Health Issues at Root of Swollen Jails and Prisons; Solutions are in Diversion Programs

The science is clear. Substance use disorders affect brain chemistry, and brain chemistry affects behavior.

People with alcohol and drug problems are heavily stigmatized throughout our society and disproportionately represented in American criminal justice systems. More than half of the people in state prisons (53 percent) and two-thirds in local jails (68 percent) have been found to have a substance use disorder.

Mental health issues also are pervasive. In state prisons, more than half of the people incarcerated (56 percent) have been found to have a mental health problem and one in six (16 percent) have a serious mental illness. In local jails, almost two-thirds (64 percent) and 17 percent meet these criteria, respectively, and in fact, the latter may well be underestimated.

People with substance use and mental health conditions have been flooding state and local criminal justice systems for years, fueling unprecedented costs and rates of incarceration, and creating headaches for systems that were not designed to address health issues on a massive scale.

Across the United States, local and state criminal justice systems are managing record numbers of people. By 2011, over 2.2 million people, or 1 in 107 adults, were incarcerated in prisons or jails across the U.S. Another 4.8 million, or 1 in 50 adults, were under supervision on probation or parole.

The mammoth processing of Americans through criminal justice turnstiles is bleeding states financially without yielding useful results, says a new report by the Chicago-based Center for Health and Justice at TASC (CHJ).

In reality, our criminal justice system is functioning as triage first-responders for what is a visibly a public health crisis.

Fortunately, the new CHJ survey says that jurisdictions across the country are developing solutions to combat our national incarceration obsession. Now more than ever, prosecutors, judges, court administrators and corrections and probation officials are responding with community-based diversion alternatives at the front end of criminal justice processing, often incorporating substance use and mental health program components.

The report, which surveyed more than 100 diversion programs across the country, reveals that a deep pool of service options exist to aid criminal justice actors who are seeking to address individuals' behavior without resulting in a conviction. Such records, even for low-level offenses, create lasting barriers to employment and other aspects of productive citizenship.

A central aim of these diversion programs, according to the CHJ survey, is to apply minimum but appropriate amounts of supervision, sanctions, accountability, services and resources to achieve the intended result of preventing further crime. Such programs can cost-effectively address behavior and move people out of the justice system before they become entrenched in cycles of drug use and crime.

Research from Washington State, for example, demonstrated cost savings of $5,000-$10,000 per person treated and decreased recidivism of 17-33 percent by providing drug treatment to low-income individuals, a group that had frequent contact with the justice system.

The immense volume of people flooding criminal justice systems in the U.S. demands effective policy responses -- commensurate in scale -- from governments at all levels. Effective diversion models need to be shared widely and expanded to blunt the costs and consequences of overburdened justice systems across the country.

The vehicle to carry such a solution is right in front of us.

The Affordable Care Act, which includes requirements and resources for the provision of addiction treatment and mental health services at parity with medical services, offers the prospect of applying a public health approach at a scale to meet the existing challenge. This can clearly be a game changer -- saving and improving lives, reducing crime and recidivism, and saving money.

Fusing proven programs with resources that match the size of the problem is fueling hope among criminal justice professionals that, especially in dealing with substance use and mental health problems, we may now have the opportunity to bend the sway of criminal justice more fittingly toward public health. It's time to act.

Timothy P. Condon, PhD, is chief science advisor to the Center for Health and Justice at TASC, a national public policy group focused on strategies and solutions at the intersection of criminal justice and public health. Dr. Condon has served as the science policy advisor to the director of the White House Office of National Drug Control Policy (ONDCP) and as deputy director of the National Institute on Drug Abuse (NIDA).

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