This year, the president, the congress, state governments, counties, cities, and the courts are aligned in one direction. They all recognize that we need to reform our current practices related to jail and prison incarceration. Every day, fully 1% of the U.S. population actually is incarcerated, and up to 4% is either incarcerated, on home arrest, or on probation or parole. In comparative terms, more Americans are enmeshed in our penal system than are the citizens of any other major country.
Even more unsettling is the fact that the vast majority of those incarcerated in our jails and prisons have either a mental health or substance use condition. In county and local jails, more that 25% of those being held have a mental health condition, and an additional 50% have a substance use condition, with considerable overlap between the two groups. In state and federal prisons, more than half of those incarcerated suffer for these conditions. Clearly, the vast majority of these persons should never have become incarcerated in the first place.
The primary question is what needs to be done to change this very tragic situation?
Just a few months ago, I suggested that our outrage at this obvious injustice can drive a decarceration movement. I also suggested at that time that we must have a simple national action plan, and that we must have a practical goal.
I want to reiterate that goal here:
We must decarcerate at least 25% of those with mental or substance use conditions from our county and city jails by 2020.
Implementation of this goal through a simple, national action plan can be a decisive positive force for much needed change. The goal specifies “what” and “when.” The national action plan will define “how.” We also need to define “who” and “why.”
County governments already are taking up this challenge through the National Association of Counties-Council of State Governments Stepping Up Initiative. This initiative has the clear goal of reducing the prevalence of persons with mental illness and substance use in our county jails. The National Association of County Behavioral Health and Developmental Disability Directors has created a related effort, the Decarceration Initiative, to improve county behavioral healthcare operations to prevent incarceration of persons with mental illness and substance use conditions. Although both of these efforts are crucial, further mobilization of the “who” will be essential if we are to achieve the goal of 25% decarceration by 2020.
The Accountable Communities for Health (ACH) model can provide a framework to achieve this necessary mobilization. Originally designed for population health improvement, the ACH model seeks to mobilize the collective efforts of a broad array of key community stakeholders. These include healthcare entities, correction entities, other governmental units, and community- and faith-based organizations. These organizations unite in a common effort through separate programs that operate in parallel. The success of this approach has been demonstrated previously in other areas, including tobacco cessation.