The federally ordered massive closure of mental health institutions and movement to de-institutionalize the system in the 1970s ultimately resulted in a disservice to the mentally ill incarcerated and fracture of the correctional system.
Recent statistics reflect about 56 percent of the incarcerated population suffers from mental health disorders. Further, 68 percent of the incarcerated population at the local jail level have substance abuse disorders. Among the incarcerated population in both state and jail facilities, about 75 percent have co-occurring mental health and addiction disorders. This equates to nearly seven million Americans who are under correctional or other justice system supervision (e.g. probation or parole).
From a treatment perspective, the arrest and subsequent crisis thereafter actually hold the potential of having a positive outcome in an arrestee’s life. Because an arrest is such a significant and typically shocking experience for the offender, it can be difficult to deny substance abuse or the effects of a criminal lifestyle. An arrest may open the door for an individual to voluntarily seek and find substance abuse and mental health treatment.
Alternatives to incarceration
For an arrested individual, the pretrial services stage may offer treatment as a part of court proceedings. Diversion to treatment can occur at several points before incarceration. Unfortunately, not all jurisdictions have established programs for those who are substance addicted. This can be a big disservice for an arrested individual. It appears that treatment through diversion or alternative sentencing options remain a low priority in some criminal justice systems across the U.S. Even though it may reduce jail populations, outside of formal drug court or diversion programs, programming access is still limited. For those jurisdictions that offer alternative sentencing options, a common condition upon release from custody is a mandatory participation in some form of treatment which is then monitored through a pre-trial or probation department.
Co-occurring complications
Many incarcerated individuals with co-occurring addiction and mental illness don’t respond well to traditional interventions. The co-occurring problems are too complex and require a more specific level of individualized care and treatment which may require a multi-faceted approach.
Defendants can sometimes experience significant cognitive and emotional disruptions as a result of their arrest which can make them difficult to engage with. This disruption can influence a counselor’s ability to get the defendant’s willing collaboration for treatment. For others, the arrest is so stressful and destabilizing that the disposition of their case leaves them less receptive to treatment options, and sometimes the incident of arrest can serve as exceptional motivation to participate in an alternative sentencing program.
Collaborative and effective
On many levels, the modern justice system offers broad based, collaborative, holistic interventions along with the appropriate justice supervision. In many communities, program resources include public health features in addition to treatment of addiction and mental health services. The offered resources can even fall under the umbrella of the Federal Affordable Care Act and align with requirements for mental health treatment and medical services under the insurance plans.
For non-violent offenders, with alcohol or drug related addiction problems, jail diversion and alternative sentencing programs can be an effective substitute for in-custody jail sentencing. Alternative sentencing and diversion programs may allow a non-violent offender to keep a job, support his or her families, avoid the negative influences of the jail setting, avoid the trauma of incarceration and address the underlying issues of substance abuse while getting the necessary mental health treatment.
When I spoke to Erin McNish, a retired law enforcement officer and now a career therapist, she expressed her firm belief in the potential for effectiveness of alternative sentencing and diversion programs. After spending two years working with the incarcerated population, McNish believes specific variables must be included in order for the offender to succeed in programming and eventually at home.
McNish said the duration of programming for most offenders with co-occurring mental health and addiction issues is simply not long enough.
“They need a significant long term stay in order to address PTSD which is usually an underlying disorder,” McNish explained. “Substance abuse and mental health needs are finally catching up to each other.”
If the programming holds the offender accountable, offers job and life skills and includes individualized mental health treatment, then McNish believes the offender has a good chance for success.
Because offenders with co-occurring disorders do not respond well to traditional alternative sentence programming, integrated treatment is believed to be more effective. Statistics reflected an improvement with treatment lasting 18 months or longer.
Programming options
Varied program design options can support the offender and offer a chance of increased success when treating co-occurring mental health and addiction problems.
Day reporting centers supervise detainees who are awaiting trial. The centers also assure appearance in court. When offenders are mandated to report as ordered and are held accountable each day, they are more likely to engage in substance abuse treatment.
Court imposed sanctions for the offenders’ failure to follow court ordered directives, such as participation in treatment activities, can magnify the positive impact of programs. Should the offender fail to complete required tasks, restitution may be imposed in the form of victim impact meetings. The victim impact meetings demonstrate to the offender how their drug related activities affect their community.
Specific curfews and house arrest can be enforced by means of an electronic monitoring device. Holding the offender accountable for his or her whereabouts, including attendance in treatment, work or at home can provide safe boundaries, support and ensure success in program completion.
Examples
Facilities across the U.S. are attempting to bridge the gap between mental health and addiction treatment in an attempt to keep offenders out of custody.
In Oregon, a specific program offers a multidisciplinary approach to the incarcerated mentally ill and addicted offenders which may be especially beneficial. Although not specifically focused on detox, once the offender is off drugs and alcohol and able to be released safely, the program offers vocational training, job readiness assessment and preparation, an employer liaison, literacy assessment, anger management, HIV education, criminal thinking assessment and treatment. Additionally, the program can provide assistance to the offender in accessing state or federal entitlements such as Medicaid and food stamps.
A Chicago day reporting center supervises offenders prior to their pretrial appearance and assists with early substance abuse needs. The specific program offers a mandatory 15-day orientation which includes an individualized assessment and suitability to specific program tracks.
A California jail facility is in the early phases of creating an in house alternative sentencing option. Oriented to a small population, the programming is to include classes focused on job skills, interview skills, leadership skills, housing options, anger management and mental health counseling.
In the past, the mental health treatment community and criminal justice system worked independent of one another. The time has come for the two entities to collaborate. Although the variables are great and statistics cannot confirm efficacy, long term alternative sentencing and diversion programs offering whole life skills and individualized mental health counseling to low risk offenders may provide the hope of reducing recidivism rates and the incarcerated population in the U.S.
