By Shannon Scully
March is Criminal Justice Awareness Month. Established by Congress in 2009 to create awareness of the causes and consequences of crime, and how to respond to and prevent it, Criminal Justice Awareness Month has now become an opportunity to highlight the need for reforms and the inequities created by our nation’s criminal justice system.
At NAMI, the injustices and inequities of the criminal legal system are deeply personal. Nearly 2 million times each year, people with mental illness are booked into our nations jails — many because of their untreated symptoms and limited access to care in their communities. Jails and prisons have become de-facto mental health institutions; many states provide mental health services to more people than state mental health hospitals. These aren’t just numbers and talking points. These represent people who NAMI advocates for — the parents, children, siblings and loved ones of our community.
We’re committed to diverting people with mental illness from justice system involvement, while also ensuring that any interaction someone has with the justice system preserves their health, well-being and dignity. This is our guiding star as we work to address the overrepresentation of people with mental illness in our justice system. It requires that we not only seek reforms in the criminal legal system, but concurrently work toward increasing access to mental health care and support at the local level.
With a goal this large, it can be difficult to recognize or celebrate the achievements we’ve made along the way. In honor of Criminal Justice Awareness Month, let’s take a moment to highlight some of the victories our NAMI community has achieved over the last few years.
NAMI has long engaged in work related to early diversion from justice system involvement. With law enforcement serving as the “front door” of the criminal justice system as well as the primary first responder to mental health crisis, we’re committed to ensuring that people in crisis aren’t needlessly incarcerated. There were several victories in legislation at the end of the 117th Congress supporting early diversion for people with mental illness.
Reauthorization of the Justice and Mental Health Collaboration Program (JMHCP)
JMHCP has been a cornerstone of innovation to address the overrepresentation of people with mental illness in the justice system. Last year, NAMI worked with other national partners to ensure that the program was reauthorized, securing funding for this program and expanding the types of issues JMHCP can address, like suicide in jails and leveraging 988 as a resource for justice diversion.
Passage of the Law Enforcement De-escalation Training Act
It is important that law enforcement has the skills and resources to be a collaborative partner in responding to mental health crises. After months of advocacy by NAMI and partners, Congress passed the Law Enforcement De-escalation Training Act to ensure that agencies both big and small have access to quality de-escalation training and to evaluate the impact of these trainings.
Far too many people with mental illness find themselves in the revolving door of the criminal justice system. That’s why providing services and supports to people returning from incarceration is so important. In fact, evidence shows that when people who are returning from incarceration have access to health care, they are more likely to engage in services and programs that prevent recidivism. NAMI advocates for the full repeal of the Medicaid Inmate Exclusion Policy, and, in the last several months, we have seen progress on this important policy issue.
Guidance from the Centers for Medicaid and Medicare (CMS)
SUPPORT for Patients and Communities Act directed CMS to issue guidance for how states could use the Medicaid program to support people re-entering, including providing coverage 30 days prior to their release. In February, CMS approved California’s 1115 waiver to provide coverage for people 90 days prior to their re-entry from incarceration. This is now the new national standard and a baseline for NAMI’s continued advocacy on this issue.
Provisions in the FY23 Omnibus Addressing Coverage for Juveniles
Nearly 70% of young people in the juvenile justice system have a diagnosed mental health condition. It’s essential that we ensure these young people have the supports they need when transitioning back to the community. The FY23 omnibus bill included several provisions that addressed continued coverage of Medicaid and the Children’s Health Insurance Program for juveniles, prior to being convicted in a court. Additionally, the bill included provisions to ensure young people began receiving certain services prior to their re-entry.
Despite efforts to prioritize diversion, we continue to see high rates of people with mental illness who are incarcerated. Often these individuals have the highest needs, and their stories are reflective of a failing community mental health system. Our alliance is working hard to ensure that people who are incarcerated have access to mental health care and are treated with dignity and fairness.
Advocacy to Eliminate the Death Penalty
NAMI has a long history of advocating in death penalty cases involving people with serious mental illness. In many of these cases, the individual did not receive appropriate treatment for their mental health condition prior to their crimes. In many of the cases, the impact of mental illness was not raised, evaluated or considered during trial. NAMI State Organizations have engaged in advocacy to eliminate the death penalty in their state. Recently, NAMI Ohio successfully advocated for a new law that prohibits the use of the death penalty in Ohio for people with serious mental illness.
Creating Treatment Standards
While there are high rates of people with mental illness who are incarcerated, the care and treatment provided in jails and prisons is often lacking. There is little guidance on the standard level of mental health care afforded to someone under the Eighth Amendment. Some states have taken to setting their own standard of care in legislation. NAMI Minnesota has successfully worked with their state legislature to create a process for establishing minimum screening and care practices for everyone who is incarcerated in the state.
Correctional Officers De-escalation Education (CODE)
In response to a call from the field to provide training resources for people working in jails and prisons, NAMI developed and published Correctional Officers De-escalation Education (CODE). Created in partnership with NAMI Tennessee, CODE can be used help train correctional professionals to increase their knowledge and awareness about mental illness and provide them skills to support interactions with people who are incarcerated and might be symptomatic.
No one policy or initiative will reform our nation’s criminal justice system or solve our overreliance on this system to address communities’ mental health needs. Alone, each of these seem small, but it will take small victories, piling up over time, to reach our final goal. The importance of taking time to celebrate small victories is something I have learned to do throughout my career — not only to acknowledge the hard work that is happening, but also to maintain our mental health as advocates as we continue down the long road of criminal justice reform.
Shannon Scully is the Director of Justice Policy & Initiatives at NAMI’s national office where she provides strategic guidance and support across the alliance regarding criminal justice reform, diversion and crisis response. Shannon has spent most of her career working in and around the criminal justice system, and she is passionate about creating systems that meet communities’ needs instead of perpetuating injustice.
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