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
Mental Health Courts and Beyond: Improving the Response to People with Mental Illness in the Criminal Justice System
The power of partnerships and a public health approach
Los Angeles, CA
June 21, 2005
Attached is the text prepared for delivery; however, some material may have been added or omitted at the time of delivery.
Good morning and welcome. I am Kathryn Power, Director of the Center for Mental Health Services, part of the Substance Abuse and Mental Health Services Administration—SAMHSA—an Agency of the Department of Health and Human Services.
For those of you who may not be familiar with SAMHSA, ours is the lead Federal agency charged with improving the quality and availability of prevention and treatment services for people with or at risk for mental illnesses and substance use disorders. Among its top priorities, SAMHSA has taken the lead in funding jail diversion programs across the country designed to divert adults and juveniles involved with the justice system into appropriate services...services that will restore their hope...and their lives. This is our mandate...and our moral imperative. This is what justice is all about.
In his poignant Letter from Birmingham Jail in 1963,
Dr. Martin Luther King, Jr. said:
“Law and order exist for the purpose of establishing justice…when they fail in this purpose they become the dangerously structured dams that block the flow of social progress.”
More than 40 years later, Dr. King’s words remain all too relevant. Today, our nation’s jails and prisons have become what some have called the “psychiatric warehouses of the new millennium.” When people with mental illnesses fall through the cracks and land in the criminal justice system for crimes that are too often symptoms of their disorders…when they are incarcerated for longer periods than other offenders…when they don’t receive adequate treatment for the psychiatric conditions that caused the incarceration in the first place…we have jointly failed in our purpose.
But there is good news: we have made a collective commitment to dismantle this dam…to work together to improve outcomes for individuals with mental illnesses who come in contact with the criminal justice system. We know exactly what we must do.
Through collaboration, we have to challenge the boundaries of traditional roles and case processing rules to reduce the use of jail and repeated interaction with the criminal justice system for mental health consumers. We must coordinate court based programs, jail diversion programs, crisis intervention teams, re-entry initiatives, and other efforts to truly solve the systemic problems that cause people with mental illnesses to be arrested and incarcerated in disproportionate numbers.
We, in mental health, are developing an appreciation for the fact that these individuals are not just your defendants and offenders...but they are also our consumers. Our mental health courts and other diversion programs cannot be meaningful or effective unless the services that individuals with mental illnesses need to live productive lives in the community are available for them. We are working to respond to needs being expressed at the local level through efforts to build capacity and better focus services.
Partnerships are the key to achieving our goals. We are taking decided and deliberate steps…together…to make America’s communities safer…and healthier.
I commend BJA Director, Mr. Domingo Herraiz, who has recognized the pressing need to address mental health issues in the criminal justice system. Domingo, I greatly appreciate the work you and Betsi Griffith have been doing to bridge mental health and justice activities at the senior executive level. Thanks, too, to Michael Guerriere for his efforts and commitment to working together.
This conference is a shining example of the power of partnerships. It is the result of an extensive collaboration among the Bureau of Justice Assistance, SAMHSA, and the National Institute of Corrections. It is also the first time that representatives of all of our nation’s mental health courts…our esteemed judges and their teams… representatives of innovative jail diversion programs from across this country…and others who are committed to addressing these complex issues—have come together for a single event.
I commend each of you for recognizing that this is a collective concern. I salute you for seeing your role in solving these problems…for owning these issues…and for coming here today to work on collaborative solutions.
I also am here today to urge you to press on...to join with SAMHSA and partners across the Federal government to help lead the revolution in mental health called for by the New Freedom Commission on Mental Health...the transformation of our mental health system.
You may be asking, “What does mental health transformation have to do with me?” The simple answer is: it is essential! The court-based efforts that are the focus of this conference depend, in large part, on our efforts to transform the mental health system. It is through transformation that we will be able to improve alignment of services, increase efficiency, and build capacity at the local level. It is through transformation that we will be able to create a community-based system better equipped to deliver comprehensive, family-driven, culturally competent mental health care to every American. That’s why we need you to join us as agents of change...agents of transformation.
We first heard the call for transformation in April of 2002, when President Bush created the New Freedom Commission on Mental Health and charged it to study our nation’s mental health care delivery system. He asked the Commission to make recommendations that would enable adults with serious mental illnesses and children with serious emotional disturbances to live, work, learn, and participate fully in their communities.
The Commission’s Final Report, Achieving the Promise: Transforming Mental Health Care in America, confirmed that our system is not oriented to the single most important goal of the people it serves: the hope for recovery. The result: far too many Americans with mental illnesses are disconnected from the community supports they need. They are coming into contact with the criminal justice system with increasing frequency. They are swelling our jails and prisons. They are cycling repeatedly through your court rooms.
To achieve the promise of community living…and recovery… for everyone, the Report called for a fundamental transformation of America’s mental health care system.
The Report provided a vision for a transformed mental health system and outlined 6 broad goals and 19 specific recommendations for achieving it.
In a transformed mental health system —
- Americans understand that mental health is essential to overall health.
- Mental health care is consumer and family driven.
- Disparities in mental health services are eliminated.
- Early mental health screening, assessment and referral to services are common practice.
- Excellent mental health care is delivered and research is accelerated.
- Technology is used to access mental health care and information.
I thank Judge Ginger Lerner-Wren, who served on the Commission and Chaired the Criminal Justice Subcommittee, for her commitment to this endeavor. Many of the Subcommittee’s recommendations are reflected in the Final Report, including the call for jail diversion strategies such as mental health courts and innovative jail and prison re-entry efforts. You can read more about these recommendations at mentalhealthcommission.gov.
By coming together today…to look 360 degrees around the issues that the Commission raised in Achieving the Promise…and by applying your collective wisdom to formulate revolutionary, transformative solutions, you will be contributing to the kind of deep…and profound…and continuous change that transformation requires. Working together, we can magnify the impact of our efforts…exponentially.
Why is this synergy so important? People living with mental illnesses have complex and multiple issues that cut across every department, agency and system. As a result, we need leaders and partners across government and the private sector to develop a comprehensive solution.
We need leaders and partners in Housing. Of the two million adults who experienced at least one episode of homelessness in a year, 46 percent reported having a mental health issue. We have to work together to address the programmatic and regulatory barriers that stand between people in need and the mainstream housing programs that can open the door to a new life. In one ground breaking new effort, SAMHSA/CMHS is working in partnership with the Department of Housing and Urban Development and the Social Security Administration to develop training materials designed to equip local providers to assist persons who are experiencing homelessness gain eligibility for Supplemental Security Income, or SSI. SSI eligibility is not only the gateway to Medicare and Medicaid…but it is also a route to employability…to stable housing…and to recovery!
We need leaders and partners in L abor. Less than one in three persons with a mental illness is employed! To address this issue on the Federal level, the Department of Labor is leading a work group consisting of the Small Business Administration, the Rehabilitation Services Administration, the Department of Health and Human Services, and the Social Security Administration to distribute their customized employment model to the mental health community.
And certainly, we need leaders and partners in Criminal and Juvenile Justice. Each year, about 800,000 persons with serious mental illnesses are admitted to our jails! Jails, prisons, and the juvenile justice system too often fail to meet the needs of adults and youth with mental illnesses because they were never designed to be treatment facilities. On the other hand, well monitored and documented alternative interventions provide the possibility of recovery for the person with mental illness who has become entangled with the criminal justice system. SAMHSA and the Department of Justice are partnering to expand our range of diversion resources.
I’d like to take a moment here to note one very successful mental health/criminal justice partnership. BJA’s Mental Health Court TA Center, The Council of State Governments, and SAMHSA’s TAPA Center for Jail Diversion have been working together very closely. CSG refers mental health court evaluation issues to TAPA. Likewise, TAPA refers criminal justice related issues to CSG…reducing duplication of effort and maximizing efficiencies by making use of both TA centers’ strengths. This is an outstanding example of transformation in action at the federal level!
In order to provide a life in the community for everyone, we have to see jail diversion and mental health court programs as part of a public health framework. We have to understand the need to develop, evaluate, and document evidence-based programs…and to share what we learn so that we can dramatically alter public perceptions.
The concept of community is especially important when we consider populations who are involved in the criminal justice system—they are, after all, from our communities, and almost all of them will someday return there. When they do, it is up to us to see to it that we are there to build resilience to face life’s challenges...to facilitate their recovery…and to reduce the chance that they will reoffend and begin the hopeless cycle all over again.
Resiliency and recovery are two powerful and interdependent concepts at the center of a transformed system. The most compelling element of recovery is the belief that people with mental illnesses can take charge of their own lives. It is the hard work that consumers do.
A recovery focus forces the dialogue of care to revolve around the comprehensive needs of a person living in a community, such as housing programs, family therapy, and vocational rehabilitation. Recovery forces us to focus our efforts on providing opportunities for full community participation.
One of the most challenging issues we will face in the years ahead is the dilemma of how we will work together to develop the appropriate services to manage the ebb and flow that any recovering person is sure to face. In a system where an individual moves from arrest, to arraignment and bail, to trial, and probation or incarceration, where and how can we have the most impact? How can we maximize opportunities to build resiliency and the hope for recovery?
This is where you come in. You are far more powerful and vital to the transformation process than you might think.
Many mental health courts already embrace the recovery model that is the foundation of mental health transformation. Your emphasis on “therapeutic jurisprudence” goes to the heart of recovery. As a result, you can help us to ask the right questions, and find the appropriate solutions as we advance the transformation agenda. You can also help build a readiness for change among the States and communities affected by this issue.
Systems change, fueled by cross-system collaboration, is the key to changing lives. And, to echo Domingo’s earlier statement, we are keenly aware that we cannot simply call upon court and mental health systems to partner, or even to collaborate, at the State and local level if we, at the federal level, do not lead by example.
I am pleased to say that during the past year, SAMHSA/CMHS and our Federal partners have made an unprecedented commitment to work collaboratively on transformation.
A coalition of senior level staff from 9 Federal Departments and the Social Security Administration formed a workgroup and conducted an extensive inventory of recovery-focused mental health-related activities and resources at the Federal level. We also were able to determine where we could collaborate on new initiatives to support transformation or better align existing ones. This process has resulted in a Federal roadmap for change— the Federal Action Agenda.
Although not yet publicly released, our Action Agenda responds to each of the 6 goals and 19 recommendations proposed by the New Freedom Commission. The Action Agenda sets time-limited, realistic priorities for year one of what we see as the first 5-year arc for transformation. We will develop new agendas as we make progress.
One of our first steps has been to invest additional resources in transformation. We have established the Mental Health Transformation State Incentive Grants, or SIG, program to help States meet the goals of Achieving the Promise—including those that address criminal justice issues. The deadline for applications has passed, and we are currently reviewing the applications we have received. If you haven’t already, I encourage you to talk to leaders in your mental health system—your State mental health directors, in particular—to ask about their SIG application and how criminal justice issues figure into their plan.
The most important outcome of the Federal cross-agency collaboration I have described is the model it provides for what can happen at every level of the system—especially in the States. Transformation at the State level will require an equally unprecedented commitment to collaboration. Partnerships that extend well beyond the Governors office and its Department of Mental Health…to the State Departments of Housing…and Education…and Labor…and Juvenile services…and Criminal Justice will be essential to success.
Our justice/mental health partnership at the Federal level is real...and it is strong. Domingo mentioned a number of examples. I would like to add a few additional. First, CMHS and BJA have charged CSG and the National GAINS Center for People with Co-Occurring Disorders in Contact with the Justice System with creating and maintaining a comprehensive online database that will provide a single, integrated source of information about hundreds of promising programs across the country. Second, CMHS and BJA are working together to develop, test, and disseminate tools that will provide you with good data about cost savings...tools that will help you make the case for sustainability to your county and State officials.
We have much work ahead of us to fulfill the promise of recovery for persons with mental illnesses. I want to underscore that we cannot...we will not...realize the goals that remain in front of us without the help of leaders in the justice system. Together, we can create real opportunities for change. Together, we can empower adults and juveniles who have come in contact with the criminal justice system to take back their health…their lives…and their futures. Together, we can transform lives!
Working t ogether, we can honor the words of Dr. King, and ensure that “justice” for the thousands of people in the court and criminal systems is not just another word for “punishment”…or a dam that holds back the floods of hope. With you at our side, we can indeed transform the mental health system and ensure that justice is truly a synonym for social progress…the progress that gives all Americans the strength they need to be resilient and to realize thepromise of recovery. Thank you.
# # #
|
