Proposal to Correct the Institutional Injustices for Mental Illness and Addictions Patients

Proposal To Correct The Institutional Injustices For Mental Illness And Addictions Patients

Over the past 50 years we have gone from institutionalizing people with mental illnesses, often in subhuman conditions, to incarcerating them at unprecedented and appalling rates – putting recovery out of reach for millions of Americans. These people are not all the same. They are a heterogeneous group.

>> A small subgroup does resemble the State hospital patients of yesteryear, and their presence in our jails/prisons is one of the most egregious and disturbing images related to our failed systems of care. The availability of intensive care models, including hospital care for some, is critical.

>> Many other citizens with mental illnesses in our jails have less disabling conditions and with access to appropriate community treatment and support, will do quite well.

>> A third subgroup includes people with mental illnesses who have traits that are associated with high arrest and recidivism rates. These individuals would be best served with good treatment and supports, which include interventions targeted to their dynamic risk factors for arrest.

As we attempt to respond to the needs of these people and respect the legitimate public safety concerns of all community members, conditions in these correctional settings, which are designed for detention and not therapeutic purposes, are often far worse than conditions described in the State hospitals of the 1940s. Moreover, when justice-involved persons with co-occurring disorders leave correctional institutions, they repeatedly are left adrift only to recycle through the criminal justice system. Furthermore, individuals who become involved in the justice system often must contend with the additional stigma of criminal records, which make access to basic needs in the community, such as housing, education, and employment, even more difficult to obtain.

The ability to effectively design, implement, and reimburse treatment providers for delivering high quality services targeting specialized treatment needs is critical to establishing an effective community- based system of care for people who experience serious mental illnesses. In the absence of what are now seen as essential services for people with mental illnesses living in the community, people will continue to be forced into more costly, deep-end services in hospitals, crisis centers, emergency rooms, and the justice system.

The result is a recycling of individuals between jails, prisons, shelters, short-term hospitalizations, and homelessness – with public health, public safety, and public administration implications that are staggering. Now more than ever, as we strive to provide health care to our most vulnerable citizens, we must address this serious public health and public safety crisis. It is high time to be open and honest about the deplorable conditions that exist and take steps to address them. Below is a proposed solution in the form of a 2 phase plan.

Phase 1:

>> Forensic Intensive Case Management
>> Supportive Housing
>> Peer Support
>> Accessible and Appropriate Medication

These four services are the ones we believe are minimally necessary to break the cycle of illness, arrest and incarceration, and recidivism. We believe these services – described in brief below – can be implemented quickly, cost-effectively, and with positive results. However, these services can only be effective if the programs that provide them are structured and staffed by people who understand and are prepared to address trauma as a risk factor for both mental health problems and criminal justice involvement. A trauma-informed system that features trauma-specific interventions can help ensure public health and public safety and transform individuals’ lives.

Forensic Intensive Case Management (FICM) is designed for justice-involved people with multiple and complex needs and features services provided when and where they are needed. FICM focuses on brokering rather than providing services directly, making it less expensive than ACT. For a brokered service model to be effective, communities must have adequate and accessible services to which individuals can be linked. What makes these services “forensic” is “criminal justice savvy,” that is, providers understand the criminal justice system and the predicaments of their clients involvement in it.

Supportive Housing for mental illness patients is permanent, affordable housing linked to a broad range of supportive services, including treatment for mental and substance use disorders. Supportive housing can significantly decrease the chance of recidivism to jails and prisons and is less costly on a daily basis than jail

Pages: 1 2