Proposal to Correct the Institutional Injustices For Mental Illness and Addictions Patients

Over the past 50 years we have gone from institutionalizing people with mental illnesses, often in subhuman conditions, to incarcerating them at unprecedented and appalling rates – putting recovery out of reach for millions of Americans. These people are not all the same. They are a heterogeneous group.
>> A small subgroup does resemble the State hospital patients of yesteryear, and their presence in our jails/prisons is one of the most egregious and 10 Ways To Keep Your Body Healthy disturbing images related to our failed systems of care. The availability of intensive care models, including hospital care for some, is critical.
>> Many other citizens with mental illnesses in our jails have less disabling conditions and with access to appropriate community treatment and support, will do quite well.
>> A third subgroup includes people with mental illnesses who have traits that are associated with high arrest and recidivism rates. These individuals would be best served with good treatment and supports, which include interventions targeted to their dynamic risk factors for arrest.
As we attempt to respond to the needs of these people and respect the legitimate public safety concerns of all community members, conditions in these correctional settings, which are designed for detention and not therapeutic purposes, are often far worse than conditions described in the State hospitals of the 1940s. Moreover, when justice-involved persons with co-occurring disorders leave correctional institutions, they repeatedly are left adrift only to recycle through the criminal justice system. Furthermore, individuals who become involved in the justice system often must contend with the additional stigma of criminal records, which make access to basic needs in the community, such as housing, education, and employment, even more difficult to obtain.
The ability to effectively design, implement, and reimburse treatment providers for delivering high quality services targeting specialized treatment needs is critical to establishing an effective community- based system of care for people who experience serious mental illnesses. In the absence of what are now seen as essential services for people with mental illnesses living in the community, people will continue to be forced into more costly, deep-end services in hospitals, crisis centers, emergency rooms, and the justice system.
The result is a recycling of individuals between jails, prisons, shelters, short-term hospitalizations, and homelessness – with public health, public safety, and public administration implications that are staggering. Now more than ever, as we strive to provide health care to our most vulnerable citizens, we must address this serious public health and public safety crisis. It is high time to be open and honest about the deplorable conditions that exist and take steps to address them. Below is a proposed solution in the form of a 2 phase plan.
Phase 1:
>> Forensic Intensive Case Management
>> Supportive Housing
>> Peer Support
>> Accessible and Appropriate Medication
These four services are the ones we believe are minimally necessary to break the cycle of illness, arrest and incarceration, and recidivism. We believe these services – described in brief below – can be implemented quickly, cost-effectively, and with positive results. However, these services can only be effective if the programs that provide them are structured and staffed by people who understand and are prepared to address trauma as a risk factor for both mental health problems and criminal justice involvement. A trauma-informed system that features trauma-specific interventions can help ensure public health and public safety and transform individuals’ lives.
Forensic Intensive Case Management (FICM) is designed for justice-involved people with multiple and complex needs and features services provided when and where they are needed. FICM focuses on brokering rather than providing services directly, making it less expensive than ACT. For a brokered service Mental Health Awareness Quotes model to be effective, communities must have adequate and accessible services to which individuals can be linked. What makes these services “forensic” is “criminal justice savvy,” that is, providers understand the criminal justice system and the predicaments of their clients involvement in it.
Supportive Housing for mental illness patients is permanent, affordable housing linked to a broad range of supportive services, including treatment for mental and substance use disorders. Supportive housing can significantly decrease the chance of recidivism to jails and prisons and is less costly on a daily basis than jail or prison. Unfortunately, affordable housing is in short supply in many communities, and ex-offenders with drug-related offenses often have trouble securing public housing assistance. Housing for ex-offenders must balance the needs for supervision and the provision of social services.
Peer Support services can expand the continuum of services available to people with mental and substance use disorders and may help them engage in treatment. Forensic peer specialists bring real-world experience with multiple service systems and an ability to relate one-on-one to people struggling to reclaim their lives. The practice of consumer-driven care – as exemplified by the involvement of mental health consumers in service design, delivery, and evaluation – is at the heart of a transformed mental health system.
Accessible and Appropriate Medication supports continuity of care for individuals with mental illnesses whose treatment often is disrupted when they become involved in the criminal justice system. They may not receive appropriate medication in jail or prison or adequate follow-up when they return to the community. It is imperative that people with mental illnesses and co-occurring substance use disorders have access to the right medication at the right dosage for their condition, as determined by the individual together with his or her clinician.
Phase 2:
Clearly, the Phase 1 services are necessary, but not sufficient. Services that support the Essential System of Care include several evidence-based practices for people with serious mental illnesses. These services may be more expensive or difficult to implement than the four listed above, but we encourage States and communities to move toward development of these services by codifying them in policy, supporting them in practice, and rewarding their implementation.
Phase 2 services include:
>> Integrated Dual Diagnosis Treatment, which provides treatment for mental and substance use disorders simultaneously and in the same setting
>> Supported Employment, which is an evidence-based practice that helps individuals with mental illnesses find, get, and keep competitive work
>> Assertive Community Treatment (ACT)/ Forensic Assertive Community Treatment (FACT), which is a service delivery model in which treatment is provided by a team of professionals, with services determined by an individual’s needs for as long as required, and
>> Cognitive Behavioral Interventions Targeted to Risk Factors specific to offending, are a set of interventions, well researched within both institutional settings and community settings, which have a utility when extended to community treatment programs.
This list of evidence-based and promising practices is illustrative but not exhaustive. Clearly, however, there is much that can be done to help people with mental and substance use disorders avoid arrest and incarceration and return successfully to their communities after jail or prison. We acknowledge that in difficult financial times, new dollars may not be available. However, though new money is not always required for systems change, new ways of thinking are.
To meet the public health and public safety needs of our communities demands a fully collaborative campaign involving both the behavioral health and criminal justice systems. Neither system can continue business as usual. The criminal justice system needs to do an adequate job of screening, assessing, and individualizing responses to detainees and inmates identified with mental illness. The behavioral health system needs to refine and deliver evidence-based practices with an awareness of its responsibility to not only improve the quality of life of its clients, but to address interventions to factors associated with criminal recidivism in these clients and to more directly involve clients as partners in a recovery process that recognizes the community’s public safety concerns.
We must move toward a day when people with mental and substance use disorders receive the effective community-based interventions they need and deserve, and jails and prisons no longer are forced to serve as primary, de facto treatment facilities. We know what works to address successfully the needs of people with mental and substance use disorders who come in contact with the criminal justice system; now we have to DO what works. The time for action is now!