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

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:

• Crisis Services. An effective crisis response system can play a pivotal role in diverting people from jail into treatment and rehabilitation. Some key features include peer-operated warm lines for crisis calls; crisis intervention training for county and city policy (usually called CIT); a 24-hour restoration center or service for diversion; and an effective hand-off process for continuing care and support.
• Care Coordination. An effective county behavioral healthcare coordination system that extends into county courts, county jails, and the local probation and parole system can reduce recidivism and divert persons from entering jail initially.
• Electronic Health Records (EHRs) and Electronic Referral Systems. Good EHRs will help to determine whether consumers actually are receiving needed treatment and support on a continuing basis. Electronic referral systems can be used divert persons in crisis into needed treatment and rehabilitation, and they also can be used to reconnect persons with services when they are released from jail.
• Housing, Job, and Social Supports. Many persons who enter our county and city jails are homeless or near homeless, without jobs or good job skills, and without any social support networks. Thus, these services must be considered part of the care package many persons need from county behavioral healthcare programs.
• Peer Support Services. Peer support is an essential feature at each point in this reformed behavioral healthcare system. Major nodes for peer support include initial crisis response, care coordination, court determinations, and emergency rooms and jails.

NACBHDD is very grateful to our corporate partners for joining us in providing essential resources for this unique effort. They include: Alkermes, Centene, Johnson and Johnson, Optum, Otsuka, and Takeda-Lundbeck. In addition, our affiliate, the National Association for Rural Mental Health will join this endeavor.

I am reminded that Pope Francis deliberately sought out an opportunity to meet with prisoners at a Philadelphia jail while he was in the United States. There is a very important lesson for all of us in his gesture.