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NACBHDD’s initiative to decarcerate persons with mental illness and SUD

October 5, 2015
by Ron Manderscheid, PhD
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Many causes underlie the very rapid growth in the number of individuals in our county and city jails who suffer from mental illness and substance use conditions. Among these factors, one can include:

  • The failed deinstitutionalization process of the past 60 years;
  • The dramatically inadequate deployment of resources into our community behavioral healthcare programs in the past 35 years;
  • An unsuccessful national policy of punishment rather than treatment for substance use conditions during the past 45 years; and
  • An ongoing economic system that rewards excess profits at the expense of workers, particularly those who cling to their livelihoods at the sharp edges of poverty.

This picture is quite stark. Its consequences are very predictable.

Tonight, our county and city jails will house almost 750,000 persons. Among these, fully 25% will have a mental health condition, with 15% suffering severe symptoms. Fully 50% more will have a substance use condition. In both groups, a large number will suffer from both. Thus, together, the two groups will account for about 75% of all persons incarcerated in our jails.

Clearly, our society must do much better. Unwinding this complex problem will be a complicated endeavor. Key strands will include:

  • Reform substance use laws to reduce penalties for first and second drug offenses. California already has done this.
  • Reform our national Medicaid practices so that benefits are not discontinued upon incarceration.
  • Institute and improve mental health and drug courts that can divert people with these conditions into treatment rather than jail.
  • Reform our county behavioral healthcare system so that appropriate crisis and continuing treatment and support services are available to care for persons with these disabilities before they arrive at the door of the jail.

Last week, NACBHDD was exceptionally pleased to unveil a new initiative to work with county behavioral healthcare programs to develop and implement these needed services. The initiative will include individual and group consultations, training webinars, and showcasing of best practices already in place in county programs. You can learn more about the initiative here.

The following service areas will receive particular attention in this initiative:



Ron Manderscheid

Exec. Dir., NACBHDD and NARMH

Ron Manderscheid


Ron Manderscheid, Ph.D., serves as the Executive Director of the National Association of County...

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