NYAPRS Note: We join noted blogger Pete Early in endorsing Ron Manderscheid’s call for a 25% reduction in the incarceration of Americans with mental health conditions. That’s why we have worked so hard in support of greatly enhanced crisis diversion (e.g. Crisis Intervention Teams) and re-entry initiatives (applying for a federal waiver to restore Medicaid 30 days before discharge). SAMHSA’s GAINS Center website is chock full of resources on these topics: see http://www.samhsa.gov/gains-center.
(5-10-16)How many more horror stories need to be told?
It’s time for us to stop the inappropriate jailing and imprisonment of persons with mental illnesses.
On April 17, CBS 60 Minutes broadcast a segment that showed how prisoners with mental illnesses were being neglected and abused at Rikers Island in New York.
On May 2, The New Yorker published MADNESS by Eyal Press, which tells how mentally ill prisoners in Florida have been tortured, driven to suicide and killed by correctional officers.
Thenurses said that Rainey had been locked in a stall whose water supply was delivered through a hose controlled by the guards. The water was a hundred and eighty degrees, hot enough to brew a cup of tea—or, as it soon occurred to Krzykowski, to cook a bowl of ramen noodles. (Someone had apparently tampered with the T.C.U.’s water heater.) It was later revealed that Rainey had burns on more than ninety per cent of his body, and that his skin fell off at the touch.
There is a promising national effort underway. Stepping UP: A National Initiative to Reduce the Number of People with Mental Illnesses in Jailswas launched last year by the Council of State Governments Justice Center, the National Association of Counties, and the American Psychiatric Association Foundation. It is a great effort.
But I believe we need to set an achievable goal. In February, I asked Washington area management consultant Steven Kussmann to suggest ways the mental health community could be more effective. His number one recommendation was defining an actionable goal.
Define an Actionable Goal: Movements with an actionable goal succeed. Movements focused on a ‘virtuous’ goal do not. Universal CIT training for police, prison personnel and hospital emergency room staff is an actionable goal. Mental health screening and treatment for all detained prisoners is an actionable goal. Destigmatizing the public’s view of mental health is a virtuous goal. The LGBT community’s strategy was not to change attitudes but tochange state law. Their actionable goal was practical. It changed attitudes and outcomes. The mental health community’s lack an actionable goal frustrates its ability to effectively change the system that controls how mental health services are provided. Changing how our penal systems manages inmates with mental illness will change public attitudes about the mentally ill in prison. We need to retarget our movement to achieve an actionable goal.
What we have now is a virtuous goal. What we need is actionable goal.
Ron Manderscheid, executive director of theNational Association of County Behavioral Health and Developmental Disability Directors, has suggesteda25% reduction in the number of individuals with mental illness in our jails and prisons by 2020. In a recent blog, he wrote:
Just a few months ago, I suggested that our outrage at this obvious injustice can drive a decarceration movement. I also suggested at that time that we must have a simple national action plan, and that we must have a practical goal.
I want to reiterate that goal here:We must decarcerate at least 25% of those with mental or substance use conditions from our county and city jails by 2020.
Implementation of this goal through a simple, national action plan can be a decisive positive force for much needed change. The goal specifies “what” and “when.” The national action plan will define “how.” We also need to define “who” and “why.”
I am joining Manderscheid in suggesting we make that goal a priority.
It is a worthwhile challenge. An estimated 16.9% of jail detainees have a serious mental illness. The same is true of inmates in state prisons. That’s between 365,000 and 500,000 men and women in our jails and prisons on any given day.
Reducing that population by 25% would be a major shift and with that shift must come a transfer of public tax dollars. Florida alone devotes some $718 million a year to mental health programs, but it pours nearly $1 BILLION a year into jails and prison for housing and medicating inmates with mental illnesses.
Which brings us tothe second item on Kussman’s list.
Focus on State-by-State Action: The same sex marriage victory demonstrated that a state-by-state strategy can be highly successful. Political gridlock at the federal level is the norm, and the federal approach to social change is not working. Today’s successful social movements, such as the legalization of marijuana and racial prejudice, focus their efforts at the state and local level. They get a handful of pioneer states or communities out in front, and then as their movement reaches a tipping point or is catalyzed by a key event or court case, other states get engaged and federal legislation and policy follows suit. The mental health community needs to refocus its resources on actions to change state law and policies rather than federal legislations.
Stepping Up is working in Ohio because retired Justice of the Ohio Supreme Court Evelyn Stratton is driving from one community to another persuading local officials to sign on. It is working in Miami Dade County because of Judge Steven Leifman’s hand-shake by hand-shake approach. If this national effort is to have any impact, it must be implemented and supported on the grassroots level.
Kussman’s third and fifth points also should be remembered.
Reinvent our Network: Successful social movements embrace, expand and leverage their networks to bring about significant, scalable and sustained social impact for their strategic goals. The network embodies the movement. It is the collective force for social change. It is not a program or the root structure of a single organization. Strategic in scope, it is rifle-focused on a single issue or objective. Solving that problem catalyzes its influence, expands awareness, drives action, learning and participation and changes public attitudes as it targets policy and practice. Its leadership and membership are unified around a shared goal and a common understanding of how to apply its resources and influence. The network has its own identity and greater scale than any single organization engaged with it. It is the heart and soul of the movement.
Rethink Relationships: Successful movements are decentralized, geographically diverse and are comfortable operating with multi-level leadership. Most organizations struggle with this approach as it implies a loss of control over objectives and resources. Action-based networks are unified around an objective not an organization. Members of the network will come from inside and outside the mental health community, but all its members are unified around that common objective. Achieving real change in mental health policy and practice will require a community of action that transcends traditional mental health community relationships. Shared leadership, responsibility and resources will be tied to the goal set and the partnerships defined by the strategy. As the LBTG community learned over time, change requires relationships with groups and individuals united around a common goal and equally committed to its success.
Kussman has given us a blueprint. Manderscheid has give us an achievable goal. And Stepping Up has given us a platform.
25% reduction in 2020.
It’s time for all of us, despite our differences, to rally around that goal.
2016-17 NYSOMH Budget: The Transition from Incarceration
OMH News May 2016
New York State is seeking federal approval to provide Medicaid coverage to incarcerated individuals with serious behavioral and physical health conditions prior to release. In announcing the initiative, Governor Andrew M. Cuomo said that the program would ensure a smooth transition back into society for thousands of formerly incarcerated individuals and help reduce the rate of relapse and recidivism in communities across the state. The Medicaid coverage would apply to certain medical, pharmaceutical and home health care coordination services.
“We know that many people leaving our jails and prisons have serious mental health and substance use problems,” Governor Cuomo said. “It makes little sense to send them back into the community with our fingers crossed that they will be able to find the help they need. This initiative bridges the gap, providing essential transitional health services while also ensuring a smooth re-entry period and increasing public safety in communities statewide.”
Today, a critical gap exists between medical care for individuals in jail or prison, and health coverage for individuals leaving incarceration. While in prison, medical care is provided through the correctional facility, and upon release, many inmates are left without any health coverage at all.
New York seeks to be the first state in the nation to create a coordinated continuum of care to ensure individuals have access to the health coverage they need from release through re-entry. The State Department of Health has engaged with the federal government and is in the process of finalizing a waiver request with the Centers for Medicare and Medicaid Services. If the request is granted, the state would use Medicaid funding to pay for essential coordination and services in the 30 days before release.
Critical Support Services
The program would aid thousands of individuals who are dependent on critical support services – including mental health and prescription addiction medications – to ensure Medicaid coverage is accessible upon release and carried with them into the community. The initiative will also help to avoid expensive acute care interventions in emergency rooms, drug overdose and relapse incidents, and higher rates of recidivism. The state expects to see cost savings in future years, as the coverage will ensure greater continuity of care and less emergency admissions due to relapses in chronic conditions.
The primary purpose of the waiver, however, remains to better connect these individuals to the outside healthcare system and prevent any unforeseen barriers that may otherwise impede their access to health coverage both in the short and long term.
In 2015, the Governor’s Council on Community Re-Entry and Reintegration recommended expanding health care coverage for formerly incarcerated individuals as part of a series of best practices identified by the workgroup. The authority for this initiative was also included in the FY 2016-17 State Budget, and builds on federal and New York State efforts to reduce rates of incarceration and recidivism, combat the opioid epidemic and other substance use disorders, and improve community-based mental health care.
Numerous federal and state studies have shown that formerly incarcerated individuals are more susceptible to drug overdose and hospitalization than other residents statewide. In fact, one in 70 formerly incarcerated individuals are hospitalized within a week of release from prison or jail, and one in 12 are hospitalized within 90 days.
Sadly, many former inmates do not even survive re-entry. For example, a Washington State study found that the overall risk of death among former prisoners was 12.7 times the risk of death among other state residents during the first two weeks immediately following release. The risk of death from drug overdose during the first two weeks after release was 129 times that of other state residents.
This initiative was supported and hailed by a coalition of advocacy organizations that included the New York Association Psychiatric Rehabilitation Services (NYAPRS), the MHANYS, and the Legal Action Center. More than 1,000 people signed an online petition developed by the Legal Action Center in support of this initiative in just three days.
This approach has been identified as a best practice by the National Judicial College because it provides medical and mental health coverage for inmates immediately upon release, which gives them the support to stay in the community. This, in turn, lowers costs for participating states and counties.
NYAPRS Executive Director Harvey Rosenthal pointed to a steady expansion of Crisis Intervention Team initiatives, approval of the 30-day Medicaid restoration policy, and the development of specialized Health Homes as landmark state advances along the full continuum from prison diversion to discharge.
“Crisis Intervention Team initiatives that help divert New Yorkers with serious behavioral health conditions from avoidable incarcerations are allowing them to pursue their recoveries in the community,” Rosenthal said.
“Going forward, these new initiatives will provide these individuals with improved discharge planning and prompt access to better coordinated community services that can help avert relapses and re-incarceration.”