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

or prison. Unfortunately, affordable housing is in short supply in many communities, and ex-offenders with drug-related offenses often have trouble securing public housing assistance. Housing for ex-offenders must balance the needs for supervision and the provision of social services.

Peer Support services can expand the continuum of services available to people with mental and substance use disorders and may help them engage in treatment. Forensic peer specialists bring real-world experience with multiple service systems and an ability to relate one-on-one to people struggling to reclaim their lives. The practice of consumer-driven care – as exemplified by the involvement of mental health consumers in service design, delivery, and evaluation – is at the heart of a transformed mental health system.

Accessible and Appropriate Medication supports continuity of care for individuals with mental illnesses whose treatment often is disrupted when they become involved in the criminal justice system. They may not receive appropriate medication in jail or prison or adequate follow-up when they return to the community. It is imperative that people with mental illnesses and co-occurring substance use disorders have access to the right medication at the right dosage for their condition, as determined by the individual together with his or her clinician.

Phase 2:

Clearly, the Phase 1 services are necessary, but not sufficient. Services that support the Essential System of Care include several evidence-based practices for people with serious mental illnesses. These services may be more expensive or difficult to implement than the four listed above, but we encourage States and communities to move toward development of these services by codifying them in policy, supporting them in practice, and rewarding their implementation.

Phase 2 services include:

>> Integrated Dual Diagnosis Treatment, which provides treatment for mental and substance use disorders simultaneously and in the same setting

>> Supported Employment, which is an evidence-based practice that helps individuals with mental illnesses find, get, and keep competitive work

>> Assertive Community Treatment (ACT)/ Forensic Assertive Community Treatment (FACT), which is a service delivery model in which treatment is provided by a team of professionals, with services determined by an individual’s needs for as long as required, and

>> Cognitive Behavioral Interventions Targeted to Risk Factors specific to offending, are a set of interventions, well researched within both institutional settings and community settings, which have a utility when extended to community treatment programs.

This list of evidence-based and promising practices is illustrative but not exhaustive. Clearly, however, there is much that can be done to help people with mental and substance use disorders avoid arrest and incarceration and return successfully to their communities after jail or prison. We acknowledge that in difficult financial times, new dollars may not be available. However, though new money is not always required for systems change, new ways of thinking are.

To meet the public health and public safety needs of our communities demands a fully collaborative campaign involving both the behavioral health and criminal justice systems. Neither system can continue business as usual. The criminal justice system needs to do an adequate job of screening, assessing, and individualizing responses to detainees and inmates identified with mental illness. The behavioral health system needs to refine and deliver evidence-based practices with an awareness of its responsibility to not only improve the quality of life of its clients, but to address interventions to factors associated with criminal recidivism in these clients and to more directly involve clients as partners in a recovery process that recognizes the community’s public safety concerns.

We must move toward a day when people with mental and substance use disorders receive the effective community-based interventions they need and deserve, and jails and prisons no longer are forced to serve as primary, de facto treatment facilities. We know what works to address successfully the needs of people with mental and substance use disorders who come in contact with the criminal justice system; now we have to DO what works. The time for action is now!

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