The heart of the matter: Identifying person-centered solutions at the intersection of the mental health and criminal justice systems

Cecilia Echeverría
Cecilia Echeverría
By Cecilia Echeverría, MPP, MPH, Senior Director for Public Policy, Strategy & Operations, Kaiser Permanente

While browsing the aisles of my local supermarket recently, I ran into a friend and former colleague (let’s call him Joseph). I hadn’t seen him in a few years, but he looked noticeably different: a little on edge, his eyes wider than usual and continually surveilling our surroundings.

Joseph told me about his recent addiction to a prescribed medication for a mental health issue. He struggled to access treatment and hit rock bottom. In his words, he “had to go to jail to get help.”  I was struck by how tragic, yet familiar his story was. My memory flashed back to author and activist Pete Early recounting a similar experience with his son at an Insitute for Health Policy forum.

In fact, nearly 2 million people with serious mental illnesses are arrested each year. According to the most recent data available, jails and prisons in 2012 housed 10 times as many people with serious mental illnesses as state hospitals. In addition, 45 percent of jail inmates and 53 percent of prisoners have a substance use disorder. And given the opioid epidemic, those numbers have likely climbed since then.

These numbers are staggering — and should cause us all to pause and reflect on how we can do better. I wondered: How had our systems failed Joseph? What could have been done to support his recovery before he ended up in prison? And what type of help is he receiving now that he is in recovery and trying to resume his life?

At a crossroads: The mental health system needs improvement

These were the types of questions we examined at a September meeting that explored ways to improve the accessibility and quality of services provided to individuals with mental health conditions who find themselves in the criminal or juvenile justice systems.

The meeting, hosted by Georgetown University’s Center for Poverty and Inequality and Mental Health America, with support from Kaiser Permanente, was the fourth and final in a series that examined innovative strategies to meet the behavioral health needs of low-income populations.

This meeting series reinforced what we at Kaiser Permanente have long known to be true: The mental health system needs systematic reform — whether we’re talking about reimbursement, workforce shortages, reducing stigma, integration with clinical and community supports, or collaboration and coordination with other systems.

Reforming the entire mental health system seems like an insurmountable challenge, but we must not let this prevent us from making meaningful progress where we can. And, most importantly, we must not lose sight of the impact that our current system has on the millions of people, families, and communities it touches.

My conversation with Joseph and the focus of our recent meeting helped me to keep that perspective at the center of our discussion.

Identifying solutions that put people and communities first

Bringing thought leaders, researchers, and experts to the table to discuss actionable public policy solutions to address this problem was a crucial step toward the systems-level, patient-centric improvements we seek.

At the meeting, participants collaboratively developed ideas, such as:

  • Decriminalizing survival behavior
  • Addressing the needs of children detained as immigrants
  • Value-based purchasing for the justice system
  • Reforming Medicaid’s institutions for mental disease policies

Others recommended providing young adults in the juvenile justice system the support offered to foster youth transitioning into adulthood, establishing new transitional housing-focused behavioral health strategies, and ensuring that members of law enforcement are sufficiently trained and supported as the front-line response to a behavioral health crisis when they are first responders.

The good news is that we see examples of innovative practices that target, reach, and support our most vulnerable populations being piloted all across the country. For example, the National Council for Behavioral Health has been working across sectors, engaging law enforcement and corrections officers, to develop trauma-informed approaches to engage residents at the city, county, and state levels.

Looking ahead to a brighter future

In Spring 2019, the Center for Poverty and Inequality, Mental Health America, and Kaiser Permanente will release findings from our meetings in a public report. We will offer recommendations for national, state, and local stakeholders to apply our learnings and implement real-world policy solutions — solutions that can improve the lives of millions struggling with behavioral health conditions and have nowhere else to turn.

Policy solutions like these can’t turn back the clock on Joseph’s experience. But they can help to create a system that ensures that, in the future, Joseph won’t have to land in jail in order to receive the help he needs to get back on his feet.