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By Monica E. Oss

In the United States, mental illness and the corrections system are inextricably linked. Statistics from the U.S. Department of Justice show that approximately 20% of state prisoners and 21% of local jail prisoners have “a recent history” of a mental health condition (see Mental Health Problems of Prison and Jail Inmates). The Urban Institute estimates are higher – half of all inmates in jails and state prisons have a mental illness (see The Processing and Treatment of Mentally Ill Persons in the Criminal Justice System). The estimate is that two million people with serious mental illnesses (SMI) enter county jails each year – more than half of whom have some form of addictive disorder.

To get a gauge of what that means, consider that there are more people with mental illness living in jails than in state hospitals. There are more than 356,000 people with mental illness imprisoned in the United States, compared to 35,000 receiving treatment in state hospitals (see US Prisons Hold 10 Times More Mentally Ill People Than State Hospitals – Report).

One interesting approach to addressing this issue at the county level is the Stepping Up Initiative, which was adopted in my home state of Pennsylvania just last month (see Pennsylvania Jails To Launch Stepping Up Initiative To Reduce Number Of Inmates With Mental Illness). This strategic initiative was developed by the Council of State Governments Justice Center, the National Association of Counties, and the American Psychiatric Association Foundation. To date, 359 counties in 43 states have passed resolutions to reduce the number of people with mental illness in county correctional facilities. (You can find a complete list of the initiatives that are currently active across the country at The Stepping Up Initiative: What You Can Do).

The Stepping Up Initiative provides “broad-based technical assistance” at no cost to the counties that participate. The counties are responsible for the funding of the program and system changes. Counties receiving more intensive technical assistance, like Dauphin County, Pennsylvania may receive funding through the Justice and Mental Health Collaboration Program (JMHCP) from the U.S. Bureau of Justice Assistance (BJA).

The goal of the Stepping Up initiative is to bring together leaders in multiple county-level agencies that are positioned to reduce the SMI population in county jails. Their goal is to identify county-level funding for their initiatives; examine current prevalence numbers and processes for identifying incoming SMI inmates; examine recidivism risk levels; and use that information to inform decisions from individual cases for treatment and other services outside of the justice system (see Stepping Up to Reduce the Number of People with Mental Illnesses in Jails).

Based on their findings, the stakeholders then develop a plan with measurable outcomes, implement research-based approaches within the plan, and establish processes to track progress and report successes. There are a few key ways to measure success for this program:

  • Total diversion of SMI population from jail to more appropriate treatment facilities following program implementation
  • Recidivism/rehabilitation rates among formerly imprisoned SMI population, before and after program implementation
  • Long-term public costs of treating SMI in incarcerated individuals, before and after program implementation

The issue of individuals with mental illness inappropriately being imprisoned has implications for government costs, health plan and provider organization costs, individual civil rights, and human misery. The problem needs a “higher level” policy solution – and the Stepping Up Initiative is just such an approach.

For more on serving complex consumers, join me June 7 at the upcoming OPEN MINDS Strategy & Innovation Institute for the session, “There Is No “Plan B” Alternative To Value: Creating A Value-Focused Competitive Strategy In A Changing Market.”


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