National Forum Highlights Substantial Progress in Improving Outcomes for Individuals with Mental Illness in the Criminal Justice System On March 15, 2013, the Bureau of Justice Assistance (BJA), the Substance Abuse and Mental Health Services Administration (SAMHSA), and the National Institute of Corrections (NIC) hosted leaders from the fields of criminal justice and behavioral health from 70 nonprofit, association, and advocacy organizations to discuss recent policy efforts to improve outcomes for people with mental illnesses involved in the criminal justice system. In particular, the forum was designed to explore the implications of a new framework for using information about individuals’criminogenic risk and behavioral health needs to promote public safety and recovery and prioritize scarce criminal justice and behavioral health resources. “This forum was an important milestone in coming together to articulate a shared approach to addressing an issue that affects state and local leaders across the country,” said BJA Director Denise O’Donnell. “We must continue to draw on the science of recidivism reduction and what works to address mental health and substance use disorders to ensure that the right people get the right integrated interventions at the right times.” Released by BJA, in collaboration with NIC, SAMHSA, and a number of national organizations, Adults with Behavioral Health Needs under Correctional Supervision: A Shared Framework (“the Framework”) brings together the latest science about treating people with mental health and substance abuse needs and the most current research about reducing recidivism into one integrated approach. Federal leaders are promoting the Framework to assist state and local criminal justice systems that often struggle to respond appropriately to individuals with mental health needs, many of whom also have a cooccurring substance use disorder. Researchers estimate that nearly 17 percent of people admitted to jail have serious mental illnesses—rates three times higher for men and six times higher for women than in the general population. Nearly 70 percent of adults in jails have a substance use disorder, and almost three-quarters of jail inmates with serious mental illnesses (72 percent) have co-occurring substance use disorders. Corrections personnel in many jurisdictions also find that individuals with mental health needs remain in jail for longer periods of time and that the health care services required to safely detain or incarcerate this population costs significantly more. Conference participants explored how jurisdictions could better address these alarming trends and translate the Framework’s principles into practice. They also discussed recent collaborative planning efforts to bring together courts, jail administrators, community corrections, law enforcement, behavioral health care administrators and treatment providers, family members, advocates for victims, and other community organizations. For instance, participants from New York City shared lessons learned from a recent groundbreaking collaborative planning effort in which the City’s Department of Correction, Department of Mental Health and Hygiene, and high-ranking city and state officials worked with analysts from the Council of State Governments Justice Center (CSG Justice Center) to identify policy options that could improve the City’s response to people with mental illnesses in its jail system. Stakeholders wanted to understand why the population with mental health needs in jail was growing, even as the jail population as a whole was declining. In 2011, people with a mental health diagnosis made up 33 percent of the average daily jail population, as opposed to 24 percent in 2005. The research revealed that despite similar case characteristics, people with mental illnesses were staying in jail considerably longer. Applying principles from the Framework, the CSG Justice Center analyzed the mental health needs, criminogenic risk, and risk of failure to appear in court for individuals admitted to the New York City Department of Correction and identified populations potentially appropriate for specialized pretrial, plea,
and sentencing options. In response, Mayor Bloomberg announced that the City would provide funding to create “Court-based Intervention and Resource Teams” in each borough to collect and quickly relay information on defendants’ mental health care needs, risk of flight, and risk of reoffense to defense counsel so that recommendations to the court and judicial decision making can be better informed. The goal of collecting this information is to ensure that people with mental illnesses are quickly connected to treatment and jail alternatives that will adequately address the risks and needs of this population. “Our jails are increasingly a place of last resort for offenders who are mentally ill,” said Dora Schriro, the New York City Department of Correction Commissioner. “Even as the department's total inmate population continues to fall, this group is unable to get out or stay out. This initiative strengthens our ability to better serve the hard to serve and in the process keeps all New Yorkers safer.” “This creative new initiative will inform us about which individuals in jail might benefit from supports and community treatment without jeopardizing public safety. This is an important step in the Health Department’s commitment to developing systemic approaches to reduce jail involvement for individuals with mental illnesses, particularly in light of new opportunities for improving the system of care that are becoming available under the Affordable Care Act and New York State Medicaid reforms,” said Dr. Adam Karpati, Executive Deputy Commissioner for Mental Hygiene, New York City Department of Health and Mental Hygiene. New York City was one of three sites where the CSG Justice Center analyzed the flow of individuals with mental illnesses through the criminal justice system. The CSG Justice Center conducted similar research projects in Hillsborough County, New Hampshire, and Johnson County, Kansas. “I’m confident that the process in New York will serve as a model for other jurisdictions—both big and small—in addressing the critical issue of better treatment for those who have mental illness who come in contact with the criminal justice system,” said Steven Canterbury, West Virginia Supreme Court Administrator and CSG Justice Center Board Member. “On face value, it might seem like New York City and West Virginia are two worlds apart; but we in the rural parts of the nation can learn vital lessons from New York City’s experience in putting the principles laid out in the Framework into practice.” The forum concluded with a substantive discussion of the implications of the Framework’s approach on the field more broadly from the perspectives of judges, prosecutors, defenders, consumers/families, and state and local policymakers. This event marks the start of what federal leaders hope will be an ongoing conversation about what it will take to make the Framework’s approach work in communities around the country. In the coming months, federal leaders will continue to work with forum participants and relevant criminal justice and behavioral health stakeholders to identify the necessary tools to continue translating the Framework’s principles into practice and share lessons learned. To access the full report, “Improving Outcomes for People with Mental Illnesses Involved with New York City's Criminal Court and Correction Systems,” please visit: consensusproject.org/jc_publications/improving-outcomes-nyc-criminal-justice-mental-health The Council of State Governments Justice Center is a national nonprofit organization that serves policymakers at the local, state, and federal levels from all branches of government. It provides practical, nonpartisan advice and evidence-based, consensus-driven strategies to increase public safety and strengthen communities. For more information, please visit: csgjusticecenter.org.