Remarks by
A. Kathryn Power, M.Ed.
Director
Center for Mental Health Services
Substance Abuse and Mental Health Services Administration
U.S. Department of Health and Human Services
Jail Diversion: A Step Along the Path to Mental Health Reform
Before the Nebraska State Legislature
PowerPoint version
January 23, 2006
Lincoln, NE
Attached is the text prepared for delivery; however, some material may have been added or omitted at the time of delivery.
[SLIDE 1. Title Slide]
Good morning. Thank you for that generous introduction, Senator Jensen. Governor Heineman (Hine-uh-man), Lieutenant Governor Sheehy (Shee – hee), honorable members of the Senate, it’s a pleasure to be with you today. I’m delighted to share the podium with Travis Parker, who heads up your Lancaster County Jail Diversion program. This is the only jail diversion program in Nebraska, but it is so successful that other States are using it as a model to develop their diversion programs. You need only to look at the benefits and dividends being achieved through this program to realize its value…both to the individuals being served and to your State.
[SLIDE 2. Jail diversion definition]
The simplest description of jail diversion is this:
A structured and well-monitored program designed to reduce incarceration and recidivism among individuals with mental illnesses by promoting their recovery and by linking them to the mental health services and supports that might have prevented their arrest in the first place.
Jail diversion is a community-based alternative to jail or prison. It provides linkages among services, such as mental health and substance abuse treatment, housing, vocational and employment services, intensive case management, and peer support. A person with a mental illness has a real promise of a better life when he or she re-enters the community with a job, a home, and the continuity of behavioral health care that can sustain recovery.
Why do we need jail diversion programs?
[SLIDE 3. Percentage of offenders with mental illness]
We need them because the percentage of individuals with mental illnesses in our jails and prisons is large…and growing. A study by the Council of State and Local Governments found that “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.” National estimates put the number at approximately a quarter-million individuals at any given time, or about 16 percent of those we incarcerate. About half of these individuals are arrested for non-violent offenses such as trespassing or disorderly conduct. Their transgressions often are the outward signs of untreated or inadequately treated mental illnesses.
[SLIDE 4. Jails are not mental institutions]
We also need jail diversion programs because our Nation’s jails and prisons were never intended to serve as mental institutions. Our jails and prisons aren’t designed to be diagnostic centers or to offer the kinds of supports and services necessary for recovery from mental illness. Most incarcerated individuals with mental illnesses receive no treatment beyond medication. One prison psychiatrist quoted in the study by the Council of State and Local Governments voiced this concern. He said, “We are literally drowning in patients, running around trying to put our fingers in the bursting dikes, while hundreds of men continue to deteriorate psychiatrically before our eyes into serious psychoses.”
The need for jail diversion programs exists for children as well as adults. For juveniles with emotional and behavioral disorders, entry into the justice system can begin a lifetime of cycling in and out. Ninety-four percent of children and teens in the juvenile justice system are NOT violent. They usually have been arrested for offenses such as vandalism, stealing, and running away from home.
What drives most children into the judicial system? A 5-year study conducted by the National Center on Addiction and Substance Abuse at Columbia University found an astounding correlation between child and teen arrestees and substance use. EIGHTY percent were under the influence of drugs and alcohol at the time of their offense, tested positive for drug use, or committed a drug-related offense.
Substance use by juveniles is a cry for intervention, not incarceration. Many juveniles in the justice system have a history of unaddressed problems, such as physical and sexual abuse, school failure, and family instability. Many also have untreated serious emotional and conduct disorders. Unless they―and their families ―receive the treatment and support they need, these children eventually may re-enter the justice system as adults. They will then bear a double or even triple burden of stigma: substance abuse, mental disorders, and a criminal record.
[SLIDE 5. Lack of equality statistics]
We also need jail diversion programs because we strive to be a just society. Nebraska’s State motto is “Equality before the law.” Tragically, individuals with mental illnesses who run afoul of the judicial system do not receive this most basic constitutional right. During street encounters, police officers are almost twice as likely to arrest someone who appears to have a mental illness. A Chicago study of thousands of police encounters found that, or the same behavior, police arrested 47 percent of individuals with a mental illness but only 28 percent of individuals without a mental illness.
Defendants with mental illnesses also are treated more harshly in court. They are more likely to be remanded without the opportunity to post bail. They receive stiffer sentences. This inequality may stem from outdated stereotypes about mental illness. Many people still hold the mistaken belief that people with mental illnesses are more dangerous than others. Others lack information about how people with mental illnesses can be successfully accommodated in diversion programs. Too often, these programs simply are not available.
Eleanor Roosevelt asked: “When will our conscience grow so tender that we will act to PREVENT human misery rather than AVENGING it?” Jail diversion is a humane response to individuals whose non-violent offenses result from undiagnosed or inadequately treated mental illnesses.
The purposes of incarceration are punishment, deterrence, and rehabilitation, in that order. The purposes of a jail diversion program are to offer individuals the possibility of recovery and a full and productive life in their community.
Jail diversion services cost money, but it is money well spent. I have often heard SAMHSA Administrator Charles Curie say that “Untreated mental illness exacts a high cost in our society. Our choice is how we invest our resources to pay the bill.” The question before us then, is: how and when will we pay? Will we choose to pay less now or be destined to pay MORE later – both in terms of financial resources, and social and individual consequence?
Our President and our National Congress have signified their belief that an investment in human lives NOW will pay heavy dividends in the future. Last year, our Government enacted S. 1194, the Mentally Ill Offender Treatment and Crime Reduction Act. With the passage and signing of this Act, the President and Congress signaled their support of programs that avoid inappropriate incarceration or support re-entry and transitional programs for persons with mental illnesses. Both the House and Senate passed the bill unanimously. Every single voting member of Congress endorsed it. In passing this bill, Congress plainly stated what we already know: that the majority of persons with mental and emotional disorders can be treated successfully through integrated community-based treatment, rehabilitation, and support services.
Nationally, there are approximately 300 diversion programs offering a wide variety of diversion initiatives. SAMHSA currently funds 26 jail diversion programs nationwide. These are 3-year grant programs. Federal funding will end for 10 of them this year. The value of continuing these programs, however, is clear. Nine of these programs will be sustained through a combination of State and local funds.
The program here in Nebraska is one of the best. We are using it as a model program for new grantees and we are asking Mr. Parker to be a resource for others. I commend the program administrators for taking full advantage of every technical assistance opportunity offered by SAMHSA.
Staff representatives have attended peer specialist training. They have attended a session on gender and trauma and developed an action plan as part of the training. They have sought continuously to improve their knowledge… their skills…and the opportunities for recovery for the people they serve. This is the kind of leadership we need to promote jail diversion programs across the country: leadership that is practiced more by attitude and actions than by words.
Jail diversion programs work! Research conducted through SAMHSA’s Jail Diversion Knowledge and Application Program shows that people living with mental illness, who were diverted from jails and prisons into the mental health system:
[SLIDE 6. Jail diversion results—national]
- Spent more time in the community, rather than in the hospital or incarcerated;
- Received significantly more mental health treatment; and
- Were no more likely to be rearrested during the follow-up year than persons who were not diverted.
[SLIDE 7. Jail diversion results, Nebraska]
These are a few results from your own Lancaster County program: less recidivism among participants, decreased use of costly emergency services, and an increased use of less-costly ongoing services. Participants also demonstrate an improvement in both attitudes and symptoms. They report a greater ability to control their lives and to deal with crisis as well as less depression and loneliness.
Jail diversion is about giving new hope and new life to individuals. This morning, you [will hear/have heard] about one person’s experiences with jail diversion, but there are many stories of success and recovery. All of the participants say essentially the same thing: “I needed help. When it was given to me, I was able to make changes that I had not previously been able to make. My life is immeasurably better as a result.” With the support of jail diversion, these individuals give back to their communities. They give back in terms of time and effort and by helping others to recover. They become contributing, tax-paying members of their State and our Nation.
Here in Nebraska, your very successful program in Lincoln County will exhaust its Federal grant funding next year. This program is looking to you—the State—to supplement county funds so that it may continue. The payback will be reduced recidivism of participants and the opportunity for recovery among those who need the services that diversion offers.
I urge you to fund this program as well as other programs. The need for jail diversion is statewide.
[SLIDE 8. Recidivism data]
According to statewide data, individuals who may have a mental illness make up the majority of repeat offenders in Nebraska.
Other Nebraska communities, such as Omaha, Grand Island, Hastings, and Kearney, are eager to institute their own programs. Without strong leadership at the State level, jail diversion programs will not receive the financial support they need. That’s why I’m particularly pleased to be speaking to this body and to Lieutenant Governor Sheehy today.
Nebraska has demonstrated a solid commitment to mental health reform. In 2004, you passed the Nebraska Behavioral Health Services Act, which is the framework for your reform efforts. Your Act is a major step toward transforming your mental health care system to one that is more community-based and consumer-directed. It allows those with mental illnesses to receive care closer to their home communities, thereby ensuring the ongoing support of their families and friends. It provides for the varying levels of services required by consumers in a less restrictive and more appropriate manner.
Your Act, however, is but one part of mental health reform. Sufficient community-based services, including jail diversion, are necessary to ensure that individuals receive appropriate treatment. As mental institutions have closed nationwide, our criminal justice system has become, for many, the primary source of mental health care. Their recovery is frequently derailed by inadequate care and the superimposed stigma of a criminal record. If the person also has a substance abuse disorder, as most do, they become even more stigmatized and marginalized, making re-entry into the community all the more difficult.
Nearly 3 years ago, the President’s New Freedom Commission on Mental Health called for a complete transformation in the way our Nation views and provides mental health services. Since then, SAMHSA has convened a Federal Partners Workgroup to guide transformation efforts at the Federal level.
[SLIDE 9. Federal Partners Workgroup]
Nine Federal departments, including the U.S. Departments of Justice, Housing, and Labor, have made a united commitment to increasing collaboration and reducing fragmentation of services.
I have brought with me summaries of the New Freedom Commission report. I also have brought copies of Transforming Mental Health Care in America: The Federal Action Agenda. This action agenda describes the steps we will take to move mental health transformation forward. We intend that the collaboration taking place at the Federal level will become a model for similar action at the State and local levels.
Mental health transformation requires the continuity of services across systems. Your mental health reform will be successful when all your departments become involved. Education should be involved to help identify children who need intervention early on. Your police should be trained in possible symptoms of mental illness. The person they are about to arrest may need to be taken to the emergency room rather than to jail. Drug courts have proven to be valuable means to treatment. Housing and employment services must be available for persons with mental illnesses who need them. All agencies involved in such activities must collaborate to provide the seamless service system we are striving to develop.
Mental health reform is achieved through a public health approach to preventing and treating illness. The premise of a public health is simple: caring for the health of an individual protects the community, while caring for the health of the community protects the individual―with an overall benefit to society at large.
Criminalization of mental illnesses is a public health issue because the punitive incarceration of individuals with mental illnesses fails to address their mental health needs. In fact, incarceration can exacerbate the symptoms of mental illness and lead to even more severe outcomes for both the individual and for law enforcement personnel. And what happens if a person receives little or no treatment while incarcerated? The answer is that they re-enter their communities with the same mental and psychosocial illnesses they had prior to being jailed―to the benefit of none.
Jail diversion recognizes the interdependence of individual and community health. In addition, it presents us with a tremendous opportunity to work with the penal system in caring for a population at high risk for many physical and mental illnesses. Through jail diversion, we can help individuals, their communities, and public health in general by reducing disease rates, improving public safety, and making better, most cost-effective use of the health care and the corrections systems. By “wrapping” these people with services and treatment, we will minimize the chance they will re-offend and return to incarceration.
Jail diversion has far-reaching ramifications for your State and your constituents. It holds great significance in the public health framework of our Nation. Jail diversion is a worthwhile investment on the human scale, on the community scale, and on the economic scale.
[SLIDE 10. Population numbers and incarceration costs]
Here in Nebraska, taxpayers spend more than $25,000 per year to incarcerate an individual. This, by the way, is approximately $3,000 more per year than the national average. By comparison, the estimated cost for the Lancaster County jail diversion program is $3,500 per person. With an average of 8,000 offenders being housed in Nebraska on any given day, less costly jail diversion programs can save the State an enormous amount of money.
Nearly twice as many Nebraskans now are sentenced for drug violations than were sentenced 20 years ago. The average sentence for drug offenders has increased to 2 to 4 years. In 1985, the average sentence was between 23 and 27 months. If the underlying source of the problem for the offenders is not addressed ―and that problem, in a great many instances, is both drug addiction and mental illness―we can reasonably expect that the cost of Nebraska’s correctional system will continue to spiral upward.
We can use the disease of scurvy to illustrate this point: A person gets scurvy from a lack of Vitamin C. Regardless of how much Vitamin B or Vitamin A he receives, without Vitamin C, the individual will still have scurvy. Drug and mental health treatment is the Vitamin C necessary to help these offenders remain free of further criminal behavior and contribute again to their communities. And jail diversion is the means by which they will receive it.
According to the latest statistics from the U.S. Department of Justice, more than 2 million men and women are now behind bars in the United States. The country which is known across the globe as the “land of freedom” incarcerates a higher percentage of its people than any other country. The human costs―wasted lives, broken families, troubled children―are incalculable. So too are the adverse social, economic and political consequences of weakened communities and over-extended social services.
In Crime and Punishment, Dostoevsky wrote “The degree of civilization in a society can be judged by entering its prisons.” If we were judged on that basis today, I fear we would fall woefully short of the ideals on which this Nation was founded. Imprisoning people with mental illnesses is not the practice of a truly democratic society. Justice cannot be applied fairly when mental illness is the principal crime.
Mental illness is not a moral issue. It is not a failure of character. It is a disease and like any other type of disease, it affects people differently. Persons with mental illnesses have their own strengths and vulnerabilities. They have different needs in building the resilience necessary to face the challenges of life. Perhaps there is no group for whom this is truer than for those entangled in the criminal justice system.
[SLIDE 12. Blackmun quote]
Supreme Court Justice Harry Blackmun said, “In order to treat some people equally, we must treat them differently.” When individuals with mental illnesses encounter our judicial system, we must take into account their vulnerabilities and act in kind. We must offer mercy where it is merited. Illness is part of the human condition. It is not a choice; it is not a lifestyle. Mental illness targets those it chooses, but recovery is possible—with adequate diagnosis and treatment. In jail diversion, we have a marvelous opportunity to offer those with mental illnesses the help they need. In so doing, we provide benefits to all of our citizens as well as to those who are served directly.
I ask for your help in transforming our Nation’s mental health care system into one that treats its citizens with the care they both need and deserve. I appeal to your compassion…and to your practicality. Jail diversion is sound public policy from an economic, public safety, and humanitarian perspective.
Jail diversion is an investment in your State’s future and in its people. It provides a higher quality of life and greater independence for participants. For them, your State, and our Nation, jail diversion also means these individuals may be able to realize their full citizenship as taxpayers and give back to society. There is no better use of resources than to invest wisely in human potential.
I trust that you will provide solutions to the problems of jail overcrowding, untreated mental illness, and the waste of thousands of lives to unmerited punishment. I appeal to you to invest in Nebraska’s future by funding jail diversion programs as part of mental health reform in your State. These programs will prove to be among the best investments Nebraskans have ever made. Thank you.
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