Developing Post-Release Supervision Assignment Guidelines to Prevent Overdose And Suicide Mortality Among Formerly Incarcerated People

Formerly incarcerated people are highly vulnerable to drug overdose and suicide deaths upon release from incarceration, yet there are few interventions to address these concerns. Post-release community supervision (“supervision”) is one of the most common criminal legal system programs during reentry and represents a potential lever for improving health. While supervision has traditionally focused on surveillance and recidivism reduction, its structure also shapes access to treatment, services, and social supports. At the same time, supervision requirements can increase stress, restrict autonomy, and heighten the risk of reincarceration. Thoughtful modification of supervision policy may therefore offer an opportunity to reduce harm and promote health during this high-risk transition period. This dissertation evaluates how modifications to North Carolina’s PRS policies could reduce suicide and overdose mortality and reincarceration. Specifically, it examines whether reducing the maximum duration of supervision lowers risk of suicide or drug overdose mortality and reincarceration, and whether psychiatric or substance use mandates as a supervision condition improves these outcomes. Using North Carolina prison administrative data linked to death certificate data, we applied parametric g-computation to estimate the effect of hypothetical reductions in supervision duration on suicide or drug overdose mortality, and reincarceration. To evaluate the effects of psychiatric or substance use mandates, we used weighted Aalen–Johansen models.Reducing the maximum duration of supervision produced minimal changes in risk of suicide or drug overdose mortality but substantially decreased five-year risk of reincarceration. In contrast, compared to individuals without psychiatric or substance use mandates, those who received mandates had lower three-year risks of both suicide or drug overdose mortality and reincarceration, although effect magnitude varied across subgroups.Together, these findings indicate that supervision policy can be recalibrated to better align with public health goals. Shortening supervision duration may reduce reincarceration without worsening risk of suicide or drug overdose mortality, while incorporating psychiatric or substance use mandates may confer health benefits for some individuals. However, evidence suggests that supervision in its current form does not protect against some of the most severe, yet preventable, health outcomes among people returning from prison. Reducing preventable deaths may require moving beyond surveillance-focused approaches entirely.