True justice: Mental health intervention vs. incarceration
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 percent 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.
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 mental health and 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”.