Ware rechtvaardigheid: interventie in de geestelijke gezondheidszorg versus opsluiting

Many factors are driving the awareness of mental health in the United States, ranging from the launch of the Affordable Care Act in 2010 to the mental health implications of the current COVID-19 public health crisis. However, we still have a ways to go before mental health is treated equally with physical health.

Our criminal justice system is a case in point. There is a disproportionate representation of individuals with mental health conditions in courtrooms, jails and prisons. Essentially, correctional institutions have become de facto mental health facilities. Consequently, communities are recognizing the value in identifying the points at which individuals with mental health conditions are coming into contact with the juvenile and criminal justice systems.

But how can communities organize collaboration across the multiple systems that justice-involved individuals often touch? It calls for interagency collaboration to coordinate services and divert individuals from the criminal justice system to needed services.

The courts’ mental health challenge

Nearly 25 percent of individuals involved with the US criminal justice system report a serious mental illness. Specifically, between 2011-2012, 37 percent of adult prisoners and 44 percent of jail inmates had a history of a mental health condition, according to the 2017 report from the Bureau of Justice Statistics. Further, approximately 65 percent have a substance use disorder (SUD), according to the National Institute on Drug Abuse.

People with mental health conditions and SUD are more likely to be arrested than people without these challenges. Sometimes they may engage in acts that appear to be criminal, but in fact are not, or they may exhibit behavior that is upsetting or misunderstood. Often in these circumstances, bystanders will call 911 – triggering law enforcement involvement – instead of contacting a crisis response system, if a community is lucky enough to have one.

And the cycle repeats. Upon release from prison, approximately 50 procent of those with a mental illness reenter prisons within three years of release, partly due to inadequate community-based treatment or a lack of connection to care.

Interagency collaboration

Juvenile justice, criminal justice and behavioral health agency leaders understand that treating mental illness improves health and reduces recidivism. In spite of this shared goal, these agencies too often work at cross-purposes, with little or no interagency collaboration. Their different missions and different styles of delivering services can lead to duplicative efforts and unintended gaps in care.

With the shared view that collaboration is key for coordinated services, agencies can develop processes to drive high-functioning collaboration. Braided funding acts as the system’s forcing function, supporting shared responsibility and liability; pooled resources; systematic information-sharing; and general equity among participating agencies. Further, quality management and oversight, buoyed by outcomes measurement, drive collaboration success.

This collaboration requires organization. The Sequential Intercept Model (SIM) provides a framework for change that organizes collaboration across the multiple systems that justice-involved individuals often touch. Beacon Health Options supports the SIM, which identifies six points – or intercepts – at which individuals come into contact with the criminal justice system and describes how an organized system can react at each of those points to prevent continued criminal justice involvement. Specifically, the SIM does the following:

  • Requires cross-sector partnerships and collaborations
  • Builds strategies for multiple stages of intervention (with emphasis on upstream interventions preventing damage and high costs to a person in crisis, the community, and the system)
  • Relies on strong logistical capability
  • Employs wide-ranging competency development across multiple sectors
  • Must understand where the mental health and criminal justice system must necessarily intersect and collectively works on strategies to uncouple this response when they do not

Specialty courts support jail diversion

By way of example, Intercept 3 includes jails and courts as intercept points for mental health. At this juncture, the model promotes mentale gezondheid en drug courts as treatment-oriented courts that divert offenders with mental illness and SUD into mandated, community-based treatment. The courts’ goal is to divert this group of offenders away from the criminal justice system, thus reducing recidivism.

One study cited by the National Institute of Corrections shows that offenders with a mental illness who have gone through mental health courts have significantly reduced arrest rates 12-months post-enrollment compared to the arrest rate in the year prior to enrollment. Mental health courts also lead to decreased emergency room visits for crime-related injuries, fewer child welfare interventions, improved success in treatment programs and more. The Washington State Institute for Public Policy found that mental health courts’ benefits to both the taxpayer and non-taxpayer totaled $19,080 for 2016, with a 99 percent chance that the benefits will exceed the costs.

Individuals with mental illness deserve to get care – not incarceration – just as people with cancer or heart disease deserve to get care – in health facilities – not jails. To learn more about how communities can drive health parity through interagency collaboration and the Sequential Intercept Model, read Beacon’s white paper, “TRUE JUSTICE: Mental health intervention vs. incarceration”.


37 Opmerkingen. Verlaat nieuw

Interesting read. Drug court has shown a lot of promise in Westmoreland county.

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Margaret Murphy
november 12, 2020 4:44 pm

I have worked in the prisons and the conditions to those suffering with mental illness is awful!! When I worked in Ohio we had treatment centers where sentences were reduced if you completed the program. We then set you up with mental health in the community and a sober home. In CA we drop you off at a greyhound station and your on your own.

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Thank you, Beacon, for helping to bring about change in the way we interpret human behavior and the way we respond. We have known for a very long time that incarceration is not the answer to an illness for any age.

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As a Licensed Independent Clinical Social Worker, I have found that many of my clients need both psychological support as well as access to healthcare, safe housing, and a connection to the community. That is why I founded “Clarity Community Connections,” a non-profit organization who helps women who are starting over after incarceration or substance use treatment as well as young adults who are having a difficult time getting started on their own. We provide programming, case management, mentorship, education, and support.

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I worked as a psychotherapist in the prison system for years. This initiative is sorely needed.

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This piece addresses a long-standing gap in mental health/criminal justice policy and practice. With the 20 years of research and data on the ACEs and their effect on mental and physical health and criminal justice involvement, it’s time to look beyond ACEs to the systemic and systematic mitigation of the impact of ACEs through real prevention services and targeted traumatic stress impact abatement. This is best accomplished through the types of partnerships this piece encourages, and more importantly must be supported through merged funding streams to allow for low to no-cost services on a continual basis. In the age of COVID, this should be more easily accomplished than ever via telehealth educational video groups. The remedy is trauma-informed care, the prevention is trauma-informed communities.

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Laurie M Forbes, LCSW
november 12, 2020 5:11 pm

I totally agree with this. I worked in Utah where their court systems have Drug Courts, Domestic Violence Courts, and Mental Illness Courts. I saw clients from the Drug and Mental Illness courts and the process was very good. it kept their jails and prisons less populated, keeping in the hard core criminals because there was room for them.

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This is all good and well, but we need a public buy in. Part of the issue stems from the deinstitutionalization movement. The idea was to have community mental health centers, but these were never adequately funded. That the public has so eagerly divested from public education (at the local, state and national levels the share of funding for education has decreased – controlling for inflation – over time). We as practitioners need to make our voices heard to support funding for services. We also have to address racial inequity. The first step is to acknowledge that it is there and to take active steps to change. This requires that we acknowledge that some of the problems we face in low income communities stem from social policies such as redlining under the FDR administration – that made it difficult for people of color to buy houses. Until we find a way, as a nation, to admit that racial inequality and social policies that reinforce economic inequality have led to the problems we face, some of the surface level changes are just that, cosmetic and destined to fail.

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I am a LMFT that has on occasion counseled with individuals who have been incarcerated. I also have a son who has some significant mental health issues and is incarcerated for poor choices. I question if the choices are not part of the mental health. I also see him as one who falls through the cracks because he can function in the world appearing as if he is just doing criminal behavior. But his mental health issues are not ‘significant enough’ for other services to be initiated for him. This is a major problem for many in the criminal system. I am not sure I have any answers though. I am glad someone may be attempting to make a difference.

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Debra Lee Suierveld
november 12, 2020 5:45 pm

I am glad to see that these issues are finally being addressed. Prisons are overrun with people who need mental health services and we have ignored it for too long.

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I am a part of an agency that works with the criminal justice system providing SUD’s , Batterer’s program and mental health treatment to probationers from county, state and federal agencies. for 5 years we case managed drug court in Napa County until funding ran out.

We need to treat and humanize those who need to be supported and engaged in our community, not marginalize them with little or no resources.

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On point! Totally agree. Well written and needs to be considered, especially now, with the rise of COVID-19 pandemic. Numerous people are catching the residue of this disease and are mentally distraught. Evidently, there is likely to be a rise in mental health challenged individuals. I agree that there is a need to plan ahead to engage various agencies, including mental health, to analyze, define, collaborate, and assign service delivery appropriately to yield utmost result; justice and healing to our nation.

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Brenda Wilking
november 12, 2020 5:59 pm

Specialty courts, like drug courts and special court for veterans with mental health problems can be highly successful. Working together to provide psycho-education and counseling as well as appropriate medical help can create increased positive outcomes for individuals who would otherwise end up in jail.

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Christine Reed, LCSW
november 12, 2020 6:26 pm

Great ideas that reflect a need for major social systemic changes. This is in the areas of criminal justice reform related to mental health interventions. These issues were worsened due to the breakdown of institutional facilities for mental health treatment. When those options basically disappeared due to insurance & profit driven motives, the seriously mentally ill became the patient & family & communities problem versus a social solution. Jails & prisons became the new treatment facilities. Granted those older mental health facilities were sorely in need of improvements in their treatment interventions. But there has been great progress in this area. It seems changes are needed to reach across many levels: criminal justice reforms, health insurance reforms, institutional racism reforms, economic reforms. All of these areas are in need of change as we also make improvements in the understanding of mental health and substance abuse disorders, effective treatment interventions at the individual & family and social levels. I think this also relates to the need for more holistic changes in the medical model of disease treatment versus promotion of prevention and understanding & promoting healthy life style interventions. That takes us to other levels of environmental and agricultural systems needing reform. Which leads to the choice of reforming corporation dominance or social change. But I love the model proposed for judicial reforms and we need to start somewhere.

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I would love to partner and participate in the efforts to serve the mentally ill in jail! Besides of the facts mentioned in this article, which are very true, There is also a lot of those who become mentally ill because of the injustices and abuses they suffer as inmates. Innocent People that are sentenced, due to lack of funds for a good attorney, racism and discrimination against immigrants and minorities. In my clinic I serve many patients in those circumstances, but i would LOVE to expand the services I could provide, individually and in groups to this community, collecting more clinical data to further study this problem that affects our communities, at a level of public health. How can I join forces with Beacon to do that? Thank you for this phenomenal initiative!

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Good to hear that the needs of those involved in the criminal justice system are being recognized as human beings in need of support and not always punishment first. Mental illness is real, and has real consequences, especially when left untreated.

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Joseph Poitier, M. D .
november 12, 2020 6:35 pm

This is the elephant in the room, “Race”. Jails and prisons are disproportionally occupied by people of color. The majority of those incarcerated are people of color. We need better schools in these communities, better health and mental health care . We also should need total community involvement to prevent incarceration rather than have private companies profit from mass incarceration or as it has been called’Slavery By Another Name’.

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While I agree that a persons mental health issues should be treated, I also feel their criminal actions should be addressed. Both need to be managed at the same time in an appropriate facility. This person has still committed a crime and needs to be held responsible for their actions. While doing so, they should be assessed for a mental health condition and if one exists this should be managed. I am not sure that putting them in a “community” based setting is safe for the community. Why not manage their mental health while inside and make them a safer person to be released to the community. There could be a mental health correctional facility that they are sent to. Perhaps I do not understand what these alternative programs entail.

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Corby Caffrey-Dobosh
november 12, 2020 6:42 pm

I believe we need to involve criminal justice bachelor’s level programs. I instructed various sociology courses and a biological psychology course at Waynesburg University for 18 years. I often had CJ majors and they frequently fought a sociological perspective on human behavior. I attempted to introduce a Sociology of Mental Disorder course, encouraging the CJ majors to participate – but the CJ department told me it wasn’t a necessary course, despite the fact that so many people with mental disorder are killed by police, incarcerated, or have their mental health needs go unattended. Those in criminal justice programs frequently neglect the systemic and neurobiological issues that surround and influence the presentation of mental disorder and criminality. The prison systems do not provide adequate mental health supports for those in need – reminds me of Titticut Follies… we need the criminal justice collegiate departments to get on board, recognize that human behavior is not black and white, and work with social sciences toward change.

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Joseph Poitier, M.D.
november 12, 2020 6:47 pm

Thanks to Beacon Health Options for bringing notice to this alarming issue.

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The sad part is that the information presented has been known to the criminal justice system, as well as in forensic psychology, sociology and related fields. While completing my doctoral dissertation (Juvenile offenders and recidivism rates), it became clear that we live in a country that has intentionally ignored the needs of the mentally ill, especially when it come to black citizens in our society. The impact of such intentionality has let to the highest incarceration rate of adults and juveniles (disproportionately black & brown) of any developed nation. This is an intentional failure of the US criminal justice system and the US government due to known policies that specifically ignore mitigating factors in crime and criminality such as mental health status, as well as the insurmountable data available that points to inequality in sentencing across race and SES. The above suggestions unfortunately are not innovative, in that they are recommendation that have been proposed over and over in reentry and prevention reform. Instead, as one reply stated, this nation must acknowledge how systemic racism has lead to our criminal justice disparities and failure, and work to correct this wrong (e.g., changes in the law, allocation of resources). This is bigger than crime and punishment in America. As clinicians, we cannot have a meaningful impact unless we have a understanding of the role of racism in the criminal justice system and sentencing laws in the US. Funding must be demanded and holding elected officials accountable is key (before and after elections). Thank you for having this discussion

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Frank Satterfield
november 12, 2020 7:12 pm

I agree that those individuals with mental health disorders should be given proper treatment in an appropriate setting. I would also suggest that statistics show that a good number of people in our prisons suffer from substance use disorders and they too should be given treatment.
Let’s put our resources and ideas together and try to come up with solutions to both of these issues.

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Suzanne Kresiak
november 12, 2020 7:48 pm

The agency that I work for in Berkshire County, Massachusetts has had crisis clinicians co-responding with the police to calls for a couple years now and it is a phenomenally successful program. Not only have countless individuals been diverted from arrest and then often incarceration, but the individual is able to be fast tracked into outpatient services to get the help that they need. The clinician is also able to provide service to the family members or other involved parties that are a witness to and/or involved in the acute situation. The collaboration has also been an opportunity for the domains of social work and law enforcement to understand each other, educate each other, and build alliances in the community for the benefit of all persons served.

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I have worked as a trauma counselor in a county jail. Honestly every one there had trauma. The other counselors were not equipped to help the inmates with their traumas . Much landed on my shoulders. We saw a great reduction of recidivism after doing trauma treatment along with addiction counseling.
Part of the problem was the officers who felt we were taking their jobs away by reducing recidivism.Some tried to work against us. we have to stop looking at offenders as degenerates and more like people who fell thru the cracks and need support and stop looking at prison as a for profit institution that is depended on others’ pains.

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I had a client who was referred to a mental health alternative.
* he was required to take medication that he reacted badly to.
* he was required to take group classes in an area that triggered underlying trauma.
* he had no voice in his treatment.
* he committed suicide!
I believe in alternatives to incarceration. When in jail, he was not allowed his medications, was beaten up by his cellmate, was otherwise abused. But he and his family needed to have a say in the process!!!!!

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Amen! Thank you ! Finally a true resolution. All links have to be connected from the start in order to avoid the criminal justice system. The start is always the mother, the family unit. Help & support should be freely available at every store in the community, just like there is Publix or a CVS at every corner. If parents and children are involved and connected with community support and help, the family unit will function healthy, producing healthy children, becoming and functioning as healthy, happy adults, with less or hopefully no challenges at all in the future.

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Thank you for sharing this article. It is testimony once again, that if you won’t apply the correct response if you don’t understand and accurately know the problem. Hopefully policy/healthcare will meet where the need is so people can get the help they so desperately need.

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I love this!! A component that is addressed here is letting people keep their self- respect within the system. It is so important! Thank you!!

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Start from the beginning. Every school system should have ample qualified counselors, and intensive family support. This alliance should begin early, proactive involvement. Pretty simple solution
F D Pritt, MS LPC NCC

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Intervention is definitely needed and I can see how it can reduce the recidivism. I am completely for it.

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Madelon kendricks, LCSW-R
november 13, 2020 2:45 pm

Poverty is a main driver of mental health issues, lack of access to mental health services is acute.
The model for community based services did not materialize as planned. Lack of healthcare, housing, and a living wage has created a permanent underclass. Covid has exposed the foundational issues that were always affecting many communities.

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Alexia Baca Morgan
november 13, 2020 4:03 pm

My name is Doctor Alexia Baca Morgan and I was involved with the creations of the mental health systems for the California Department of Corrections at the two women’s facilities and in parole Outpatient Clinic. I agree with the changes that need to be made and I would very much like to be part of it. Our hit rate was definitely 25% across the entire State of California for incarcerated citizens. Please let me know how I can become involved. I am currently organizing a speaker’s committee to speak to local police departments and other agencies about this issue. I am so proud of you for working on this issue. Sincerely Dr Alexia Baca Morgan

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I worked in a California prison with the mentally ill for over nine years. Oddly, the treatment provided is far superior to what people receive in the community. Each of the inmates was scheduled for fourteen groups per week. These included psychotherapy oriented, groups, and recreational groups. Additionally they saw a psychiatrist about once a month, and a therapist at least every other week. However, for most of these inmates, they could have received this treatment in the community. It is especially appalling to learn the cost of them being in prison. For the the nonmentally ill the cost is about $50,000 per year. For the mentally ill, it is about $75,000. Think what we could be doing for the mentally ill in this state if these funds were transferred to the mental health system.

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Mary Cooper PhD
november 17, 2020 5:35 pm

This is an excellent start for a serious societal problem. Since long-term mental health hospitals were closed in the 1970s, and the proposed infrastucture of community mental health centers PLUS residential facilities in the community didn’t develop, jails and prisons have become homes for the mentally ill. Thank you for working on this serious problem.

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So glad to see this! Anyone that would like to become involved and promote unitive justice, versus the punitive justice of our current system, please check out the Alliance for Unitive Justice at a4uj.org.
Best! Maire Taylor, LCSW

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