The Criminal Justice ‘Crisis’ in Mental Health Care

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Inadequate care for the mental and behavioral health needs of persons who are criminally accused, convicted, or preparing to leave prison will continue to fuel a “criminal justice crisis,” unless health care and justice professionals fully exploit the opportunities provided by a federal law passed over a year ago, a Washington, D.C. conference was told this week.

The Excellence in Mental Health Act, enacted in 2014 to address the shortcomings of the current system operating in jails, prisons and re-entry programs across the country, still is not sufficiently understood by those working in the field, Linda Rosenberg, president and CEO of the Washington, D.C.-based National Council for Behavioral Health, told the December 8 conference.

“(The Act) truly has the ability to be transformative, but nothing gets done unless we commit and rev up our focus,” said Rosenberg, whose organization, along with Oakland, California-based Community Oriented Correctional Health Services (COCHS) , co-hosted the conference on “The Excellence Act and Criminal Justice Reform: Opportunities and Intersections.”

Such a transformation depends on how well court, correctional, health care and related professionals understand the law’s provisions—and collaborate to make it work, Rosenberg and other speakers said during the conference.

Rosenberg added: “We are seeing a public health crisis [in mental health] that is now leading to a criminal justice crisis.”

A March 2015 report from the Washington, D.C.-based Urban Institute, parsing county, state and federal data, suggested that 56 percent of state prison inmates, 45 percent of federal inmates and 64 percent of local jail inmates have diagnosed or undiagnosed mental illnesses.

And, according to the federal Bureau of Justice Statistics’ most recent available data, 54 percent of state prisoners and 47 percent of federal prisoners reported that they’d used illegal drugs during the month before committing the offense that got them convicted.

Also, at least one study has suggested that 72 percent of jail inmates, who mainly are awaiting trial, are mentally ill and addicted to drugs at the same time.

Of the $1 billion earmarked for the Excellence Act, $22.9 million has so far been allotted to help 24 states spend a year assessing the impact of mental illness, alcoholism and drug addiction among their residents, including those who are criminal justice-involved, and creating services through certified community behavioral health clinics.

The Act includes the following provisions:

  • Mental health and substance abuse services must be provided at community clinics nearest to patients’ homes;
  • Community clinic staffers must include those who are “culturally competent” and well-versed, among other things, in how patients from different communities and sub-populations tend to access care, and how patients perceive the medical establishment;
  • 24-hour mental and behavioral health crisis hotlines, teams and services must be available;
  • Clinics, where possible, must provide mental and behavioral health care for patients who cannot pay for such services.

However promising the Excellence Act may be—it aims, partly, to lower incarceration rates for some mentally ill and addicted people, ensuring they get dependable community-based health care—it also faces some potential challenges, conference speakers and audience members said.

For one thing, forthcoming services will go largely to poor people whose health care is funded through the federal Medicaid program for the low-income.

But five states that are counted among the 24 conducting yearlong demonstration projects—Georgia, Missouri, North Carolina, Oklahoma and Texas—have voted against adopting President Obama’s Affordable Care Act. Consequently, those states are ineligible for the extra Medicaid dollars that landmark health coverage law offers. [The Excellence Act is an outgrowth of the Affordable Care Act.]

Most of the uninsured in those states are racial minorities—groups that disproportionately fill the nation’s prisons and jails, noted attorney Judith Solomon, vice president for health policy at the Washington, D.C.-based Center on Budget and Policy Priorities.

Those kinds of facts show how “criminal justice, health care and health disparities [are] in one big bucket,” Steve Rosenberg, president of COCHS (No relation to Linda Rosenberg), told conference attendees.

“It may not seem like it on the surface. But it’s really one big bucket.”

Some conference attendees also contended that many judges, prosecutors and other correctional professionals are unaware of the Excellence Act and how crucial they are to its implementation.

After asking some criminal justice policy-makers, prosecutors, judges and others if they knew the Act’s provisions, Solomon, from the Center on Budget and Policy Priorities, said she got “blank stares … This conversation has to be made much bigger.”

To be sure, some prosecutors, judges and other corrections professionals already are part of that discussion.

Several of them were in that December 8 audience or on stage as panelists.

They included the Burlington County, N.J. warden who so effectively reduced the number of detained juveniles—a group with its own mental and behavioral health issues—that his county’s juvenile facility closed earlier this year.

And they included the Jackson County, Mo. prosecutor who created an in-house re-entry program to help those leaving incarceration to find jobs, housing, health care and other supports—but also highlighted the need to “not forget the victims of crime” while shoring up the formerly incarcerated.

That prosecutor, Jean Peters Baker, hired an ex-felon to run Jackson County’s re-entry program, and gave him the title of client advocate.

“He knew how to work with this population better than I did,” she told the conference “He had serious felony convictions—and that did not go over well with the [assistant prosecutors]. But it was the right thing to do.”

Moves like the ones in New Jersey and Missouri have yielded substantial savings in government spending.

But, said attorney Solomon, “We have to talk about this in another way, we have to sell it in another way.”

The dollars need to be reinvested in health, housing and other re-entry programs, but such reinvestment isn’t widespread enough, she added.

Rosenberg of the behavioral health council said neither that kind of reinvestment nor a revamped mental and behavioral health system for persons involved in the criminal justice system will happen on its own.

“This is not simple and this is not sexy,” she told the conference. “But how do we describe it in a way that makes is simple and sexy? … We have to turn our attention to the marketing piece: How do we get this to be everybody’s agenda and for everybody to feel they’re going to benefit and want to be part of the action?”

Katti Gray, a contributing editor of The Crime Report , coordinates the An Imprisoned Mind: The Mentally Ill and the Criminal Justice System Journalism Fellowship for 25 journalists working for newsrooms across the country. She was a 2014-15 Rosalynn Carter Mental Health Journalism Fellow, exploring special programs for incarcerated and court-involved and probation-involved veterans. Katti welcomes your comments.

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