Criminal Justice Reform for Behavioral Health Consumers
A look at how the shift in behavioral health programs have affected the criminal justice system
With budget cuts and many in-patient facilities being closed down, mental health consumers are finding themselves caught up in the criminal justice system. The issues at hand are how to adequately track and monitor these consumers once they have made their way into the criminal justice system, and how to put plans and programs in place to prevent any subsequent reentry into the criminal justice system after their initial release. Education and training for those involved in the criminal justice system, especially law enforcement officers, is among the highest priority of needed mitigation policies. Once the mental health consumer has become involved in the criminal justice system, there is a greater need for support programs to be implemented to manage the mental health consumer for more detailed monitoring and managing, and also to help prevent reentry into the criminal justice system.
One of the major areas of concern that plague our society today is the number of mental health consumers that find their way into the criminal justice system. With many state hospitals having been closed down and funding being cut for outpatient programs in the private sector, integration into communities can present as a great challenge for many mental health consumers. With gaps in guidance or access to their much-needed medications to manage their conditions, many of those mental health consumers find their way into criminal justice system unintentionally. This concept has been addressed in an article written by Laura Medford-Davis and Rakel Beal entitled, The Changing Health Policy Environment and Behavioral Health Services Delivery. “Deinstitutionalization has left an inadequate supply of inpatient psychiatric beds. Simultaneous cuts to public funding and insurance coverage for outpatient mental health treatment have increased the frequency of acute psychiatric crises. The resulting lack of available options has shifted the burden of treatment to emergency departments and the criminal justice system.” That, compounded with the idea that there is little training or education for law enforcement in the way of relating to or responding to mental health consumers, poses the question, what plans can be implemented that could better serve the mental health population and prevent entry or reentry into the criminal justice system?
While the criminal justice system may not be inundated with mental health consumers, there is little argument that there still exists a noticeable number who make their way into the system. In a report that discussed behavioral health and the criminal justice system, it was noted that, “Among the greatest needs of jail and prison inmates is treatment of mental health and substance abuse disorders. Over 12% of federal prison inmates and over 25% of state prison and jail inmates report at least on previously diagnosed mental health condition.” (Cuellar. 2014). There does not seem to be a definitive data tool for tracking the numbers of mental health consumers that have entered into the criminal justice system as stated in a recent report in the International Journal Of Offender Therapy & Comparative Criminology. “Arrest and incarceration are a pervasive reality for people with mental illnesses. Wide variation, however, exists in the estimates of the percentage of people with mental illnesses who become involved in the criminal justice system.” (Morabito. 2017). Given the fact that there are inconsistencies in the actual numbers of mental health consumers within the criminal justice system, there needs to be a better plan for tracking those consumers. However, that poses an even greater question, how? It would be important to know how many of these mental health consumers are actually tracked, and the system used for tracking them, and the numbers of mental health consumers who fall through the cracks.
Although there are programs in place that are designed to track and manage the mental health population who have found their way into the criminal justice system, they have not proven to be one hundred percent successful in the entry or reentry into the system. A collaborative piece in the International Journal Of Law And Psychiatry addressed this matter in an article published in 2014, Stating that, “Specialized interventions, such as police and jail diversion, mental health courts, specialized probation, forensic assertive community treatment, designed to engage justice-involved persons with serious mental illnesses, have expanded over the past two decades. Some of these “first generation” interventions have demonstrated efficacy and several have earned recognition as evidence-based practices. Yet, overall, they have not appreciably reduced the prevalence of persons with serious mental illnesses involved in the criminal justice system.” (Wolff. 2013). With these current plans that are in place not showing the effectiveness that one would hope to see in terms of preventing reentry into the criminal justice system, the programs must be looked at more closely to evaluate what parts of them work and which ones do not, in an effort to reform the current programs to better serve the consumer. Aiming to meet the overall objective of preventing entry into the criminal justice system at all is a priority that should begin in the communities where the mental health consumers are integrated into, and build upon the idea that mitigation is the key.
Education for law enforcement officers needs to be on the forefront of practices for better monitoring of mental health consumers within the criminal justice system. A 2013 article in the International Journal Of Law And Psychiatry addresses this issue, in that, “Law enforcement officers continue to serve on the front lines as mental health interventionists, and as such have been subject to a wave of “first generation” reform designed to enhance their crisis response capabilities. Yet, this focus on crisis intervention has not answered recent calls to move “upstream” and bolster early intervention in the name of long-term recovery.” (Wood. 2014). The objective, according to the report, is to place more focus on behavioral health interventions within the city to business and agencies to devise a more community based support system that would work toward preventing the criminal acts perpetrated by the mental health consumers. Having law enforcement officers work more closely with behavioral health professionals and gaining more insight into crisis intervention methods would also be a tremendous benefit to the cause of better monitoring and management of mental health consumers in the criminal justice system, and may even provide a more conducive environment to better prevent entry into the criminal justice system altogether.
To conclude, the best measure of preventing reentry into the criminal justice system if to have a good support system outside of the system, one that is community based, and would allow the mental health consumer to have access to resources needed to maintain activities of daily living, including work and managing their medications and therapy needs. However, in a collaborative report in the International Journal Of Law And Psychiatry in 2014, authors Angell, Matthews, Barrenger, Watson, & Draine, pointed out how little evidence that exists to prove how effective the current programs are working, stating that, “Linking prisoners with mental illness with treatment following release is critical to preventing recidivism, but little research exists to inform efforts to engage them effectively.” (Angell. 2014). This information leads to the question, what can be done to better serve the mental health consumer who finds themselves in the criminal justice system?
- Angell, B., Matthews, E., Barrenger, S., Watson, A. C., & Draine, J. (2014). Engagement processes in model programs for community reentry from prison for people with serious mental illness. International Journal Of Law And Psychiatry, 37(New Directions for Behavioral Health and Criminal Justice Interventions), 490-500. doi:10.1016/j.ijlp.2014.02.022
- Cuellar, A. E., & Cheema, J. (2014). Health Care Reform, Behavioral Health, and the Criminal Justice Population. Journal Of Behavioral Health Services & Research, 41(4), 447-459. doi:10.1007/s11414-014-9404-0
- Medford-Davis, L. N., & Beall, R. C. (2017). The Changing Health Policy Environment and Behavioral Health Services Delivery. Psychiatric Clinics Of North America, 40(Behavioral Emergencies), 533-540. doi:10.1016/j.psc.2017.05.013
- Morabito, M. S., & Wilson, A. B. (2017). Selecting a Method of Case Identification to Estimate the Involvement of People With Mental Illnesses in the Criminal Justice System: A Research Note. International Journal Of Offender Therapy & Comparative Criminology, 61(8), 919. doi:10.1177/0306624X15608823
- Wolff, N., Frueh, B. C., Huening, J., Shi, J., Epperson, M. W., Morgan, R., & Fisher, W. (2013). Practice informs the next generation of behavioral health and criminal justice interventions. International Journal Of Law And Psychiatry, 361-10. doi:10.1016/j.ijlp.2012.11.001
- Wood, J. D., & Beierschmitt, L. (2014). Beyond police crisis intervention: Moving “upstream” to manage cases and places of behavioral health vulnerability. International Journal Of Law And Psychiatry, 37(New Directions for Behavioral Health and Criminal Justice Interventions), 439-447. doi:10.1016/j.ijlp.2014.02.016