Tuesday, January 25, 2011

The Right Thing To Do

The Herald-Sun
January 24, 2011

By Ellen S. Holliman, Gudrun Parmer and Marcia H. Morey
Guest columnists

We noted with interest the recent Herald-Sun article called “Jails Tackle Tough Issue,” which highlighted what has been a source of serious concern in the behavioral health community locally and nationally for years. It should not be a revelation today that our jails (in addition to our homeless shelters and hospital emergency departments) have long been a collection point for individuals experiencing mental illness or substance use disorders, or both. However, we welcome any attention paid to this chronic and troubling issue, as well as this opportunity to balance the story by describing some innovative initiatives in Durham to address it.

The relationship between mental illness and involvement with the criminal justice system is a highly complex one often involving numerous other life issues such as homelessness and poverty. Isolating mental illness as the cause of criminal behavior is unjust and overly simplistic. Data tell us that across the country a significantly higher percentage of persons with mental illness find their way into our correctional systems as compared to the general population, and Durham is no different.

This could lead many to believe that persons with mental illness are dangerous or violent and need to be locked up to keep the public safe. This is just a myth. In fact, persons with mental illness are 12 times more likely to be the victim of a crime than to be an offender. In a recent study of repeat offenders with symptoms of mental illness conducted by The Durham Center, almost 80 percent were jailed on non-violent misdemeanors, but they spent an average of 35 days longer in jail than the general population.

The Durham Center and the Durham County Criminal Justice Resource Center have nurtured a close collaboration with other members of Durham’s Mental Health Criminal Justice Advisory Committee to work toward preventing our citizens with behavioral health issues from ending up in jail, and providing them with appropriate treament and support when they do. The group works to identify recommendations that would address the “revolving door” of individuals entering into and being released from jail in need of behavioral health services.

Since 2007 The Durham Center has teamed with NAMI-Durham and our law enforcement partners to provide Crisis Intervention Team training to over 180 local law enforcement officers, plus all of Durham’s emergency telecommunicators. This 40-hour training is part of a nationally acclaimed model teaching officers to recognize the signs of mental illness in individuals in crisis and to respond in a way that requires less force and promotes access to treatment rather than arrest and jail.

Recently The Durham Center received a significant grant from the U.S. Substance Abuse and Mental Health Services Administration (SAMHSA) and partnered with the Durham Police Department, the Criminal Justice Resource Center and the Center for Child and Family Health to win another from the U.S. Bureau of Justice Assistance (BJA).

The SAMHSA grant provides almost $6 million over six years to allow a diverse group of local agencies to target 16-21-year-olds with a serious mental illness and other high risk factors such as poor school performance or dropping out, teenage parenting, criminal justice involvement and lack of employment skills. These vunerable youth will be provided with the comprehensive services and support they need to assist with a successful transition to adulthood, free of involvement with the criminal justice system.

The BJA grant provides over $300,000 to fund a Mental Health Outreach Program designed to reduce re-arrest for non-violent offenses, increase court-involved individuals engaged in mental health treatment, and further increase patrol officers who receive mental health training.

Two social workers and a part-time psychiatrist are housed at the Durham County jail to respond to the mental health needs of inmates and to help ensure that when they are released they are able to transition to appropriate ongoing care and support. People incarcerated at the jail or the local youth detention facility also have access to a psychiatrist through a telepsychiatry program managed by The Durham Center. We continue to focus on expanding community-based care that addresses the unique needs of persons living with mental illness who are criminal-justice involved.

In combination, these measures are designed to route individuals into needed treatment rather than incarceration, when appropiate, and to provide them the help they need when they do end up in jail. Working together we are beginning to see a positive impact. However, the need is great and much more could be done.

More than 150 communities across the country have instituted mental health courts to implement innovative, collaborative efforts among judges, attorneys and other court personnel working alongside mental health practioners to decrease the frequency of contacts that adult offenders have with the criminal justice system by providing courts with resources to improve their social functioning and link them to employment, housing, treatment and support services. The Durham Center is teaming with court officers and elected officials in our community to explore the feasibility of creating a mental health court here. We believe it would have a tangible impact on the numbers of individuals with mental illness in our jail, and we encourage public support for this important initiative.

We realize these initiatives come with a cost during a weakened local economy. However, we submit that providing the services necessary to keep our citizens with behavioral health issues out of our jails, and providing them with the treatment and comprehensive ongoing support that can help reduce their time in jail and keep them from returning, is a wise and necessary investment of tax dollars.

Do we choose to continue to pay over $12,000 per jail stay for individuals with mental illness? Shall we continue to expand our jail capacity to the tune of over $76 million projected in fiscal years 2011 and 2012? Or would the more cost-efficient alternative be to make comparatively meager investments in additional clinical staff for our jail, create additional therapeutic and supportive housing options and develop a mental health court that could divert people from incarceration so they can lead productive, healthy and law-abiding lives?

We want our community to know that this is a serious and complex problem. We want citizens to be aware of the important measures already in place to address it. And we urge members of our community to advocate for public and private support, financial and otherwise, for the additional initiatives that have the potential to save millions of dollars over time while helping our brothers and sisters with behavioral health problems start on the road to recovery.

It’s just the right thing to do.

Ellen S. Holliman is area director of The Durham Center; Gudrun Parmer is director of the Durham County Criminal Justice Resource Center; and Marcia H. Morey is a Durham County District Court judge.

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