Mental Illness and Criminal Justice: Questions and Answers

Some people view our country's jails and penitentiaries as this century's new "mental asylums." This is because, rather than treating the mental illnesses and addiction disorders, we remand convicted mental health patients to prisons and penitentiaries for their crimes. Often times these crimes are the result of mental health patients who are not receiving the treatment and medicine they need in the first place. Sending them to prisons unprepared to handle their special needs only makes a growing problem worse. Below are some general questions - and answers - that arise when discussing the issue of mental illness and criminal justice.

What challenges exist in serving justice for people with mental illness and addiction disorders?

There are many challenges in connecting justice with mental health services. The individuals in question are usually people with little money or power and they may have little or no interest in mental health or addictions treatment services. They've not found services useful or relevant and often dislike programs that are highly structured. It is the job of national mental health organizations to identify member organizations in these individuals' communities that have developed successful services for this population and then to facilitate the member to member spread of these programs.

Some states, including New York, have assisted outpatient treatment laws - why is there controversy behind such laws?

Some view these laws as victimizing - or blaming - people with mental illness. In a perfect world, court ordered treatment would be unnecessary but in our world the combined power of the court and treatment can mean successful community living for consumers that would otherwise be in and out of hospital or jail. Assisted outpatient treatment must be carefully used but when all else fails it can connect people to vital services. But assisted outpatient treatment alone isn't enough - a full array of community services including housing, effective treatments, work supports, and general medical care must be available and accessible. Unfortunately, passage of assisted outpatient treatment laws and regulations is often a political reaction to an unfortunate incident. In other words, a law is passed, but with no financing of the services that are critical to keeping both individuals with mental illnesses and our communities safe.

What benefits do "mental health courts" bring to providers and the individuals they serve? Do they help address the issue at hand?

Mental health courts - and, to an even greater extent, drug courts - emerge as a powerful means through which people are able to access mental health care. In many places the court begins with a judge who has personal and/or professional interest in behavioral health issues. However, mental health and drug courts aren't meant to be applied broadly - these courts are alternatives for people with serious mental illnesses and addictions that are on the way to jail or prison. And like assisted outpatient treatment, there must be seamless connections to the full continuum of treatment and support services. These problem-solving courts give individuals with serious behavioral health disorders a unique opportunity to engage with a judge around their needs. The courts provide alternatives to people with mental illnesses and addiction - offering services instead of time behind bars.

How can states move forward in creating programs for justice-involved persons in this era of budget cuts? What role do community providers play?

Unfortunately, it looks like we've reached a tipping point in regard to diversion and re-entry. Change is often incremental in our very complex world and policy change is often driven by a convergence of ideas and money. States are in tremendous economic distress and can't continue to build new jails and prisons or support growing numbers of incarcerated individuals. At the same time it's becoming clear that treatment and services works and are less expensive alternatives. Look at the recent budget proposals - growth in financing of alternatives to criminal justice involvement. This is an area where there is both new money and potential for re-investment of dollars currently directed to incarceration. And as always leadership is essential - excited by the possibilities; local leaders emerge, enlist others in their vision and the money follows.

How do people with mental illnesses "fall through the cracks? "

The falling through the cracks problem is not unique to justice-involved individuals. Every time we create a new program or service to keep people from falling through the cracks, we are creating another crack for someone else to fall through. The system has gotten so rich and so complicated - multiple programs and services, most under different corporate auspices and each with its unique rules and operating practices - that it's difficult to navigate it. A person's treatment is run by one organization, their housing by another, their employment supports by another - and getting all these organizations on the same page and at the same table becomes nearly impossible. It is very, very difficult to coordinate services for mental health patients.

What can be done to support coordinated treatment for mental illnesses?

In the end, we need a system where one organization/person is responsible. If everyone is responsible, then no one is responsible. The buck has to stop somewhere and most mental health experts think it needs to stop with an organization that gets an adequate pot of money and ensures that the consumer gets the services they need and want. With adequate financing, clarity as to what treatments and services are effective and the delivery of those interventions, use of health information technology, and the ongoing measurement of simple outcomes - hospitalization, incarceration and homelessness - we can coordinate care and go a long way toward supporting successful community tenure. That doesn't mean that all justice-involved people will have a straight trajectory to recovery. Some mental health patients will be hospitalized while some might still be incarcerated or become homeless. The bottom line is that we can do better, but challenges will remain. The job of mental health care in this country is to address the challenges, always exploring new approaches and refining our efforts to improve lives.