Ending An American Tragedy: Mental Illness And The Justice System
There is a crisis in our nation's jails and prisons. Men and women with mental illnesses and addictions incarcerated because they didn't get the treatments they desperately need -- and an inspiration -- highlighting the possibilities of effective services. The only way this trend will change is if leaders in all communities can come together, pool resources, and work as one. People with enough care and conviction to combat this injustice must be endlessly creative in overcoming financial, bureaucratic, and cultural barriers and establishing collaborations that solve community problems. Looking forward to the growth and spread of programs and services that offer productive lives to people with mental illnesses and addictions as the alternative to incarceration, here are four recommendations for immediate action.
1. The President should appoint a Special Advisor for Mental Health/Criminal Justice Collaboration:
Currently, there is no fixed responsibility within the Federal government to promote effective mental health/criminal justice activities and ensure accountability for the use of public dollars. The Special Advisor will serve as an advocate and ombudsman across the wide array of Federal agencies that serve the multiple needs of justice-involved people with mental and substance use disorders. One of his or her tasks will be to implement an immediate review of all CMS and SAMHSA regulations to identify conflicts and inconsistencies for people with mental illnesses and co-occurring substance use disorders -- particularly those involved in the justice system.
2. Federal Medicaid policies that limit or discourage access to more effective and cost-efficient health care services for individuals with serious mental illnesses and co-occurring substance use disorders should be reviewed and action taken to create more efficient programs:
Congress is encouraged to review Medicaid policies and take action that will enable states to create more effective and appropriate programs targeting eligible beneficiaries most likely to experience avoidable admissions to acute care settings. Such programs should allow states flexibility in designing and implementing targeted outreach and engagement services, coordinated care management, and community support services that are likely to reduce expenditures on deep-end services, and engage people in prevention, early intervention, and wellness care in the community. Services provided should reflect evidence-based and promising practices and should be designed around principles of recovery, person-centered planning, and consumer choice. Because of the high rates of co-morbid health care needs among people with serious mental illnesses and co-occurring substance use disorders, programs should seek to establish more effective integration of primary and behavioral health care service delivery system as well.
3. All States should create cross-system agencies, commissions, or positions charged with removing barriers and creating incentives for cross-agency activity at the State and local level:
No one system can solve this problem alone. These cross-system groups or individuals will play a key role in spanning the different administrative structures, funding mechanisms, and treatment philosophies of the mental health, substance abuse, and criminal justice systems. States must make clear that collaboration is not only possible but expected.
In Montana, for example, the State Department of
Corrections and Department of Public Health and Human Services jointly fund a boundary spanner position that facilitates shared planning, communication, resources, and treatment methods between the mental health and criminal justice systems.
4. Localities must develop and implement core services that comprise an Essential System of Care:
Recognizing the limited resources often available and the complexities of the cross-system collaborations required, the eight components of an Essential System of Care would be best approached in two phases. Phase 1 would include less expensive, easier to mount services. Phase 2 would include essential evidence-based practices that are more expensive and more challenging to implement, but are critical to actually increasing positive public safety and public health outcomes.
Prospective Phase 1 Services:
>> Forensic Intensive Case Management
>> Supportive Housing
>> Peer Support
>> Accessible and Appropriate Medication
Prospective Phase 2 Services:
>> Integrated Dual Diagnosis Treatment, which provides treatment for mental illnesses and substance use disorders simultaneously and in the same setting
>> Supported Employment, which is an evidence-based practice that helps individuals with mental illnesses find, get, and keep competitive work
>> Assertive Community Treatment (ACT)/ Forensic Assertive Community Treatment (FACT), which is a service delivery model in which treatment is provided by a team of professionals, with services determined by an individual's needs for as long as required, and
>> Cognitive Behavioral Interventions Targeted to Risk Factors specific to offending, are a set of interventions, well researched within both institutional settings and community settings that have a utility when extended to community treatment programs.