Criminal Justice Reform Will Fail if We Don’t Fix Mental Health Care Too: Johnson

NYAPRS Note: Another great posting from NYAPRS intern David Martino.

This commentary introduces a proposal to create a more seamless mental health treatment pathway for people in need of services in San Francisco. The concept paper it links to describes an approach to mental health treatment that can help to alleviate the crisis of severe over-representation of mental health consumers in our prisons.

Criminal Justice Reform Will Fail if We Don’t Fix Mental Health Care Too

By Jennifer K. Johnson

July 7, 2016 Updated: July 8, 2016 10:26am

To me, a deputy public defender in San Francisco, the term “mass incarceration” is not an abstraction — at least 40 of my 125 clients are behind bars on any given day. And as a co-founder of San Francisco’s Behavioral Health Court, all of my clients have serious mental illness. Every day I watch as men and women deteriorate in the county jail, their symptoms exacerbated by a punitive, correctional environment.

Our nation has begun to make meaningful reforms to reduce our prison population, but America’s jails and prisons are increasingly filled with individuals with mental illness. What is clear to me, and to experts in mental health, judges and prosecutors, is that any reform of our criminal justice system that does not overhaul our approach to those with mental illness will fail.

To unravel decades of damage, we must recognize the crucial role that the mental health system plays in ensuring public safety, and prioritize its resources accordingly. Here is where San Francisco has the opportunity to lead. We know what we need to do — and we have a plan — but without buy-in from politicians and the public, our window of opportunity will soon close. The number of people in our jails and prisons will continue to soar, and our streets will continue to serve as home for our most vulnerable citizens.

For 40 years, we have swept homeless, vulnerable, poor, addicted, black and brown people into our jails and prisons. Nearly half of those people have a mental illness. Men and women jailed with mental illness are the most underserved population in our overburdened and underfunded public health system. Instead of receiving treatment, they languish behind bars waiting for a treatment bed. Or they are released to the community without any treatment plan at all and fall through gaping holes in our social safety net.

How did we get to this untenable place? The dismantling of our mental health system began with noble intentions when the deinstitutionalization movement sought to replace abysmal and abusive mental hospitals with community-based alternatives. That laudable goal was premised on the federal government’s promise of funding for community-based treatment. But the funding never arrived and mental health budgets were cut and cut again.

Complicating the picture, drug companies in the 1950s convinced the government and service providers that psychotropic medication was a miracle cure for madness and a substitute for individualized treatment.

The result was that we pushed people out of mental hospitals with a pill and a pat on the back — but no treatment. Not surprisingly, we were thrust into a public mental health disaster that has morphed into a public safety crisis.

And then, as our mental health system crumbled, we turned our attention elsewhere — to a war on crime, followed by a disastrous war on drugs. Draconian criminal justice legislation that started in the 1970s and crested in the mid-1990s set the stage for turning vulnerable citizens into criminals. In fact, low-level criminals with unmet social service needs were boldly targeted — we called them “broken windows” and sought to fix them with arrest, prosecution and incarceration.

At the request of San Francisco District Attorney George Gascón, I and three other experts in mental health and criminal justice have proposed a solution — a centralized system of behavioral health care in a facility dedicated to and designed specifically for those in the criminal justice system. Beyond just centralizing services, we envision a comprehensive system of care where mental health goals and criminal justice outcomes are coordinated and complementary.

We need a new and novel approach to serving individuals who cycle between the streets, the hospitals and the jails. That approach is enshrined in a Behavioral Health Justice Center.

The spotlight is trained on criminal justice reform. If we do not address mental health reform with equal passion and equal precision, criminal justice reform will fail.

Jennifer K. Johnson is one of the authors of “Justice that Heals.”