Well, the part I really don’t understand – if you’re looking for self-help [books], why would you read a book written by somebody else? That’s not self-help, that’s help! There’s no such thing as self-help. If you did it yourself, you did not help! You did it yourself.—George Carlin
When hearing the terms “mental health” or “mental illness,” the stereotype is to think of “crazy.” This stereotypical image is of a person suffering from radical delusions and/or hallucinations, which is also often associated with violence. This common distortion of the realities of mental illness is certainly one leading reason why data collection is important. That is, the best way to combat stereotypes and educate the public on the true face of mental health or mental illness is to gather and deploy factual information. These facts detailing the actual number of people diagnosed with a mental illness help with educating the public of problems in their community. Additionally, friends and families can better understand the needs of their loved ones. Communities can create ways to address the needs of those with a diagnosis or help to prevent symptoms before onset occurs.
A screenshot of the online version of NAMI St Tammany’s (Louisiana) resource guidebook (2017)
4.1 Where Do People Fall Through the Cracks?
Treatment is essential in any health-related area for the overall wellness of an individual and for the communities they reside. The justice-involved population is certainly no exception and is particularly in need of treatment in several ways as it relates to mental health and, at times, also substance use. The unmet need for treatment is great for persons without a criminal background let alone for individuals with more complex mental health histories; this issue lends itself to the crux part of the problem—how can treatment change so all Americans can remain healthy? How does a person get help, especially when stigma presents such a roadblock to seeking help in the first place? How does a community overcome the lack of funding and the difficulties often present when citizens try accessing services?
Luckily, the conversations regarding change and improvement are happening across the country. As a society, the United States is beginning to acknowledge the need for criminal justice reform ; further, many communities have taken decisive strides to address the largest gaps in complex criminal justice systems in which people tend to fall through the cracks without the help they need to succeed in everyday life. With that, the idea of working toward more proactive measures to help other concerns with each individual has and will hopefully continue to be part of the discussion. Yet it is important to review the critical lapses in mental health-care systems that persist as policymakers and stakeholders move to address these gaps.
Imagine trying to navigate these issues if you did not feel physically well. Similar comparisons could be made to trying to navigate these issues when not feeling mentally well.ATTENTION FLORIDA DRIVERS LICENSE HOLDERS WHO DO NOT HAVE CARS: I just went to local DMV to transfer FL license to [Pennsylvania]. Could not do it--after three hours of rigmarole-- because my FL license could not be verified by PA. I call FL DMV, they tell me license is “suspended.” I ask why. They tell me “for lack of car insurance.” I tell them “but I haven’t had a car since 2012, and that’s why I got rid of car insurance.” And I get silence on the phone.
Then I ask how/when was I notified of this suspension, and I get silence on the phone. They tell me they can fix it on phone since “it has been longer than three years,” but that it takes 24-48 hours to update system. I ask them if they can send confirmation to PA DMV, they say yes, we’ll fax it. 45 minutes later, no fax.
This is on top of ridiculous PA …ID requirements which include the following documents to be presented in order to transfer license:
Passport, or raised seal birth certificate--note photo ID from Florida NOT acceptable for ID at PA DMV
TWO of following: tax records, current gun permit, mortgage, lease, w2, utility bill in my name
ALL addresses must match.
AND social security card
So, gotta hit DMV again in “24-28 hours” I guess. (Khey, unpublished research—unnamed informant)
In addition, bureaucracies are certainly not easy to change; adjustments to federal, state, and local law/policy require time, systems need to lay out how to address these changes to stay in compliance with the law/policy, and these plans require action that may take a while to perfect. While the intent of this text is not delve into complexities of public administration, it may be helpful to highlight some of the issues in civic processes to answer questions like “why doesn’t someone just change it?” Of course the answer is that this is easier said than done, but it helps to remind ourselves why. State legislatures, for example, operate in sessions in which new bills or amendments to bills can be introduced. One problem lies in the amount of time it takes for legislation to be reviewed and the number of hands it must pass through to get approved. This process could take weeks or months and still fail in the end. Further, it could take years to even develop into a bill worthy of bringing to the legislature in the first place, let alone the issues of political gridlock and partisanship, the influence of special interests, and so on.
There are several facts about mental illness in the United states that always seem to surprise those who are not directly involved:
Each year, there are nearly twice as many suicides (33,000) as homicides (18,000)
The life expectancy for people with major mental illness is 56 years (the average life expectancy in the U.S. is 77.7 years)
Mental disorders and substance abuse are the leading cause of disability in the United States and Canada
To this list we can now add another statistic—according to the Treatment Advocacy Center, and based on an analysis of data provided by the Substance Abuse & Mental Health Services Administration, people with mental illness are three times more likely to be in the criminal justice system than hospitals. In some states, such as Nevada and Arizona, the ratio is closer to 10 times more people with mental illness in jails and prisons (Insel, 2010).
As mentioned earlier in this text, there has been a drastic decrease (about 90%) in the number of state hospital beds over the past 50 years. Yet, the number of Americans with mental illness continues to increase as the population expands. Policy changes have significantly impacted the number of individuals with mental illness being sent to jails and prisons. As discussed earlier, people with mental illness are more likely to also have a substance abuse problem. Keeping this in mind, mandatory sentencing requirements for drug crimes mean that these individuals are now being incarcerated without any (or at minimum with little) consideration to the underlying mental health concerns in fueling drug-related offending. “Most of all, however, [the] statistic [above] reveals a failure to provide alternatives in the mental health care system for people requiring hospitalization” (Insel, 2010).
Individuals with mental health concerns begin to fall through the cracks in the systems of care in American communities. Recall that the National Alliance on Mental Illness commonly cites an important National Institute of Mental Health statistic—typically, it takes an average of 8–10 years after the onset of mental health symptomatology to begin to formally address these mental health concerns (NAMI, 2017a). This does not take into consideration any gender or cultural differences that may even further delay the time it takes to seek help. Rhetorically, it appears as though the popular perception of mental illness in the form of a crazy, delusional, and violent individual aggravates this delay in seeking help; or alternatively, the lack of mental health awareness blunts our ability to detect mental health concerns until mental health symptomatology reaches some critical mass. This critical mass could present itself when an individual winds up homeless, in an emergency room, or as a jail inmate; yet, it does seem that, many times, these costly issues to remedy tend to be a starting point in addressing underlying mental health concerns. The following section takes a deeper look into mental health safety net and its continued inherent problems.
4.2 Common Problems
Often, transportation can be one of the costliest parts on a treatment budget, and this can have an impact on the treatment quality given the high cost of gasoline, insurance (including liability), motor pool maintenance, and so on; some care providers may be a great distance from clients, particularly in suburban and urban areas. Or there may be only one provider in a large area because the funding and options are based on population rather than size of the area. In these cases, creativity is needed to ensure proper treatment. For example, some programs offer treatment providers to go to the clients (e.g., make house calls) rather than the other way around. This is part of the benefit of “assertive community treatment ,” described more in depth in an upcoming section within this chapter (Table 4.1).There is stiff competition for limited transportation resources, Ed Christopher said, and Congress requires justification for the spending of public money to ensure that the money spent achieves a positive return…. He observed that return on investment is viewed differently by different stakeholders. For transportation access to care, he said, the questions revolve around whether the efforts are making people healthier. Lefler noted that return on investment is difficult to ascertain in health care because it depends on illness, age, income level, and other factors of the many individuals involved. The ultimate question is whether quality of life is being improved…. Cronin highlighted the need for new and innovative cross-discipline research and stressed the need to “speak the language” of those you are trying to convince. He described some of his early work on return-on-investment calculations for medically related transportation services. One approach is to calculate cost avoidance (as a result of, for example, reduced ED visits, hospitalizations, or missed days of work). He said that much of the work at that time was based on assumptions about relationships between transportation and care (e.g., how many trips to care might correlate with avoidance of a 1-day in-hospital stay). He agreed that medical trips are about quality of life improvement, but he added that those controlling the funding (i.e., the tax dollars) want to show that they are generating a financial return (NASEM, 2016).
Summary of the main points of speakers of the workshop on the value of connecting patients with treatment services, National Academies of Science, Engineering, and Medicine
• Inclusive planning is a key element of success. It is important to directly engage the people who will be served by community transportation in the planning process and to understand what their specific needs are |
• Education can improve transportation. Transportation providers might not understand what accommodations the patient needs; health-care providers often do not know the transportation options available and therefore cannot advocate for patients; and patients are often unaware of or do not understand how to use the transportation that is available in the community |
• Different stakeholders view return on investment differently, depending on their individual goals |
• Cross-sector collaboration will be aided by developing a shared vocabulary and shared metrics. |
• There is an immediate need to make the business case that investing in transportation to care is of economic value, and there is also a need for longer-term research that demonstrates improvement in quality of life and the impacts of prevention |
With ongoing budget cuts and political barriers, mental health and substance abuse services have become increasingly scarce in many communities across the United States. Less public facilities, less providers (and less quality providers), and less beds/space available continue to be the primary concerns among mental health-care leaders. Statistics show that behavioral health needs are increasing but the availability of treatment is decreasing. This leads to the major focus of this text: the obstacles described here lay the foundation of the key problem that has existed for years. Now more than ever, more individuals are using jails and prisons as a means to get clean. Families and friends are also encouraging this idea due to the fact that there are no other options. Ironically, for those suffering from a mental illness, “getting clean” can increase the possibility of mental health concerns surfacing—leading to a particularly vulnerable moment in people’s lives.
4.2.1 Medical Coverage
A very obvious obstacle to seeking treatment is the lack of insurance, particularly access to Medicaid, to cover the cost of care. “Medicaid is the single-most important financing source of mental health services in the [United States], covering nearly 27% of all mental health care in [the country] and nearly half of the public mental health spending, according to SAMHSA” (NAMI, 2017b). Further, if a person is unable to acquire gainful and meaningful employment due to a criminal background, they are often unable to secure private health insurance of any kind. Without health insurance, the options for treatment are very limited, require the most severe symptoms before consideration, often have considerable waitlists, or are completely unavailable. Fortunately, some states have been moving forward with plans to help people leaving prison; this change typically comes in the form of adopting Medicaid expansion under the Affordable Care Act .
Louisiana offers a recent example. In 2016, after a long period of resisting Medicaid expansion, a bipartisan effort was spearheaded to join over 30 states which have expansion in place. This policy shift allows for ex-prisoners to be eligible for Medicaid upon release, with the potential of having benefits the moment these individuals leave prison facilities. While not currently in place, the goal is to initiate and complete the process to receive Medicaid (as well as other relevant benefits) in the months leading up to release. To do so, the Louisiana Department of Health (LDH) is collaborating with the Department of Public Safety and Corrections (DOC) to develop the ability to maintain a “suspended” status on Medicaid benefits that can be activated on a particular date (e.g., a release date). To date, it is routine to simply cancel benefits, forcing individuals to handle reapplication on their own upon reentry; as an interim process, sporadic reentry programs across the state employ case managers who assist with the application process. Allowing inmates to gain access to health benefits will hopefully allow improvements in health and decrease in returns to prison. “LDH and DOC implemented phase one of the prerelease enrollment initiative in January for offenders in the seven DOC state facilities. As of February 27, 2017, 230 offenders have been linked to a health plan, and it is expected that approximately 2,800 offenders will qualify for coverage annually, with about 30 percent of these former offenders being eligible for case management” (Louisiana Department of Health, 2017).
With the Affordable Care Act , and Medicaid for that matter, in peril due to loud calls for reform in the current political discourse, it is very difficult to anticipate how these trends will continue into the intermediate or distant future in regard to individuals with a criminal record (particularly, felons). While it is easy to cast political opponents of Medicaid expansion as adversaries of mental health, bipartisan political forces seem to be sending mixed messages. For example, the Twenty-First Century Cures Act continues to receive bipartisan support. Any movement to defund Medicaid may be supplanted with the support embedded in the Twenty-First Century Cures Act to some extent. Since the fates of the Affordable Care Act and Medicaid are still being debated and the policy changes of the Twenty-First Century Cures Act are being put into place, positive gains in mental health infrastructure appear to be secure in the near future, with the distant future having a murkier outlook.
4.2.2 Medical Records
Electronic health records (EHR) or electronic medical records are digital copies of an individual’s clinical history. Hospitals are working to adopt these electronic records for many reasons. First, the ease of use is highly beneficial in most medical settings. A doctor can use a laptop or iPad throughout the hospital to have a patient’s current medical information in seconds. Additionally, the information can be much more accurate and real-time since staff has the ability to input information immediately. EHRs allow for less use of resources since there is less need for storage, copies, and physical transfers of information. On a bigger scale, EHRs can offer access to information among many facilities, across many areas. If a person moves out of state, their electronic file can be easily obtained by the new treating physician to maintain care without any “cracks.” Perhaps the most important reason of any listed here, EHRs have become required for any organization to seek federally funded research dollars.
The use of EHRs can be vital in working with individuals with mental illness. Maintaining accurate history regarding physical issues, medications, or even family contacts can be difficult with some who suffer from a mental health diagnosis. Additionally, individuals who have a mental health diagnosis and begin medication management often stop taking their medication once they “feel better.” Having issues such as these well documented can empower each provider, stakeholder, and/or partner to engage in informed decision-making with their patient/client. In other words, EHRs can be vital in maintaining a continuum of care for an individual, especially those with mental illness and in the criminal justice system (particularly, those who are passing from one system to the other and vice versa). Often with mental illness, and not unlike other illnesses, treatment may not be immediate. Individuals can use resources like medication management and other therapies to help treat their diagnosis. Using electronic medical records, other doctors and treatment professionals can understand the medical history of the individual being treated. Understanding a person’s medical history can help treatment professionals identify best practices and hopefully prevent future setbacks. Ideally, jails and prisons will also move toward the use of electronic medical records to also ensure the best care for individuals involved in the criminal justice system with a mental health diagnosis. With this process, the hopes would be to eliminate further “cracks” in treatment.
Secure access to your personal health information
Easy care coordination between providers
Access to remote care from your home
Self-management tools for you and your caregivers (SAMHSA, 2017)
While the concept of EHRs is far from new, the issue is that health-care systems have been slow to adopt this tool or have yet to fully integrate this tool into all facets of each system (Palabindala, Pamarthy, & Jonnalagadda, 2016). Yet, much progress has been made in the wake of the Health Information Technology for Economic and Clinical Health Act (enacted 2009; United States Department of Health and Hospitals, 2017). Data on EHR adoption can be found at the Office of the National Coordinator for Health Information Technology (https://dashboard.healthit.gov), which details that the vast majority of American physicians using some form of EHR and over 90% of critical access hospitals of various sizes throughout the country (2017). Thus, at this point, the issue is not whether or not the tool is in use but how it is used. As providers gain more experience using EHRs , the benefits of using these systems—improved clinical decision-making, better communication among providers and between providers and patients, and reducing medication errors—can be fully realized. In addition, and of critical value for mental health professionals, the quality of case notes placed in EHRs can vary from provider to provider. While having access to medical histories can provide a rich resource to current providers, an abundance of poor case notes within an EHR may present a lost opportunity to make use of previous treatment encounters. For example, a recent review of a local agency providing mental health services in Louisiana showed considerable variation in the quality of case notes entered into a popular EHR. One provider working at the agency tended to use very brief and often repetitive narratives to describe his/her interactions with clients. As such, the case notes did not offer any individualized narratives for each client. This finding was shared with the agency’s quality assurance manager as it is highly unlikely that all clients are presenting the same circumstances, experiences, and symptoms nearly in the same way (Khey, unpublished research—Findings from an audit of a local Louisiana mental health provider).
At this time, it is unclear just how much of the narrative type of information placed in EHRs can be considered valuable and usable. What is clear is that medication histories have been reliable, and EHRs have a proven track record of reducing medication errors relative to medication errors of patients in systems not using EHRs. This medication history can also offer mental health professionals clues as to prior treatment decisions and, in conjunction with even moderate-quality case notes, can continue to be invaluable for making contemporary decisions. As these systems continue to flourish, their capacity to aid patients will certainly continue to grow.
4.2.3 Double and Multiple Stigma
As discussed earlier, stigma can be a difficult obstacle to overcome. Within the criminal justice system, the label of “criminal” can be harsh, misunderstood, and almost impossible to wipe clean. In the mental health realm, stigma can be just as harsh and limit or prevent an individual from seeking treatment. Now, imagine the stigma of incarceration and mental illness together. Having both labels and negativity piled on can be the catalyst to harmful and tragic outcomes. For example, the statistics for suicide in both populations are high in isolation, but the compounded stigma of both being a “criminal” and “crazy” often places these individuals at greater risk of self-harm and/or suicide.
Double stigma is defined as the presence of two stigmatized qualities present in one person. This can be a criminal history and mental health concerns. Some researchers have attributed a double stigma to be present among transgendered individuals who have mental health concerns, others have argued a double stigma among Muslim Americans who have mental health concerns, and so on. Beyond double stigma, multiple stigma is simply the presence of additional stigmatized qualities in one person. Each stigmatized status arguably confounds and magnifies each other, leading to poorer and poorer outcomes, and lessens the likelihood of healthy, “normal” lives.
While this simplistic terminology does not appear in many mainstream sources, its underlying assertions are clear. This will be addressed more fully in a subsequent chapter, but it is important to note here that stigma and labels can often be likened to a snowball effect—in other words, stigma and labels and build off of each other to knife off potential opportunities the legitimate and pro-social world, pushing those with stigma away from society and leaving them vulnerable to victimization, self-medication, homelessness, and much more.
4.2.4 Barriers of Public Housing
The Guidebook goes on to discuss in more detail on what would eliminate a person from eligibility:Public Housing Occupancy Guidebook provided by the United States Department of Housing and Urban Development
Ineligibility Because of Criminal Activity (24 CFR § 960.204) PHAs are required to prohibit admission of families with members:
Who were evicted from federally assisted housing for drug-related criminal activity for 3 years following the date of eviction (unless the family can demonstrate that the person who engaged in the drug-related activity has been rehabilitated or is no longer a member of the household); or
Who are currently engaging in illegal use of a drug; or
Who have shown a pattern of use of illegal drugs that may interfere with the health, safety, or right to peaceful enjoyment of the premises by other residents; or
Who are subject to a lifetime registration requirement under a State sex offender registration program; or
Whose abuse of alcohol or pattern of abuse of alcohol would interfere with the health, safety or right to peaceful enjoyment of the premises by other residents; or
Who have ever been convicted of drug-related criminal activity for manufacture of methamphetamine on the premises of federally assisted housing.
Involvement in Criminal Activity on the Part of Any Applicant Family Member that Would Adversely Affect the Health, Safety or Right to Peaceful Enjoyment of the Premises by Other Tenants (24 CFR § 960.203(c)(3) and 960.204) PHAs are required to check an applicant’s history of criminal activity for a history of crimes that would be lease violations if they were committed by a public housing resident. Before the screening steps are examined, consider that certain actions and behaviors require a rejection of an applicant:[emphasis added] · Persons evicted from federally assisted housing for drug-related criminal activities may not be admitted for three years from the date of eviction. In cases where the statute prohibits admission for a certain period of time, PHAs may now set a longer period of time for the prohibition (24 CFR § 960.203 (c) (3) (ii)). - Where the regulations specify a prohibition period for certain behavior, PHAs can consider the mandatory period and any extension of the discretionary period. - The discretionary time period for prohibition of admission can vary based on the type of activity. For example, a PHA may have a policy that an eviction where the applicant was manufacturing or dealing drugs results in a 5-year prohibition. In the case of life-time sex offender registrants, a PHA may establish long periods or a lifetime ban. · Persons engaging in the illegal use of a drug…. (U.S. Housing and Urban Development, 2017)
Solutions to housing restrictions are described below in the following section.
4.3 Common Resources
Outside of incarcerated settings and in the “free world,” there are a number of treatment options for and resources available to individuals suffering from mental health concerns. Traditional treatment options often include individual or group therapy and even family therapy. Individual therapy features regular one-on-one sessions with a licensed mental health professional and, on its own, offers a light and effective treatment for common mental health symptomatology. Also known as counseling or psychotherapy, individual therapy sessions often occur weekly in the therapist’s office. Therapists can be licensed professional counselors, licensed clinical social workers, and psychologists, and ideally, these mental health professionals would work in conjunction with a psychiatrist who could potentially prescribe medication to the patient, if/as needed. Each session generally lasts around 1 hour, with the length depending on the needs of the client. Sessions can discuss an array of topics including social skills, coping skills, and relationships, to name a few.
On the other hand, assertive community treatment (ACT) is considered one of the most intensive treatment options available for severe mental illness that demands an “all-hands” approach. ACT is a team-based model designed to treat individuals on a 24-h-a-day, 7-day-a-week basis while the patient remains in the community. Described in detail below, an ACT team features professionals across several disciplines and perspectives that can aid treatment provision. Thus, there are many different types of treatment that vary depending on the severity of illness, time available, and, as always, funding. Further, treatment options include a variety of settings, each with advantages to consider when customizing a patient’s individualized treatment plan.
Additionally, group therapy can be beneficial for some individuals. Group therapy consists of a therapist and a group of clients. The ideal number for a successful group should be less than 12 clients, but this can vary in different settings. Also, groups can be topic based as well and range from grief to substance abuse to parenting and beyond. Often, group therapy is most readily available to a majority of mental health “consumers” due to its relative low cost and effectiveness. More frequently, support groups are also leveraged for the same reasons. In many circumstances, support groups lack the lead of a trained clinician; however, and more often, support groups feature peer support specialists that can aid individuals with mental illness and/or substance use disorder cope with their disease, learn more about their triggers, and heal through shared experiences.
Each of these modalities is described below, along with other resources available in the community to help individuals with mental illness heal, learn to live with their illness, live comfortably, and live life to the fullest extent possible.
4.3.1 Transitional Housing and Recovery Residences: Halfway Houses, Sober Houses, and Three-Quarter Houses
For some leaving prison or a secure medical facility, a “halfway house” or other form or transitional housing is a great option (oftentimes, the only tangible option) that allows an individual to learn how to reenter society. This type of housing helps to slowly re-acclimate to everyday life, learn life skills and coping skills, and begin the process of recovery on solid footing alongside others who can benefit from the group therapy dynamic. An individual begins to regain their independence while also maintaining structure and support to ensure ease in the most difficult transition time.
The vernacular for transitional housing varies across the country. Broadly speaking, transitional houses—or recovery residences—refer to an array of housing options that offer different levels of rule strictness, obligations to attend treatment, and structure. For example, halfway houses have stricter rules, often have requirements of attending AA/NA or other 12-step (or similar) meetings, and engage in drug testing to ensure abstinence in comparison to three-quarter houses. In addition, halfway houses may place restrictions on residents in their ability to leave the house freely as they wish. In reality, a variety of transitional housing resources exist throughout the country with varying levels of rules, restrictions, and resources; the goal would be to find a resource that would match the facility to the needs of the client with the overarching goal, in most cases, to gradually step down the restrictions on this client until he or she can live independently and healthy and engage in broad pro-social behaviors.
4.3.2 Detox
Some substance use disorders must be treated immediately with medically monitored detoxification or “detox.” In this process, the patient will be forced into withdrawal from their drug(s) of choice in the safest way possible, which many times requires medication to moderate the discomfort of withdrawal symptoms, to stabilize vital signs, and to protect a patient from harm and death directly due to withdrawal or indirectly due to the psychological effects of withdrawal. Medical detox is most important for the cessation of chronic alcohol, barbiturates, and opioids; in particular, the withdrawal syndromes produced by chronic alcohol and/or barbiturates consistently produce life-threatening effects.
Guiding principles and assumptions of detoxification and substance abuse treatment (SAMHSA, 2006)
1. Detoxification alone is not sufficient treatment for substance dependence but it is one part of a continuum of care for substance-related disorders |
2. The detoxification process consists of the following three components: • Evaluation • Stabilization • Fostering patient readiness for and entry into treatment A detoxification process that does not incorporate all three critical components is considered incomplete and inadequate by the consensus panel |
3. Detoxification can take place in a wide variety of settings and at a number of levels of intensity within these settings. Placement should be appropriate to the patient’s needs |
4. Persons seeking detoxification should have access to the components of the detoxification process described above, no matter what the setting or the level of treatment intensity |
5. All persons requiring treatment for substance use disorders should receive treatment of the same quality and appropriate thoroughness and should be put into contact with a treatment program for substance use disorders after detoxification |
6. Ultimately, insurance coverage for the full range of detoxification and follow-up treatment services is cost-effective. If reimbursement systems do not provide payment for the complete detoxification process, patients may be released prematurely, leading to medically or socially unattended withdrawal |
7. Patients seeking detoxification services have diverse cultural and ethnic backgrounds as well as unique health needs and life situations. Organizations that provide detoxification services need to ensure that they have standard practices in place to address cultural diversity |
8. A successful detoxification process can be measured, in part, by whether an individual who is substance dependent enters, remains in, and is compliant with the treatment protocol of a substance abuse treatment/rehabilitation program after detoxification |
- 1.
Detox is not a cure for substance abuse or substance use disorder. Instead, it is likely to be a first step into drug recovery (and a recovery orientation) and can be the first entry point into an array of treatment events in one’s life.
- 2.
Substance use disorder can be treated and patients can have hope to progress into recovery.
- 3.
Substance use disorder is a chronic brain disease that often features relapse. This disease should not be mistaken for moral weakness.
- 4.
Patients are to be treated with respect and in a dignified manner.
- 5.
Further, patients are to be treated supportively and without judgment.
- 6.
Individualized treatment plans should be made in partnership with the patient and, as warranted, with his or her support network (e.g., family, friends, partners, and/or employers).
- 7.
All treatment personal should promote rehabilitation and maintenance activities at all times, as appropriate, and should be prepared to link the patient with subsequent services immediately after discharge from detox.
- 8.
Active participation and involvement of a patient’s support system should be encouraged when appropriate while ensuring patient’s privacy, confidentiality, and HIPAA rights.
- 9.
Treatment professionals must consider differences in background, culture, preferences, sexual orientation, disability, vulnerabilities, and strengths of each patient when providing care (SAMHSA, 2006). Emphasis must be placed on the fact that detox often serves as an entry event that begins the path to recovery (also known as a treatment “career”) but also may be necessary several times across one’s substance use “career.”
4.3.3 Inpatient Treatment Services
Inpatient treatment can be beneficial and possibly necessary for a person experiencing serious mental illness and/or severe substance abuse. The inpatient setting allows for 24/7 care in both medical and mental health. Individuals often receive a multitude of complementary treatments, supports, and care while in an inpatient treatment center. An individual receives social support, medication management, medical care, individual therapy, group therapy, at times recreational therapy, and possibly art therapy. All facets work together with the overall goal of recovery from mental illness and substance use. This comprehensive treatment approach can also work to aid in overcoming past trauma or other underlying causes of the mental illness or substance use yet is the costliest of options (outside of incarceration; NAMI, 2017c).
Continuum of mental health services, courtesy of the Minnesota Department of Human Services (2017)
4.3.4 Intensive Outpatient (IOP) Treatment
Intensive outpatient treatment or IOP is akin to “partial hospitalization ” in that a person receives treatment on a regular basis in a medical setting but returns home each night (NAMI, 2017e). In an IOP program, an individual has multiple treatment sessions each week. This type of treatment is often used in a transition after inpatient and leads to a step-down to outpatient treatment. It can also be coordinated with a sober or halfway house for a fuller range of treatment support. Some programs differentiate between IOP and partial hospitalization in that the former is the less intensive version of the latter, but essentially, both require attendance during the day for several days a week and will release patients into the community in the afternoon or late afternoon.
4.3.5 12 Steps: AA/NA
Alcoholics Anonymous and Narcotics Anonymous (AA/NA) are group support meetings, not therapy, that take place with a community-like approach to support recovery from alcohol and drugs. These meetings are run and attended by individuals that suffer from addiction. Meetings can be open to the public or closed, specific groups. Additionally, some meetings can be segregated to just women only. The purpose of AA/NA meetings is to hold members accountable for their processing of the 12-steps of the program. As the title implies, group members remain anonymous in that what is discussed in the meeting is not discussed outside in public.
The 12 steps of Alcoholics Anonymous (Alcoholics Anonymous, 1981)
4.3.6 Assertive Community Treatment (ACT) Teams
Assertive community treatment (ACT) is a multidisciplinary team-based approach that provides around the clock care to patients in situ (i.e., where the patients are in the community and not at any particular facility; NAMI, 2017d). Rather than a work through referral process, ACT provides treatment directly to clients by offering a team of professionals to handle any would-be referral among the team and not “refer out.” In other words, any service a patient may need can be handled among team members immediately, cutting out any “middlemen” of treatment provision. ACT operates as a 24/7 treatment team just like inpatient services; however, ACT services are provided at the location of the client rather than in a hospital/inpatient setting. The team members are trained on multiple areas of topics including nursing, substance abuse, social work, psychiatry, and vocational counseling.
According to NAMI , assertive community treatment began in 1972 as the brainchild of Arnold Marx, Leonard Stein, and Mary Ann Test at Mendota State Hospital in Wisconsin. ACT was initially meant to serve as a support system for patients reentering the community from state hospitals during the early stages of the deinstitutionalization movement. In particular, these mental health professionals noted that many gains in mental health quickly tended to devolve after patients return back into their communities. As ACT services are reaching its half-centennial of existence, its proven success has earned it the distinction of being an evidence-based service by SAMHSA.
- 1.
“Treatment: psychopharmacologic treatment, including new atypical antipsychotic and antidepressant medications, individual supportive therapy, mobile crisis intervention, hospitalization, substance abuse treatment, including group therapy (for clients with a [co-occurring disorder ] of substance abuse and mental illness)”
- 2.
“ Rehabilitation : behaviorally oriented skill teaching (supportive and cognitive-behavioral therapy), including structuring time and handling activities of daily living, supported employment, both paid and volunteer work support for resuming education”
- 3.
“ Support services : support, education, and skill teaching to family members, collaboration with families and assistance to clients with children, direct support to help clients obtain legal and advocacy services, financial support, supported housing, money-management services, and transportation” (NAMI Minnesota, 2017)
4.3.7 The Value of Compulsory Treatment
Specialty courts are discussed in a different chapter within this book, but there are other ways that treatment can be required for those involved in the criminal justice system. In fact, compulsory treatment often leads to the most successful treatment experiences among patients, particularly when evaluating the likelihood of treatment completion. Importantly, successful completion of treatment is correlated with lasting success in recovery and healthy lives.
With court-mandated treatment , the added “benefit” of legal ramification with treatment noncompliance helps to keep patients on the path to successfully complete treatment regimes, often giving them the best chances of future success. Further, treatment can be an option in lieu of incarceration or prosecution, which also aids in giving people reason to stay clean, compliant, and out of trouble. According to the NIDA, “most studies suggest that outcomes for those who are legally pressured to enter treatment are as good or better than outcomes for those who entered treatment without legal pressure. Individuals under legal pressure also tend to have higher attendance rates and remain in treatment for longer periods, which can also have a positive impact on treatment outcomes” (2017).
4.4 Treatment Settings
Treatment can be provided in a number of settings and locations. The settings depend on the goals and recovery process of the individual seeking treatment. The benefit of multiple options is that there can be multisystemic approach. In other words, what works for one person may not work for another, so trying different settings to find the “right fit” may be best.
Private practice for a therapist is similar to a doctor’s office. Often a therapist has their own office or is with a group in a building. This setting lends to a more open environment that is designed and decorated by the therapists themselves rather than a more hospital-type vibe. Typically, if in a group, each therapist has their own office in which to meet with clients. Insurance can be used in private practice settings to help offset the cost of sessions. Individual, family, and group sessions can take place in private practice offices. The following sections offer a review of other treatment settings available to patients in the community setting.
4.4.1 Community Mental Health Centers
Community mental health centers (CMHC) provide mental health services to the public. Generally, those visiting a community mental health center receive Social Security disability and/or Medicaid benefits (Centers for Medicare and Medicaid Services, 2017). Local governments of the parish or county operate these centers, which offer a variety of services to the public. Those services can include outpatient treatment, group therapy and/or support groups, medication management, and case management, and some offer specific substance abuse addiction services. CMHCs can be very helpful in that they can offer referrals to other treatment providers and useful programs in the community. Most people who seek help at a CMHC experience a severe impact of symptoms on their activities of daily living. This can range between a variety of needs which result in a variety of referrals from day programs to longer-term inpatient supportive housing.
4.4.2 Emergency Rooms and Hospitalization
As with certain medical situations , there are times when an emergency arises and immediate treatment is needed for mental health as well. Additionally, in times of suicidal ideations or homicidal ideations, seeking emergency help is in the best interest for safety of the individual and/or others. A person can be brought to the emergency room for immediate attention for a mental health concern. As NAMI describes, “Situations that might require a trip to the emergency room include: a suicide attempt, assault or threatening actions against another person, hearing voices, paranoia, confusion, et cetera, or drugs or alcohol escalating to a person’s mental health issue” (2017e). Often, going to an emergency room, whether voluntarily or involuntarily (loved one, ambulance, law enforcement, etc.), can be the first step in beginning the process of treatment. Luckily, many emergency rooms in major metropolitan areas have psychiatric areas specifically used to treatment-emergent situations with a mentally ill person. Also, the staff is trained to handle a psychiatric crisis and make the best decision for continued care.
4.4.3 Group Homes
At times, a group home may be a necessary type of supportive housing for a person who needs more attention and care. For individuals who are in need of medication management, but not in mental health crisis, a group home can be an option (NAMI, 2017f). As SAMHSA describes, “research literature documents that persons with serious mental illnesses, and substance use disorders die younger than the general population—mainly due to preventable risk factors (e.g., smoking) and treatable conditions (e.g., cardiovascular disease and cancer)” (SAMHSA, 2012, p. 7). Part of the measures taken to work to overcome these risk factors includes improving access to primary care. In some cases, that care can be provided “in-house” while a person is living in a group home or supportive housing, in collaboration with medical partners in the community. Individuals who are chronically ill can have access to both medical and mental health treatment within the setting of the group home or be transported by the group home to attend appointments for these services in the community. Additionally, individuals can live with other peers and work toward social improvements. Group homes often offer the opportunity to learn skills and activities all with the extra care.
4.5 Federal/National Resources
The federal system for criminal justice and health-care changes with each change in administration. These changes can be both good and bad. First, the instability on the system and all involved every 4–8 years can be a struggle. Additionally, each administration can vary wildly in regard to views and ways to handle the needs of the country, including by setting priorities and funding schemes to match these priorities (particularly among major federal grant-funding agencies). Fortunately or unfortunately, each state in the United States operates differently on some systems. There are federal standards to adhere to for hospitals and levels of treatment, but with other matters, policies can be changed or adjusted by state government. Further, the issue of treating mental health as a separate issue allows for more “flexibility” with treatment and funding at the state level. State governments make decisions about the allocation of money to each different entity, like public-run hospitals. If a state is in need of making financial adjustments, they can choose to defund those programs and even hospital. The following sections feature nationwide or federal resources that offer support to the issues documented in this book.
4.5.1 SAMHSA
SAMHSA-funded programs (2017)
Grant program | Program description |
|---|---|
State Pilot Grant Program for Treatment for Pregnant and Postpartum Women | “supports family-based services for pregnant and postpartum women with a primary diagnosis of a substance use disorder, including opioid disorders; 2) help state substance abuse agencies address the continuum of care, including services provided to women in nonresidential-based settings; and 3) promote a coordinated, effective and efficient state system managed by state substance abuse agencies by encouraging new approaches and models of service delivery” |
Cooperative Agreements for Expansion and Sustainability of the Comprehensive Community Mental Health Services for Children with Serious Emotional Disturbances | “This cooperative agreement will support the provision of mental health and related recovery support services to children and youth with SED and those with early signs and symptoms of serious mental illness (SMI), including first episode psychosis (FEP), and their families…The SOC Expansion and Sustainability Cooperative Agreements will build upon progress made in developing comprehensive SOC across the country by focusing on sustainable financing, cross-agency collaboration, the creation of policy and infrastructure, and the development and implementation of evidence-based and evidence-informed services and supports” |
State Targeted Response to the Opioid Crisis Grants | “The program aims to address the opioid crisis by increasing access to treatment, reducing unmet treatment need, and reducing opioid overdose related deaths through the provision of prevention, treatment and recovery activities for opioid use disorder (OUD) (including prescription opioids as well as illicit drugs such as heroin)” |
Cooperative Agreement for the Provider’s Clinical Support System—Medication Assisted Treatment Supplement | “Program purpose is to expand on the Drug Addiction Treatment Act (DATA) of 2000 and continue SAMHSA’s currently funded PCSS-MAT initiative…This supplement will provide additional support to the current PCSS-MAT grantee by enhancing/expanding medication assisted treatment (MAT) training and educational resources to health professionals on evidence-based practices for preventing, identifying, and treating opioid use disorders” |
Promoting Integration of Primary and Behavioral Health Care | “The purpose of this cooperative agreement is to: (1) promote full integration and collaboration in clinical practice between primary and behavioral healthcare; (2) support the improvement of integrated care models for primary care and behavioral health care to improve the overall wellness and physical health status of adults with a serious mental illness (SMI) or children with a serious emotional disturbance (SED); and (3) promote and offer integrated care services related to screening, diagnosis, prevention, and treatment of mental and substance use disorders, and co-occurring physical health conditions and chronic diseases” |
Grants for the Benefit of Homeless Individuals | “The purpose of this program is to support the development and/or expansion of local implementation of a community infrastructure that integrates behavioral health treatment and services for substance use disorders (SUD) and co-occurring mental and substance use disorders (COD), permanent housing, and other critical services for individuals (including youth) and families experiencing homelessness” |
Cooperative Agreement for the Historically Black Colleges and Universities Center for Excellence in Behavioral Health | “The purpose of this program is to continue to enhance the effort to network the 105 HBCUs throughout the United States to promote behavioral health, expand campus service capacity, and facilitate workforce development. The HBCU-CFE seeks to address behavioral health disparities among racial and ethnic minorities by encouraging the implementation of strategies to decrease the differences in access, service use, and outcomes among the racial and ethnic minority populations served and trained by the program. The goals of the HBCU-CFE are to promote student behavioral health to positively impact student retention; expand campus service capacity, including the provision of culturally and linguistically appropriate behavioral health resources; facilitate best practices dissemination and behavioral health workforce development; and increase awareness of the early signs of emotional distress and resources for early intervention” |
Comprehensive Addiction and Recovery Act: Building Communities of Recovery | “The purpose of this program is to mobilize resources within and outside of the recovery community to increase the prevalence and quality of long-term recovery support from substance abuse and addiction. These grants are intended to support the development, enhancement, expansion, and delivery of recovery support services (RSS) as well as promotion of and education about recovery” |
Grants to Expand Substance Abuse Treatment Capacity in Family Treatment Drug Courts | “The purpose of this program is to expand and/or enhance substance use disorder (SUD) treatment services in existing family treatment drug courts, which use the family treatment drug court model in order to provide alcohol and drug treatment (including recovery support services, screening, assessment, case management, and program coordination) to parents with a SUD and/or co-occurring SUD and mental disorders who have had a dependency petition filed against them or are at risk of such filing. Services must address the needs of the family as a whole and include direct service provision to children (18 and under) of individuals served by this project” |
The Substance Abuse and HIV Prevention Navigator Program for Racial/Ethnic Minorities Ages 13-24 Cooperative Agreement | “The purpose of this program is to provide services to those at highest risk for HIV and substance use disorders, especially racial/ethnic males ages 13-24 at risk for HIV/AIDS including males who have sex with other males (MSM). The program will place a particular emphasis on those individuals who are not in stable housing in communities with high incidence and prevalence rates of substance misuse and HIV infection. It will provide opportunities to enhance outreach to the population of focus and assist them in receiving HIV medical care” |
Resiliency in Communities After Stress and Trauma | “The purpose of this program is to assist high-risk youth and families and promote resilience and equity in communities that have recently faced civil unrest through implementation of evidence-based, violence prevention, and community youth engagement programs, as well as linkages to trauma-informed behavioral health services. The goal of the ReCAST Program is for local community entities to work together in ways that lead to improved behavioral health, empowered community residents, reductions in trauma, and sustained community change” |
Cooperative Agreements to Implement the National Strategy for Suicide Prevention | “The purpose of this program is to support states in implementing the 2012 National Strategy for Suicide Prevention (NSSP) goals and objectives focused on preventing suicide and suicide attempts among adults age 25 and older in order to reduce the overall suicide rate and number of suicides in the U.S. nationally” |
Grants for the Benefit of Homeless Individuals | “The purpose of this program is to support the development and/or expansion of local implementation of a community infrastructure that integrates behavioral health treatment and services for substance use disorders (SUD) and co-occurring mental and substance use disorders (COD), permanent housing, and other critical services for individuals (including youth) and families experiencing homelessness” |
Cooperative Agreement for the Historically Black Colleges and Universities Center for Excellence in Behavioral Health | “The purpose of this program is to continue to enhance the effort to network the 105 HBCUs throughout the United States to promote behavioral health, expand campus service capacity, and facilitate workforce development. The HBCU-CFE seeks to address behavioral health disparities among racial and ethnic minorities by encouraging the implementation of strategies to decrease the differences in access, service use, and outcomes among the racial and ethnic minority populations served and trained by the program. The goals of the HBCU-CFE are to promote student behavioral health to positively impact student retention; expand campus service capacity, including the provision of culturally and linguistically appropriate behavioral health resources; facilitate best practices dissemination and behavioral health workforce development; and increase awareness of the early signs of emotional distress and resources for early intervention” |
Comprehensive Addiction and Recovery Act: Building Communities of Recovery | “The purpose of this program is to mobilize resources within and outside of the recovery community to increase the prevalence and quality of long-term recovery support from substance abuse and addiction. These grants are intended to support the development, enhancement, expansion, and delivery of recovery support services (RSS) as well as promotion of and education about recovery” |
Grants to Expand Substance Abuse Treatment Capacity in Family Treatment Drug Courts | “The purpose of this program is to expand and/or enhance substance use disorder (SUD) treatment services in existing family treatment drug courts, which use the family treatment drug court model in order to provide alcohol and drug treatment (including recovery support services, screening, assessment, case management, and program coordination) to parents with a SUD and/or co-occurring SUD and mental disorders who have had a dependency petition filed against them or are at risk of such filing. Services must address the needs of the family as a whole and include direct service provision to children (18 and under) of individuals served by this project” |
The Substance Abuse and HIV Prevention Navigator Program for Racial/Ethnic Minorities Ages 13–24 Cooperative Agreement | “The purpose of this program is to provide services to those at highest risk for HIV and substance use disorders, especially racial/ethnic males ages 13–24 at risk for HIV/AIDS including males who have sex with other males (MSM). The program will place a particular emphasis on those individuals who are not in stable housing in communities with high incidence and prevalence rates of substance misuse and HIV infection. It will provide opportunities to enhance outreach to the population of focus and assist them in receiving HIV medical care” |
Resiliency in Communities After Stress and Trauma | “The purpose of this program is to assist high-risk youth and families and promote resilience and equity in communities that have recently faced civil unrest through implementation of evidence-based, violence prevention, and community youth engagement programs, as well as linkages to trauma-informed behavioral health services. The goal of the ReCAST Program is for local community entities to work together in ways that lead to improved behavioral health, empowered community residents, reductions in trauma, and sustained community change” |
Cooperative Agreements to Implement the National Strategy for Suicide Prevention | “The purpose of this program is to support states in implementing the 2012 National Strategy for Suicide Prevention (NSSP) goals and objectives focused on preventing suicide and suicide attempts among adults age 25 and older in order to reduce the overall suicide rate and number of suicides in the U.S. nationally” |
4.5.2 National Alliance on Mental Illness
The National Alliance on Mental Illness or NAMI is a mental health organization created to help improve the lives of people suffering from mental illness. The goals of NAMI include educating and advocating on topics related to mental illness. Additionally, the organization works to promote awareness with events including NAMIWalks as well as offer help and support with the NAMI HelpLine. For colleges and universities, NAMI on Campus is a campus club that works to end the stigma associated with mental illness as well as help to make connections for services and needs for students on campus. NAMI offers a startup packet and support to create a club on campus for those interested.
The Drop-In Center provides groups weekly as well as educational courses that last for 10 weeks regularly. These groups are run by peers trained by the NAMI Peer-to-Peer program. “The Peer-to-Peer program helps [an individual]:
Create a personalized relapse prevention plan
Learn how to interact with healthcare providers
Develop confidence for making decisions and reducing stress
Stay up-to-date on mental health research
Understand the impact of symptoms on the person’s life
Access practical resources on how to maintain the journey toward recovery” (NAMI, 2017g)
Programs like these are important in that an individual with mental illness can receive support and help from others who understand their situation. Additionally, and importantly, individuals can learn to advocate for themselves in their own lives, especially in relation to medical needs. Ultimately, support and confidence can aid in the overall recovery and wellness for the person with mental illness.
In addition to services provided directly to the individuals in need in the community, NAMI also provides programming for family members and caretakers of those with mental illness. These programs can beneficial to understand the illness of a loved one, understand their role in recovery and wellness, help to reduce stigma and boost awareness, and finally aid in reduction of burnout and compassion fatigue. NAMI New Orleans provides Mental Health First Aid, Mental Healthcare Navigation Team, Family Education and Support, Peer Education and Support, Advocacy and Community Education, and Advance Directive for Mental Health Treatment.
The Family Education and Support programs vary from structured multi-week courses taught by trained professionals to the Survivors of Suicide Loss support group which “is a free peer-led support group for adults whose lives have been impacted by the loss of a loved one to suicide, whether recently or in the past” (NAMI New Orleans, 2017).
4.6 Example of Innovation in Available Resources and Emerging Technology: Mobile Health (mHealth)
The use of applications or apps by many has grown for all sorts of options. From shopping to language skills and everything in between, “there’s an app for that.” Now, there are also apps for therapy and treatment. Talkspace is a web-based treatment platform that can be used on a computer or cell phone. The process involves an initial assessment and then a matching process (not unlike online dating) to establish a positive relationship between therapist and potential client. Users can denote special needs like LGBTQ friendly or Veteran knowledge to assure their needs are met in future therapy session.
Though application and web-based treatment options are nontraditional, they do provide options and help for those who may not otherwise have access or not seek treatment. The use of electronic devices can make the argument of both a help and a hindrance since there have been many studies regarding the limits on screen time or being present rather than glued to a phone, but that is a different book entirely.
The four areas comprising the model (beyond gathering basic background information) are:
- 1.
Safety/Privacy
- 2.
Evidence (i.e., effectiveness)
- 3.
Ease of Use
- 4.
Interoperability (American Psychiatric Association, 2017).
4.7 A Canary in the Shaft: American Mental Health Troubles Seen Abroad
It appears that the American experience is not exclusive nor unique. As such, American students and professionals should be aware of other systems under stress and observe differences (and similarities) to other approaches to navigate these problems as a learning device. Further, growth from shared experiences works for mental health patients; why should it not be helpful for mental health professionals as well?In 2012, a new law (Law 9/2012) established that new residential facilities had to be developed to better meet the needs of providing intensive and high-quality mental healthcare to socially dangerous individuals with mental disorders under proper secure conditions. These small-scale facilities (no more than 20 individuals, up to 4 patients per bedroom) are intended to replace admissions to forensic psychiatric hospitals…. As expected, the new law has activated a heated debate among Italian mental health professionals. As a general point it should be emphasised that this reform has been approved without clear cut evidence of its cost-effectiveness. Similarly, the results of studies describing the outcomes of patients discharged from forensic psychiatric hospitals are unavailable, and no recent and reliable information on the clinical characteristics and care needs of forensic psychiatric patients have been collected…. [A]nother critical consideration is the extra burden that community services will face. Several facilities in Italy are presently understaffed and in the past few years economic resources have been cut, to a varying degree, across the country. Additional resources will also be needed to increase the competence of mental health professionals working in community services in treating criminal offenders with mental disorders (Barbui & Saraceno, 2015, p. 445).
4.8 Conclusion
In the conversation about treatment, specifically for justice-involved individuals, there are both good news and bad news. There are new innovations and technology being created daily to aid in allowing access to treatment for persons who otherwise may not have had any help. Additionally, federal grant funding allows for counties, parishes, and states to incorporate successful models that have been proven to work but would not have been a possibility due to funding. That being said, there continues to be strife in the realm of treatment for many states. The point here is that individuals experiencing symptoms of mental illness need treatment, not unlike any other illness. If a person is in need of treatment, then why are they often incarcerated? The answer is broken system.
Those with severe mental illness are more likely to be homeless. If they are homeless, they may be out in public experiencing delusions and/or hallucinations. As mentioned before, the stigma and stereotype with mental illness lead the public and sometimes first responders (who may not be properly trained) to believe these individuals are violent or cause a public threat. In reality, most are not violent but are in dire need of help and care. Taking a person to jail who is hearing voices or is severely paranoid is not the answer. Jail will not help because it is not treatment. Not only that, if they are paranoid or in the midst of a delusion or hallucination being taken against their will only to be locked up will most likely escalate the situation. Imagine being locked away and not understanding why or fearing harm. This compromises the safety of the individual, the first responders, the public, and those inside the jail/prison system.
This brings back the conversation regarding jail and prison staff and their safety. Without treatment, illnesses get worse, and in this case those illnesses lead to further delusions or hallucinations. Often, this results in self-harm, possibly suicide. Then, consider those witnessing these acts and attempting to help. Incarceration does not cure mental illness.
Even further, the cost of incarcerating an individual comes into play. Keeping a person in jail or prison for days, weeks, months, or even years gets expensive. Alternatively, treatment can be provided and may be shorter and cost less.
Obviously, some violent crimes are the exception to the treatment instead of incarceration argument. There is a reality of those who commit horrible, violent crimes due to a mental illness, and incarceration is part of the sentence for those crimes.
Humanity should be considered in all situations. No one would ever think to lock up a person with diabetes or cancer, so why should bipolar disorder or schizophrenia be any different. Even consider nonpsychotic disorders like depression and anxiety. If a person experiencing clinical depression is incarcerated without treatment, how is that person expected to recover? If they are released, how can society expect success? Also, as mentioned before, these individuals tend to return time and time again to jail. Each time costs money, and each time does nothing to help the person with mental illness. Therefore, time and money are wasted, and the person’s illness gets worse. Additionally, the person may seek medical attention as well, thus costing more money from the health-care system. This benefits no one including the taxpayer.
Changes should be made at all levels of interaction: local, state, and federal. On one side, there are taxpayers and government officials often discussing the fiscal side of the argument. The other side includes individuals with mental illness, their loved ones, and health professionals. It may appear to have a simple solution—send those with mental illness to treatment rather than jail or prison. It saves the local county/parish money, state, and federal government and helps the person. Ideally, that is simple, but the obstacles and barriers involved can be overwhelming, time-consuming, and shrouded with fear and misunderstanding often crippling the system and halting any change.
Many people know of someone with mental illness or a substance abuse problem. Whether it be a close friend or family member or a distant relative or coworker, these concerns do exist and are prevalent. Now, considering that person, do they not deserve treatment to help them recover?
First responders often struggle with the reality of the broken system as well. As discussed before, their job (and often identity) is to help others in need. Keeping that in mind, imagine the difficulty of repeated attempts to help individuals encountered on a regular basis. How does a first responder keep faith in the system? In their job? Further, the local/state/federal government? These situations all lead to burnout and mental health struggles for those on the front line, not to mention the growing frustration of the lack of help being provided to those in need. Visually seeing people deteriorate regularly cannot be easy.
Furthermore, for the individual inside the system, hope and positivity can be difficult to find. Fear of incarceration may be the sole reason for a person to avoid seeking help when needed, leading to hopelessness and, again, worsening symptoms. Without a proper support system, this fear may also lead to grave consequences with suicide. Add in the stigma of mental illness, substance abuse, and criminal history and the results are a trifecta of negativity. It can seem impossible to change or even begin steps to recover, sobriety, and wellness. Those in need of help may also not know the resources available to them or, even worse, may not have access to seek out said resources.
Thinking of loved ones, the importance of education and support is also essential here. Families can play a crucial role in helping a person change for the better after a mental illness crisis or even just a diagnosis. Also, those with substance abuse and criminal history are in dire need of education and support. Those who live with the individual in need can learn to understand the signs and symptoms of their illness(es). Learning these can aid in proactive measures to possibly prevent further issues or from an eruption of symptoms. Additionally, support after treatment can be beneficial to possibly prevent further issues.