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By Monica E. Oss

For the behavioral health field, the interface (or lack of interface) between the justice system, the social service system, and the health care system has been a major contributor to human misery, poor consumer outcomes, and high service costs in all systems. The headlines are all too familiar:

  1. In 44 States, Jails & Prisons Are The Largest Institution Housing People With Serious Mental Illness
  2. State Per-Inmate Spending On Prison Health Care Varies From $2,558 In Oklahoma, To $14,495 In California
  3. 76% Of State Prisoners Rearrested Within Five Years
  4. Depression & Schizophrenia Prevalence In Prison Populations Significantly Higher Than General Population
  5. One in 31; the Long Reach of American Corrections
  6. Another Corrections Interface – Dementia
  7. The Cost Of Untreated Mental Illness? $1,000 Per Citizen Per Year
  8. Offenders With Mental Illness Rank Housing, Not Community Based Treatment As A Top Reentry Priority
  9. The Rest of the Story…

But we are seeing a number of jurisdictions across the U.S. move ahead with policies and programs that address this human service gap and its high-cost consequences. One approach is the “smart justice” approach – basically, diverting people with serious mental illness out of jail and into treatment instead. One such program, recently reported on by NPR in Mental Health Cops Help Reweave Social Safety Net In San Antonio profiles this “smart justice” approach. This is how it works – San Antonio’s six-person police unit called the “mental health squad,” responds to calls where a person may have mental illness, and diverts all non-felonies to a specially designed and funded treatment facility, called the Restoration Center, where they can receive services and care.  With this law enforcement approach, the Restoration Center serves more than 18,000 people a year with an operating budget of $50 million in its five years of operation – and providing Bexar County with an estimated savings of $10 million annually.

And the concept of “smarter” criminal justice systems is spreading. In Spokane, Washington, criminal justice consumes 70 percent of the county’s $140 million, annual general fund, prompting a coalition to push reforms to reduce populations in already crowded jails and end the use of jail for non-violent, low level offenders (see Announcing ‘Smart Justice’ Spokane). In Florida, the Florida Smart Justice Alliance is working to reduce the number of children and mentally ill who are jailed, and use sentencing diversion alternatives and reentry (see About the Florida Smart Justice Alliance).

In addition, many jurisdictions are trying to solve the problems of the behavioral health/corrections interface with innovative policies. This list provides an idea of the range of approaches:

  1. Nearly Half of U.S. States Enact Juvenile Justice Reforms To Keep Youths Out Of Adult Systems
  2. Federal Bureau Of Prisons To Impose New Requirements For Residential Reentry Centers
  3. Illinois, Iowa & Tennessee Corrections To Launch Data Sharing Initiatives To Reduce Recidivism
  4. Indianapolis & Indiana Department of Correction Launch New Reentry Program For High-Risk Parolees
  5. California Launches Pilot Program To Prepare Long-Term Inmates For Re-entry
  6. California’s San Diego County Awards Microsoft Contract To Create Offender Data Hub To Measure Reentry Outcomes
  7. Benton County, Oregon to Start Pilot Mental Health Jail Diversion Program
  8. Kennebec County Jail to Pilot Differential Substance Abuse Treatment
  9. Ohio Launching Five Pilot Drug Courts That Will Provide Medication-Assisted Treatment For Opioid Or Alcohol Dependence

The justice-involved population in the U.S. is large (6.9 million people in 2012), expensive (with total spending of $86 billion), and 16% are estimated to have a mental illness (see The U.S. Corrections Market: 7 Million Adults In Correctional Systems & $86 Billion In Annual Spending and Addiction & The Criminal Justice System). With this ballooning corrections population and corrections-related costs, there is a gradual shift in view that providing treatment and support to justice-involved populations may provide a better ROI for public funds.

While challenging, this is an opportunity for the behavioral health field to “make a difference” and deliver value. For more, look at our recent coverage on the costs and challenges for serving “justice-involved consumers” – see A New Opportunity To Serve Justice-Involved Consumers, The ROI Of Recidivism PreventionPPACA & Medicaid Enrollment Post Incarceration, and  Is Your Organization Prepared To Treat Mentally Ill Offenders? Changes In California Mean New Opportunities.

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