Consumers and the Criminal Justice System

On any given day the Los Angeles County Jail holds more people with mental illnesses than any state hospital or mental-health institution in the U.S.

The Criminal Justice/Mental Health Consensus Project Is A Watershed for Consumers and for Society

"People with mental illness are falling through the cracks of this country's social safety net and are landing in the criminal justice system at an alarming rate." So begins the 432-page report of the Criminal Justice/Mental Health Consensus Project. The report is aimed at addressing an egregious societal problem: Our country has been essentially transferring increasing numbers of consumers out of mental-health institutions and into the criminal justice system, instead of providing consumers with community-based treatment and reintegration programs. The U.S. Department of Justice reported in 1999 that about 16 percent of the population in prison or jail had a serious mental illness, compared with approximately 5 percent having a serious mental illness in the overall U.S. population.

Two years in the making, the Consensus Project report is serious about producing a real change. It advocates 46 policies to "improve the criminal justice system's response to people with mental illness." At least as important, the policy statements are backed up with practical recommendations and examples of successful programs that are actually underway. Released in June 2002, the landmark report and its continuing implementation are the work of a uniquely collaborative group-a consortium comprised of state governments, law enforcement agencies, courts, correctional facilities and mental-health organizations. The Project was initiated and co-chaired in a bipartisan spirit by Senator Robert Thompson, Republican, of Pennsylvania and Representative Michael Lawlor, Democrat, of Connecticut.

Significantly, consumers and crime victims were always present on the Project's four advisory boards that represent law enforcement, the courts, corrections and mental health. The consortium thus represents an unprecedented convergence of all the elements making up the diverse spectrum of the criminal justice and mental-health systems in our country.

The task the Consensus Project faced was daunting. "The problem we're addressing has been that mental health people look at treatment and recovery, while criminal justice people look at public safety," says Michael Thompson, one of the principal authors of the Consensus Project report who is Director of Criminal Justice Programs of the Council of State Governments. "The two views are distinct, but they aren't mutually exclusive. The Consensus Project's goal is to bring together the views of the mental health and criminal justice agencies and their associated individuals, see where there's overlap and have them all work collaboratively to improve the criminal justice system's response to people with mental illness."

SOCIETAL DYSFUNCTION

The numbers tell a story of societal dysfunction on a monumental scale. Rates of serious mental illness among the 10 million people booked into U.S. jails every year are at least three to four times higher than rates for serious mental illnesses in the general population. While some prisoners with mental illnesses may indeed have committed a violent crime to warrant their incarceration, millions have been jailed simply because they have done nothing more than display the behavior of untreated mental illnesses.

Everyone is familiar with the disheveled woman shouting obscenities in the street, or the apparently confused man found trespassing. Too often, these people are afflicted with serious untreated mental illnesses. They could wind up being put away in jails or prisons that aggravate their mental diseases and does nothing prepare them for reintegration upon release. They then have a criminal record, further hampering their reintegration efforts.

"It's not that a person with mental illness should never be involved in the criminal justice system; they should be responded to appropriately when they are there." Says Daniel Souweine of the Council of State Governments. "Andrea Yates, Jeffery Dahmer and Ted Bundy are the exceptions and not the real issue, though the media often leave people with the perception that they are. The fact is most people with mental illness aren't committing murder."

"The problem with our mental health system is that it's overwhelmed and can only focus on people who are completely debilitated," says Tom Lane, Director of the Office of Consumer Affairs at the National Alliance for the Mentally Ill (NAMI) who served as an advisor to the Project. "The situation is analogous to a medical hospital that refuses to treat someone with appendicitis until the appendix bursts. So we've inadvertently created a situation where a huge proportion of consumers are not getting the community-based treatment they need."

The result is that jails and prisons, never meant for severely mentally ill patients, are overflowing with people suffering from some form of mental illness. "On any given day," states the Consensus Project Report, "the Los Angeles County Jail holds more people with mental illness than any state hospital or mental health institution in the U.S."

TWO SCENARIOS

Here's the typical way the criminal justice system fails-throughout the country, every day of the year: Someone calls 911 to report a crime, say a violent episode in a convenience store. The police dispatcher who receives the call is untrained to inquire about the possible role of a mental illness. The dispatcher sends police, who are also untrained in mental illness, to the scene. They arrive and handle the accused as they would any potential criminal. They pay little or no attention to the fact that the accused has special mental-health-related needs. Further confounding the situation is the fact that the person with a severe mental illness may in fact have associated substance-abuse problems-three-fourths of consumers in jails and prisons do.

Regardless, the subject is booked into a jail and, if convicted, is sent to a state prison.

Both the jail and the prison worsen the prisoner's mental illness by providing inadequate treatment or no treatment at all. The consumer-prisoner is now exposed to extreme stress and threats at the hands of other prisoners who often target mentally ill people because of their relative defenselessness. When the person eventually is released, he or she is then further burdened with a criminal record.

Contrast that scenario with the same situation as it could play out if the Consensus Project's recommendations are followed: When the incident of violence in the convenience store is reported, a specially trained police dispatcher questions the caller about the possibility that the accused has a mental illness. The dispatcher then decides to call in a crisis intervention team made up of police trained to respond appropriately to people with mental illnesses. The police arrive at the scene and arrest the suspect in a way that doesn't exacerbate the situation.

From the squad car, they radio ahead to the jail to inform them that they're arriving with a suspect who may have a mental illness. The jail has a system already in place that screens all incoming prisoners for mental illnesses, but, upon receiving the heads-up from the police, they employ an even higher level of screening. The jail then shares its information with various agencies in the local mental-health system, including the suspect's mental-health caseworker. The caseworker is alerted, comes to the jail and confers with the police to ensure that the suspect gets the right treatment in jail.

When the case goes to court, confidential and appropriate information is shared with the prosecutor and judge who incorporate the caseworker's information into their decision-making. "We know the accused person has a mental illness, but we're still going to pursue conviction," may be their decision. But, if the person is sentenced to prison, there would be stringent screening similar to the jail's, and appropriate, longer-term treatment programs for the prisoner. Upon the person's release, he or she would be provided community support aimed, first of all, at recovery and, ultimately, full reintegration.

COLLABORATE, TRAIN, EVALUATE

"Collaboration and training are two key elements of this Project," says Thompson. "Add the additional element of a system for evaluation the effectiveness of our programs, and we fully expect to bring about fundamental improvements to our criminal justice and mental health systems."

The Consensus Project is now in the dissemination and implementation phase, developing a comprehensive Web site for facilitation inter-agency communication and evaluation. The Project is also developing an Advocacy Tool Kit to equip local stakeholders with the resources they need to effect meaningful change.

The currently dysfunctional system not only wastes lives, it wastes money. Adoption even some of the Consensus Project's recommendations could actually conserve scarce resources and deploy them more effectively.

"The severity of the fiscal situation state and county governments now face should give impetus for everyone to apply the lessons of the Consensus Project," says Thompson. "People should see this Consensus Project report as an opportunity. The criminal justice system can save money that can then be applied to the mental health system."

Bill Emmet of the National Association of State Mental Health Program Directors (NASMHPD) and an important contributor to the report is equally optimistic about the Project's promise. "This report is a blueprint for the kind of change that most consumers agree needs to be made," he says. "It outlines exactly how the mental health system and criminal justice system should interact. For consumers, it provides ways for them to participate and make sure things happen. Anyone who reads the report needs to mirror the consensus-building process of the report in their own community. Ultimately, most change will be local."

The Consensus Project reflects commitment and consensus among agencies that had traditionally been separated. The Project's report is an extraordinary resource that is already helping those involved in the criminal justice/mental health system take actions for positive change. It represents a historically important step forward for consumers and our society.

Courses:

Mental Illness: Signs, Symptoms, and Interventions

Victim Crisis Intervention

Pricing

Articles:

Deseret News Editorial: Mental-health Intervention Vital

PoliceOne News: Indiana Officers' Deaths Lead To Calls For Better Mental Health Services

ReintegrationToday: Consumers and the Criminal Justice System