On any given day, 350,000-500,000 people with serious mental illness are in jails and prisons in the U.S. The good news: that’s only 3.5%-5% of the 10 million people with serious mental illness. The bad news is that, over the course of a year, many more people with serious mental illness spend some time incarcerated and are involved with the criminal justice system in other ways, including encounters with the police, prosecutors, courts, and probation departments.
Once incarcerated, many individuals do not receive the treatment and support services they need. This leads to mental health conditions worsening and often to longer time in jails and prisons than counterparts without a mental illness.
In essence, the criminal justice system is an inherent and very problematic part of our nation’s response to mental illness. And criminal justice reform, therefore, must be a major component of any effort to improve mental health policy in the U.S.
Recently, in a rare bipartisan effort, the First Step Act, a federal law to reform the criminal justice system, was enacted. Over time it may have significant impact on overuse of federal prisons to deal with people who used or distributed illegal drugs and may contribute to successful re-entry into open society for some people convicted of federal crimes.
But will it improve the response of the criminal justice system to people with serious mental illness?
Here are the major features of the new legislation:
- An overall goal to “ensure people are prepared to come home from prison job-ready and have major incentives to pursue the life changing classes that will help them succeed on the outside”
- Provides additional opportunities for reduced time in prison
- Funds “recidivism reduction programs” to help prisoners prepare for re-entry
- Allows federal judges some latitude in sentencing for nonviolent offences
Probably, this will help some people with serious mental illness facing or serving long sentences in federal prisons to remain in, or return more rapidly to, the community. But the needs for criminal justice reform for this population are much more extensive. They include:
- Improved interaction between the police and people with serious mental illness at times of crisis
- Improved post-arrest pre-trial procedures emphasizing diversion from jail through bail reform and treatment alternatives to incarceration
- More rapid trials so as to reduce time in jail without being found guilty of a crime
- Greater use of mental health, substance abuse, and veterans’ courts
- Community-based alternatives to incarceration in high-security prisons such as half-way houses designed for people with serious mental illness
- Elimination of inhumane elements of incarceration such as solitary confinement
- Training for prison personnel regarding interactions with prisoners with serious mental illness
- Enhanced mental health services, including psychiatric rehabilitation, in jails and prisons
- Improvements of discharge planning and post-release services including eligibility for Medicaid or Medicare immediately after release
In addition, criminal justice reform must address issues of racial discrimination that affect people with serious mental illness as well as those without mental disorders.
Obviously, the First Step Act does not address many of these important components of criminal justice reform for people with serious mental illness.
The federal Substance Abuse and Mental Health Services Administration (SAMHSA), however, has gone a bit further by including an effort to address criminal justice issues in its strategic plan. It calls for “increased opportunities for diversion and improved care” for people with serious mental illness (SMI) involved in the criminal justice system.
SAMHSA’s program includes:
- Reducing incidence and duration of incarceration
- Providing education and training to first responders, courts, jails, prisons, and parole officers on how to work with individuals who have SMI
- Promoting therapeutic justice dockets in federal, state, and local courts for individuals living with SMI
- Improving information sharing among justice, mental health, and others to promote coordinated service delivery
A bit better than the provisions of the Last Step Act alone, but it still leaves much to be accomplished.
Of course, the vast majority of people with mental illness in jails or prisons or otherwise involved with the criminal justice system are involved not at the federal but at the state or local level. Can the federal government be expected to have more impact there?
We think so. We think that the federal government can play a far greater leadership role and that it can provide more financial incentives to the states, with grants for model initiatives and by including criminal justice reform among the requirements for federal block grants and federal financial participation in Medicaid.
This would include models for:
- Police interaction
- Bail reform
- Diversion programs
- Alternatives to incarceration in high-security settings
- Mental health services, including psychiatric rehabilitation, in jails and prisons
- Alternatives to solitary confinement
- Release plans
- Eligibility for health and mental health services and for income supports immediately upon release
There is so much that the federal government could do to improve the criminal justice system’s response to people with serious mental illness. Let’s hope that the First Step Act lives up to its title and is just a first step in the right direction.