operates: Durham, Orange, Wake and New Hanover.
As of Jan. 1, 2026, FIT Wellness had enrolled 213 people across the four counties — 126 of whom were successfully linked to a community clinic, according to data shared about the program in a North Carolina Medical Journal article published last month.
Even with in-reach calls, links to care aren’t always successful. That’s where the program’s community health workers can further step in to meet participants in person to build rapport.
“A lot of our guys come out and they don’t trust the doctors, and I’m the guy to say, ‘Hey, this is a different doctor,’” said Shawn Baker, a FIT Wellness community health worker who spent 15 years incarcerated.
Mary Steeley, who has been incarcerated four times and was most recently released from prison in 2024, said FIT Wellness has made all the difference in managing her mental illness and substance use problems.
“This time, I’m clean and sober, but I could not have done that without NC FIT being there to help me along every step of the way,” Steeley said. “Having your community health worker or your peer support person come with you takes a lot of the pressure off because they can tell you which way to go.
“I’ve gone back to school. I’m getting my bachelor of science. I want to be a substance abuse counselor.”
Outcomes like Steeley’s are why state officials say they’d like to see FIT Wellness expand across the state.
“It would be great if we had a FIT Wellness in every county in North Carolina,” Grillo said. “I think it’s really important to have that continuity of care, to have people who are doing the in-reach inside the prisons, and then also following up with the treatment in the community.”
The Department of Adult Correction has also been working closely with Vaya Health, the local mental health management agency serving 32 counties in western North Carolina, over the past several years to improve behavioral health appointment attendance rates once people are released. Officials recognized that low attendance can disrupt continuity of care, stabilization and reentry outcomes. A Vaya Health Quality Improvement Committee found just a 22 percent attendance rate in August 2019 and set a goal of increasing attendance to 50 percent — a benchmark reached last year.
During the most recent quarter from January through March, the attendance rate climbed to 62 percent.
“We’ve clearly demonstrated from this program that we can increase the amount of people who are showing up for appointments,” Grillo said, noting the gains are especially encouraging in a rural part of the state where public transportation isn’t as accessible.
Grillo said the improvements came from relatively small changes made using existing resources — lessons she hopes can be replicated with the state’s three other LME-MCOs.
One change involved scheduling behavioral health appointments about five days after someone’s release instead of what had been the normal practice of within 24 to 48 hours. The adjustment resulted in more people showing up to clinics, she said.
“When you think about it, when you first get out of prison, the last thing you want to do is go have a mental health assessment with someone you’ve never met before,” Grillo said. “You want to get some good food. You want to see some friends. You want to do a bunch of other stuff. And that also gives the probation officer some time to get involved.”
Vaya Health also began leveraging probation/parole officers as another touchpoint to support treatment by informing them about scheduled appointments and whether someone attended.
“A lot of times, these probation officers, before we started doing this, had no idea when those appointments were, and they weren’t receiving the information about their mental health needs either… so this was just a big game changer that we were able to give this information to the probation officer,” said Karla Mensah, vice president of Vaya Health member and recipient services, during a presentation at last month’s 2026 Rehabilitation and Reentry Conference in Raleigh.
Executive order targets system gaps
While work is underway to better support people with mental illnesses leaving incarceration, the existing inconsistency and gaps keep impairing outcomes, corrections officials, other state leaders and community stakeholders say.
On Feb. 5, Gov. Josh Stein signed Executive Order No. 33, which seeks to strengthen the state’s behavioral health and criminal justice systems.
The executive order had specific directives for the state Departments of Adult Correction, Health and Human Services and Public Safety along with the Office of Human Resources. They include supporting the behavioral health and public safety workforce, improving mental health care during incarceration and expanding reentry support for people with mental health needs.
“We run into a lot of challenges finding resources in the community that will work with folks coming out of prison and that will work with folks who have mental illnesses, and I think we have a really great opportunity right now in our state with Executive Order 33,” Grillo said.
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