Post on 26-Mar-2015
DeCriminalizing Mental Illness in 2007
Is the Glass Half Full or Half Empty?
Ron Honberg, Director of Policy and Legal Affairs, NAMI-National
NAMI-NC Institute On Decriminalizing Mental Illness
The National Stats
• Approximately 2,300,000 people incarcerated in jails and prisons at year end 2005.
• 16% of all jail and prison inmates suffer from serious mental illness (conservative estimate).– 368,000 people
• Approximately 550,000 people with serious mental illness on parole or probation.
• By contrast, approximately 70,000 people in hospitals at any given time– In many states, most of these are forensic patients.
. . . jails and prisons have become the new “psychiatric hospitals”
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Hospitals Jails & Prisons Homeless
High Costs of Incarceration
• Inmates with severe mental illnesses (SMI) cost more per day to incarcerate.
• E.g. Pa. Dept. of Corrections:– Average per diem cost of incarceration,
inmates with SMI - $140 per day.– Average per diem cost of incarceration, all
inmates - $80 per day.unpublished statistic provided to CJ/MH Consensus Project by John Shaffer, Pa. Department of Corrections.
Longer Incarceration
• Riker’s Island (NYC)– Average length of incarceration:
• All inmates = 42 days• Inmates with SMI = 215 days
• Pennsylvania Prisons– Inmates with SMI three times more likely
to serve maximum sentences.www.consensusproject.org
Spending Money in All the Wrong Places!
• Florida spends roughly a quarter of a billion dollars annually to treat 1,700 individuals under forensic commitments.
• Purpose of this treatment is to restore competency to stand trial, not to help people recover.
• Federal Medicaid dollars can’t be used for services provided in correctional settings or forensic hospitals.
• Denying services until people are in crisis is a “penny wise, pound foolish” strategy!
Florida Supreme Court, “Constructing a Comprehensive and Competent Criminal Justice/Mental Health/Substance Abuse Treatment System”, November, 2007, http://www.floridasupremecourt.org/pub_info/documents/11-14-2007_Mental_Health_Report.pdf
How Did We Get Here?
• Insurance disparities, managed care, and state cuts have made problems worse.
• Treatment is frequently unavailable until a crisis occurs.• Care often is terminated after crisis, with no continuity or
coordination between inpatient and outpatient.• Police relied upon as front line crisis responders• Inadequate hospital beds for people requiring inpatient
treatment• Treatment non-compliance• Punitive society (retribution favored over rehabilitation)
Innovations from the Criminal Justice Field
• Collaborative efforts have led to progress on jail diversion and reentry.
• Hundreds of CIT programs throughout the country. • At least 150 Mental Health Courts, plus other Court-
based diversion models.• Growing focus on reentry, e.g. Forensic-ACT, expedited
restoration of benefits, etc.• Initiatives to improve treatment of individuals with SMI
who are incarcerated, including correctional training in Indiana and legislation to improve conditions of confinement in NY.
Does Jail Diversion Work?
• Does It Save Money?
• Does it Reduce Crime?
• Does it Help the People Intended to Benefit?
Jail/Hospital costs per person
Program # of
Partici-pants
PRIOR to involvement
DURING involvement (plus
program cost)
Cost savings per person
Thresholds Jail
Program (Cook
County, IL)
30 (two years)
$53, 897 $35,024 $18,873
Project Link (Monroe County,
NY)
44 (one year)
$73,878 $34,360 $39,518
Source: Criminal Justice Mental Health Consensus Project
Cost Savings
Three County Data (Annualized)
12 Months Prior
to Enrollment Since
Enrollment
Days Homeless 205,992 63,764
Days Incarcerated 60,438 9,287
Days Hospitalized 10,906 2,435
Source – National GAINS Center
California’s AB 2034 Program
Allegheny (Pa) Mental Health Court
• First independent cost-benefit analysis.• Increase in mental health service costs (primarily Medicaid) virtually
offset by decrease in jail costs.– State/local costs probably less since significant proportion of
Medicaid funding is federal.• Over two years, significant reductions in criminal recidivism and
hospitalizations.• No evidence of increased public safety risks.
Rand Corporation, “Justice, Treatment and Cost: An Evaluation of the Fiscal Impact of the Allegheny County Mental Health Court”, 3/1/2007, http://www.rand.org/pubs/technical_reports/2007/RAND_TR439.pdf
The True Solution Lies In More And Better Mental Health Services
• Evidence based practices, including:– ACT– Integrated mental health/substance abuse treatment.– Supported Employment– Supportive Housing
• Peer services and supports• Acute care beds and/or crisis stabilization
services• As last resort, court ordered inpatient or
outpatient treatment
The National average is a D.• Five states received B’s.• Seventeen states received C’s • Nineteen states received D’s (North
Carolina got a D+)• Eight states received F’s.• Two states received U’s.
Grading the States
North Carolina - Positives• CIT programs are being implemented throughout
the state. • Health insurance parity law passed! • Growing interest in supportive housing (“Housing
400” initiative).• Strong mental health coalition.• New MH leadership, dedicated oversight
committee in legislature.• Alternative to hospitalization programs being
implemented in 4 sites.
North Carolina - Needs
• Although state has increased MH funding, overall spending is still inadequate.– State ranked 43rd in per capita MH spending in 2006
• Historically, state resources have been spent disproportionately on institutional care, not community services.
• Ongoing concerns about conditions in hospitals.• State needs to invest more resources in
evidence based practices, including ACT and Multi-Systemic Therapy (MST).
Financial Resources
• Criminal Justice/Mental Health Collaboration grants (U.S. Dept. of Justice – www.ojp.usdoj.gov/BJA)
– $5 million in FY 2007, $10 million in FY 2008• SAMHSA jail diversion grants (www.samhsa.gov).• Byrne Memorial State and Local Law Enforcement
Assistance Grant Program (http://www.ojp.usdoj.gov/BJA/grant/byrne.html).
• More states (e.g. Georgia, Louisiana, Kentucky, Florida, Maine) providing grants for CIT and jail diversion.– Recognition that it is a cost-effective approach.
Websites and Resources• Criminal Justice/Mental Health Consensus Project
– www.consensusproject.org• National GAINS Center
– http://www.gainscenter.samhsa.gov/html/• U.S. Department of Justice, Bureau of Justice
Assistance (Mentally Ill Offender Treatment and Crime Reduction Act, etc.)– http://www.ojp.usdoj.gov/BJA/
• NAMI website, www.nami.org, sections on:– “Criminalization” – “CIT Action Center”