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What defines a behavioral healthcare facility?

May 13, 2014
by Charlene Marietti
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Charlene Marietti

Between lawmakers who back policies and funding cuts that fuel homelessness and incarceration and advocates who promote approaches that don't criminalize or stigmatize are the mentally ill. Most at risk are those who are untreated. Many of them are homeless. Many more are incarcerated.

The Arlington, Va.-based Treatment Advocacy Center estimates that people with untreated mental disorders comprise about 16 percent of the total jail and prison population. A survey by that group and the National Sheriffs’ Association, also in Arlington, Va., found more mentally ill people in jails and prisons than in hospitals. Ten times more. In jails, nearly two in three jail inmates have some kind of mental illness.

Replacing long-term psychiatric facilities, the current correctional system is a ‘de facto’ holding tank for the mentally ill.

Recently, one project submitted to the Behavioral Healthcare Showcase competition generated a lively discussion. It is the Rankin Inlet Healing Facility in Rankin Inlet, Nunavut, Canada and it is a correctional facility for men. The crux of the debate was, ‘Does a healing facility qualify as a behavioral healthcare facility?’ Some maintained that since no mental health services were provided (or at least mentioned in the submission), it did not qualify.

But there was total agreement that the project demonstrated an innovative, holistic and community-based approach to care delivery.

The project submitters explained their goals and mission for the new structure like this:

“Contrary to the current North American preference for deterrence and incapacitation, the Government of Nunavut is committed to a restorative system based on an Inuit understanding of justice, which allows communities to take greater responsibility for offenders and victims. Emphasis is placed on healing and relapse prevention so that the offender may be received back into society.”

Rankin Inlet is a clear departure from the traditional care settings that are most familiar. But the question remains, ‘Does it qualify as a behavioral healthcare provider?’

At every mental healthcare facility I ever worked with, the goal was healing—healing the mind. The process typically involved therapeutic interaction, often in conjunction with medication, and success was defined as enabling clients to reenter the community as productive individuals.

If Rankin Inlet’s emphasis is on healing and relapse prevention, there is only one difference: The men are confined. (And no-shows probably aren’t a big problem for caregivers.)

So the question comes down to this: Does the setting make a difference?

Probably not. To date, we haven’t done a very good job of promoting recovery for people with mental illness here in the U.S.  There exist good alternative models in the U.S. Unfortunately, they are neither widely available nor supported by traditional payment systems.

Can we envision and build places for healing that nurture and rehabilitate? A recent proposal for a Ohio jail includes a community treatment plan for inmates with mentally illness and/or substance abuse disorders suggests we can. But the next challenge is even bigger: Do we have the will to support and fund such projects?

Click here to view the Rankin Inlet facility on pages 13 and 14.