Smart Justice -- Begins With Health Equity

Smart Justice -- Begins With Health Equity
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Smart Justice is a banner many state law enforcement and criminal justice stakeholders utilize to drive prison reform. Whatever strategies and programs a state's smart justice initiative may include, it must consider the primary and behavioral health needs of inmates. As reported by The Treatment Advocacy Center, "Approximately 20 percent of inmates in jails and 15 percent of inmate's state in prisons have a serious mental illness." As to substance use, data reveals an estimated 75 percent of inmates have a substance use disorder and over 70 percent of those with serious mental illness have co-occurring disorders. It is no surprise that according to the RAND Corporation, prison reform and reentry efforts must provide access to primary and behavioral health treatment and services in the community to succeed.

As the pioneering judge of the nation's first specialized Mental Health Court in 1997, I appreciate the challenges of system reform. When Broward County, Florida was looking for solutions to the problem of the criminalization of mental illness, the system reformation process was daunting. The greatest challenge was how to lead cultural change in the criminal justice system and the community-based mental health system. The second challenge was how to ensure access to care in a community with scarce resources.

Since that time, criminal justice reform has taken on a new sense of urgency, starting with the Pew Center's groundbreaking release of its 2008 Report, "One in 100 Behind Bars in America." Our nation was confronted with the alarming message that if levels and costs of incarceration are not contained and reduced, state budgets will be crippled, and the social and cultural fabric of our communities severely damaged. The debate surrounding criminal justice is on, and the question is: Will reform efforts be sufficient to drive cultural change?

As defined by The World Health Organization (WHO), Health Equity means, "A characteristic common to groups that experience health inequities -- such as poor or marginalized persons, racial and ethnic minorities, and women -- is a lack of political, social or economic power." According to WHO, the remedies to address these inequities, "Must go beyond the particular health inequity and also help empower the group in question through -- law reform or changes in social or economic relationships."

Broward's Mental Health Court embraces these principles and values. Many of our court participants have returned to work, school, and otherwise engage in the community. Without linkages and a pathway to community behavioral health treatment and services, we could not have achieved these goals.

Recently, Broward's criminal justice and behavioral health stakeholders assembled at Nova Southeastern University to attend a Sequential Mapping Forum in preparation for an opportunity to apply for a future Florida Criminal Justice Reinvestment Grant. It was difficult to envision how Florida, ranked 49th in mental health funding, would achieve broad-based criminal justice reform without expanding Medicaid to drive Health Equity. It is more than fair to say that Health Equity is an essential component of criminal justice reform and smart justice initiatives. Many states, such as Georgia, Texas, and California have invested in prison reform, and making progress. For example, California sees investment in housing as a health care solution. The success of its Los Angeles-based Housing for Health Program, which began in 2012, has prompted California to pursue permission to use Medicaid Funding to grow the program statewide.

The need for state policymakers to invest in smart justice goals, which prioritizes Health Equity is more than a matter of criminal justice -- it is a matter of health, safety and quality of life for all Americans.

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