HP: The Intersection of Reform: Criminal Justice and Behavioral Health

NYAPRS: Given that the three largest mental health providers in the country are Cook County Jail, Los Angeles Jail, and Rikers Island, it is impossible to discuss criminal justice without also discussing behavioral health. Indeed, justice-involved adults and youth have staggering rates of both mental health and substance use conditions.

Until recently, criminal justice and behavioral health advocates were more silo’d than not – working separately despite the extreme overlap between the issues. However, as we learn more about the intersection between the two, we realize the impact and influence that combining forces will yield for our communities. We must continue to work together.

The Intersection of Reform: Criminal Justice and Behavioral Health

By Robert D. Ashford HuffPost April 11, 2016

Asking any behavioral health professional, perhaps any professional in any field, and you will find quickly that one of the largest obstacles that they strive to overcome is silos. These can be silos of care, silos of information sharing, or silos of silence causing duplicated services and wasted fiscal spending. This is not a new set of obstacles, as generations of professionals in the substance use disorder and mental health fields have lamented about the lack of collaboration among professionals and para-professionals. One would hazard that with the advent of high-speed internet and technology, these silos should be crumbling from their base, but this does not seem to be the case.

These types of barriers to collaboration and success are not just particular to professional services though - it exists quite ostensibly in the peer-based and grassroots advocacy movements as well. To see evidence of this, you do not have to go far. The divisive expletives declaring “addiction recovery” or “mental health recovery”, rather than just “recovery” is perhaps the most prominent and prevalent example; a similar example would be the nature of the housing first and recovery residence advocate groups, though with the inclusion of recovery residences in a US Department of Housing and Urban Development (HUD) policy brief the relationship seems to be moving in the right direction. These previous two examples are divisive, and it would probably not be erroneous to say that the professional silos as well as these peer silos stem from a combination of blind spots, funding, ego, and a bit too much pride; however divisive and harmful though, they pale in comparison to the silo’d nature of criminal justice and behavioral health communities and advocates.

The National Institute on Drug Abuse (NIDA), who is the largest funder of behavioral health research in this country, suggests that adults involved in the criminal justice system have 400% higher rates of substance use disorders than general population - and this relationship is not only apparent in adults, as juveniles’ involved in the system have reported rates of 50-75% current substance use at the time of an offense. On the mental health side of things, the relationship is perhaps even more tangible. The three largest mental health providers in the United States? You guessed it - 3 criminal justice entities - Cook County Jail, Los Angeles County Jail, and Rikers Island in New York. How then is it possible, given the suggested facts and relationships between behavioral health and criminal justice, that the two topics and communities are not always joined at the hip? How is it possible that two of the largest advocacy constituencies have not joined voices to press for true behavioral health treatment and recovery, and criminal justice policy reform?

It is impossible to truly advocate for either groups primary issues without finding intersections between the two. If advocating for the end on the war on drugs or sentencing reform policies, you are also striving to increase access to behavioral health community or private treatment in lieu of punitive jail sentences. If when speaking to your legislators you cite that the state would save hundreds of thousands of dollars by increasing access to treatment and recovery supports, are you not also advocating for diversion programs for the at-risk? True reform, for any major social issue, by nature must be comprehensive. To have anything but comprehensive solutions is typical of politicians perhaps, but it should not be a goal of the advocates soliciting change.

Silos, whether professional or not, have quite literally been harming, and perhaps in our communities, killing human beings for decades. It does not matter the reason for the silos - what matters is breaking them down. To continue to advocate for behavioral health treatment and recovery, but to ignore criminal justice reform is to continue to reinforce the silos of our communities, to continue to ignore that 100’s of people are dying each day. Substance use disorders, mental health concerns and the criminal justice system are inexorably connected; whether we advocate with that truth internalized moving forward might be the difference between lasting and meaningful change or just another Band-Aid on the wounds.