“At least half a million Americans in prison today wouldn't be there if they had instead been ordered to treatment for their substance use or mental health problem,” says Pamela Rodriguez, president of Treatment Alternatives for Safe Communities (TASC), a statewide Illinois organization that advocates for alternatives to incarceration for non-violent offenders (NVOs). That figure doesn't count those detained in the state's county jails, many of whom are awaiting sentencing.
In Illinois, one out of four people incarcerated every year could have been diverted to substance use treatment instead, according to the TASC Center for Health and Justice. Of the 40,000 individuals admitted to the Illinois Department of Corrections, 20,000 are non-violent property or drug crime offenders, and half of these meet the criteria for substance use or dependence. The costs of incarceration are $25,000 a year.
The American Psychiatric Association (APA) estimated in 2000 that 20 percent of people in prisons and jails have a serious mental illness. One of the main reasons is deinstitutionalization-with nothing in the community to take the place of hospitals.
There were half a million people in psychiatric hospitals in this country in 1955, according to Judge Steven Leifman, associative administrative judge in Miami-Dade County and chair of the Task Force on Substance Abuse and Mental Health Issues in the Courts for the Florida Supreme Court. Now, he says that just 40,000 psychiatric hospital beds are now available and instead, there are 550,000 people in prison and jails who have a mental illness.
Leifman is a nationally known proponent of treatment instead of incarceration for people with serious mental illness, and an eloquent spokesman for diversion away from the criminal justice system to treatment. He puts it plainly: “Most of these people aren't criminals.”
Using incarceration as a substitute for treatment is not only ineffective, but also harmful and wasteful, says Leifman, noting that it is best to intervene in the justice process early, even before a suspect goes to booking, to jail, or in many cases, to a local hospital's emergency department.
But, the key to getting people diverted into treatment instead of a local jail or prison is not found with local mental health or substance treatment providers. Instead, it is with local police, who are normally the first responders for individuals who may be experiencing a psychiatric crisis.
Rodriguez of TASC agrees, saying that more and more localities are creating and using Crisis Intervention Teams (CITs), which include specially trained police officers and often, local behavioral health professionals. Traditionally, these teams have focused primarily on people in the community with serious mental illnesses. But because of their success as a front-end element of a larger jail diversion process that better manages non-violent offenders, the use of incarceration, and rates of recidivism, such teams are expanding their scope to include individuals with suspected substance use problems.
“CIT is so successful on so many levels that I don't know where to begin,” says Leifman. During the first six months of 2011, the Miami-Dade County police department handled just over 2,300 mental health calls. After screening, CIT officers were sent out and 750 people were diverted to community-based crisis units. Out of the 2,300 total 911 calls made, just one required an arrest. The CIT training in Miami-Dade County is a 40-hour program. Local 911 dispatchers are also trained in CI so that they can screen incoming calls.
CIT also plays an important role in the lives of veterans returning from Iraq and Afghanistan who have severe PTSD issues, says Leifman, who chairs Partners in Crisis. This group that promotes state and community collaborations that can reduce contact between people with mental health and substance use disorders with the criminal justice system.
“We are alerting officers that if someone is speeding, for example, it may be a vet in a huge crisis,” he says. “We do our best to get them into treatment and recovery.”
Sometimes, the client is arrested and the CITs can intervene at that point, says Leifman. “We also work post-arrest with people in jail for misdemeanors,” he says. Within 48 hours, the clients are out of jail and in a crisis stabilization unit. “If they go into our program, the state attorney will generally drop the charges,” he says. “We have a written agreement with six of our public providers to take those who were in jail.” After assessment by a social worker, a provider is called and the client proceeds directly to treatment without the need for booking. The recidivism rate for offenders treated through this approach is just 20 percent, says Leifman.
Mental health courts are also invaluable, says Rodriguez. In Illinois, people referred to mental health court are there voluntarily. A clinical social worker in the Cook County jail assesses and identifies referral candidates. The only requirements for such referrals are that the clients be receiving Medicaid or SSI and that their offenses be among those eligible for diversion to the community. According to Rodriguez, some 90 percent of diversion candidates are found to have co-occurring mental illness and substance use disorders.
Building relationships that respond to crisis
Behavioral healthcare professionals work with the police officers on the training, said Rodriguez. This cross-training means the advocacy community, consumers, and service delivery professionals are all involved, and can develop relationships with the police as they work on problems. Typically, there will be a 24-hour crisis center where police can bring people they have assessed to need help-instead of to a jail or emergency department.