Stop Locking Up People With Mental Illnesses

It's no secret that our nation's jails and prisons house individuals charged with or convicted of crimes. What most Americans don't know is that more Americans with a mental illness or addiction reside in jail and prison than in health care institutions.
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Handcuffed man standing in courtroom
Handcuffed man standing in courtroom

It's no secret that our nation's jails and prisons house individuals charged with or convicted of crimes. What most Americans don't know is that more Americans with a mental illness or addiction reside in jail and prison than in health care institutions.

Sixty-five percent of inmates meet the criteria for a substance abuse disorder (a rate seven times higher than the general population) and more than half have a mental health problem. Many are incarcerated for nonviolent offenses related to their condition, such as public disturbance or possession of substances. Once imprisoned, inmates with mental illness or addiction often become trapped in a revolving door of arrest, release, poverty, deterioration of health, and re-arrest.

Meanwhile, public safety officials are frequently the first responders in behavioral health emergencies, despite the fact that many officers lack training to handle an individual with a serious behavioral health condition. Being the first line of response to health crises takes officers away from their other duties maintaining community safety and puts them in the role of de facto health providers. The same is true for judges, prosecutors, public defenders, corrections officers, and other public employees involved throughout a person's journey from arrest to incarceration.

Health providers who can offer a range of prevention and treatment to improve health and reduce recidivism better serve nonviolent offenders living with mental illness or addiction in their communities. Intensive interventions such as assertive community treatment, residential substance use care, comprehensive case management, medication-assisted treatment, and others can help keep offenders healthy and out of trouble. Unfortunately, in far too many communities, available funding is inadequate to meet these needs. After generations of sustained funding cuts in basic services, our nation's community-based mental health and addiction treatment providers are stretched beyond their capacity; many have been forced to close programs or limit who can be served.

A new demonstration program, the Excellence in Mental Health Act, will provide a much-needed infusion of funding into addiction and mental health care, expanding treatment capacity and alleviating the burden on the nation's criminal justice system. The Excellence Act is an 8-state, 2-year demonstration program that establishes criteria for Certified Community Behavioral Health Clinics (CCBHCs) designed to provide comprehensive services and supports to people living with serious mental illnesses and substance abuse disorders. It also provides enhanced reimbursement and other resources to these clinics, allowing them to serve more people and better meet community needs. This demonstration program helps reduce the pressure on the criminal justice system by:

•Ensuring access to acute care, including addiction treatment: The Excellence Act requires certified clinics to ensure patients have access to inpatient psychiatric facilities and substance use detoxification, post-detoxification step-down services, and residential programs. They must also maintain strong relationships and coordinate care with these acute care providers, facilitating transitions from one setting of care to another and ensuring patients do not fall through the cracks and disengage with treatment.

•Increasing the availability of crisis care: The Excellence Act requires participating providers to offer 24- hour crisis services, including mobile crisis care, allowing individuals experiencing a behavioral health emergency to get the professional care they need, and providing public safety with an intervention that does not involve incarceration or pulling officials away from their other duties.

•Coordinating and improving care: Participating providers must establish and maintain partnerships with juvenile and criminal justice agencies, emergency rooms and other facilities as part of their requirement to coordinate care across settings and providers.

•Expanding access to care for the seriously ill: The demonstration program infuses over $1 billion into the community behavioral health safety net, giving clinics the funds they need to serve more people at all stages of care: from prevention to early treatment, crisis intervention, chronic care management, and more. By improving individuals' access to timely, comprehensive care, this program can improve patients' health while reducing the number of behavioral health-related calls public safety officials receive.

It's time for behavioral health systems and correctional systems to join forces as partners to help change this. At a December 8 symposium in Washington, D.C., recognized thought leaders in community mental health, health policy, and criminal justice convened to discuss opportunities the Excellence Act demonstration offers for our nation's correctional system. Senator Debbie Stabenow, who co-authored the Excellence in Mental Health Act, attended the symposium. She authored the law along with Senator Roy Blunt (R-MO) and Representatives Doris Matsui (D-CA) and Leonard Lance (R-NJ). The panelists agreed that behavioral health reforms can prevent inmates from ending up in jail in the first place--and can keep them from falling through the cracks when they return to their communities upon release.

Twenty-four states have received federal funding to embark on a one-year planning process to implement the Excellence in Mental Health Act. Yet, only eight of those 24 states will ultimately be offered a chance to participate in the demonstration. We're calling on Congress to expand the Excellence Act demonstration to all 24 states so they can offer the full range of necessary behavioral health services. Let's support behavioral health care for those with mental illness and addictions in our communities--before they're put in jail.

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