By Stephanie Welch, Executive Officer
CDCR’s Council on Mentally Ill Offenders
(Editor’s note: The Council on Mentally Ill Offenders, or COMIO, released its latest annual report in December 2016. Read the full report here: http://www.cdcr.ca.gov/COMIO/docs/COMIO-15th-Annual-Report.pdf.)
The incarceration of individuals with behavioral health problems is a national, state and local crisis. Incarceration due to untreated mental illness illustrates how systems and communities can fail those most in need. Prisons and jails have become de facto mental health treatment centers and police have become de facto mental health crisis first responders.
CDCR has seen the population with mental-health needs, particularly serious ones, expand significantly. In 2006, the mental health population, as a percent of the total in-custody population, was just shy of 19 percent. As of July 2016, that number rose to almost 30 percent.
Too often, those with mental illness do not get treatment until they become involved in the justice system. COMIO is a 12-member council of appointed subject matter experts that strive to end the criminalization of individuals with mental illness by supporting proven strategies that promote early intervention, access to effective treatments, a planned re-entry to society and the preservation of public safety. COMIO examines strategies that strengthen service coordination among state and local mental health, criminal justice, and juvenile justice programs. In addition, COMIO promotes strategies that improve the ability of adult and juvenile offenders with mental health needs to transition successfully between corrections-based, juvenile-based, and community-based treatment programs.
“Our mission at COMIO might seem daunting, but it is critically important,” said COMIO Chair and CDCR Secretary Scott Kernan. “We aim to build bridges between partners in criminal justice and mental health so that we can tackle this challenge collaboratively.”
Breaking the barrier of stigma
While effectively using our various roles in the criminal justice and mental health systems is important, achieving systemic change requires tackling stigma-based decision making. By raising awareness and consciousness, we can work to reduce the stigmas inflicting this population. Stigma leads to unfair judgment, and unfair judgment leads to unfair behavior and interaction.
Our collective challenge is to ensure stigma does not influence the policies and practices we use when working with individuals with mental health challenges. Particularly those who are, or who are at risk of becoming, incarcerated. Actions based in myths and misperceptions can reinforce the marginalized status of justice-involved individuals with mental illness, which can be far-reaching and significantly debilitating. For example, a person with mental illness arrested on theft, with no prior history of violence, should not have a higher bond than a person without mental illness who was arrested for the same crime.
COMIO focused on the three priority areas in 2016:
- Diversion – Overcoming Barriers to Build Capacity for Effective Interventions
- Training – Supporting Skills and Competencies Beyond First-Responders
- Juvenile Justice – Understanding and Addressing the Needs of a Changing Population
Waiting to address behavioral health needs until incarceration will pull scarce resources towards the wrong end of the system. The time to invest in strategies that divert individuals from incarceration and enhance service and housing capacity for those with high needs and risks is now. Difficult decisions are ahead for local and state policymakers. The COMIO report provides guidance and encourages decision-making that supports the individual living with behavioral health needs, as well as, and the various systems trying to serve that individual while fulfilling their own obligations and duties.
Below is a summary of the most pertinent key themes raised in the COMIO 2016 Annual Report.
- The stigma associated with mental illness, substance use disorder, and justice status must be recognized and not tolerated to ensure that policies and practices do not perpetuate inequities.
- Assumptions about what works and does not work must be challenged by insisting on measuring both reductions in recidivism and behavioral health symptoms.
- The majority of justice-involved individuals with mental illness have a co-occurring substance use disorder which complicates treatment and recovery. Access to adequate services for co-occurring disorders, substance misuse, medical conditions and qualified staff is essential.
- Sharing sensitive information, both health and justice data, is essential to target efforts to prevent incarceration.
- Assessment tools must be utilized to identify the level of risk and need of each justice-involved individual with mental illness to assure that appropriate treatment and services are provided and directed towards reducing recidivism.
- Maximize the use of federally supported Medi-Cal funding in all diversion efforts.
- The housing crisis, high cost and accessibility of housing, and stigma towards justice-involved individuals with mental illness are real and present barriers to efforts to build and provide community alternatives to incarceration whether it be inpatient facilities, crisis residential, group homes, or independent living. Broad, comprehensive, and creative efforts beyond addressing the needs of the homeless or at-risk of homelessness are needed.
- Support expanded efforts to keep individuals with mental illness out of jails through examining bail and pre-trial detention policies that have a disproportional impact on individuals with mental illness.
- Consider how mental illness as a basis for diversion could be expanded. Review which offenses could be additionally considered for authorization of diversion.
- Crisis response is not just about trained first responders. What is needed is a planned response that goes beyond the initial contact and leads to ongoing treatment in the community. Without developing these capacities, no amount of training can resolve law enforcement’s current burden.
- Law enforcement and community correctional officers are faced with an increasingly challenging mental health population. They need opportunities to build skills and support their own well-being so they can perform an increasingly demanding job.
- High-risk and high need justice-involved youth are congregating in our detention facilities and are in need of foster care reforms to be effective. Continued efforts to ensure the “difficult” to serve, particularly foster care youth, get the services they need, especially substance use treatment.
- At a state-level prioritize support for data infrastructure, including at the local level, but only collect data needed to monitor trends to inform policies and practices. Support local entities gain the capacity for further research and evaluation efforts on best practices.
It was a year of change for COMIO with the addition of new leadership, members and staff. COMIO embarked on efforts to strengthen our relationships with key partners across criminal justice and behavioral health systems. During this process we recognized a need to focus efforts on building bridges across systems to improve understanding of different perspectives and promote problem-solving to prevent incarceration.
Change has many positive outcomes, including an opportunity to look at COMIO’s priorities and accomplishments and adjust to seize existing opportunities and tackle challenges. In 2017, it will be a year of further change by re-structuring committee and council meetings. This will allow for more intensive issue-specific work in fewer areas with more input from state and local experts and stakeholders.