By John P. Docherty, M.D.
The number of people living with mental illness in America’s jails is alarmingly high. In 44 out of 50 states, prisons and jails hold more individuals with serious mental illness than the largest state hospital. In local jails, 64% of people experience symptoms of a mental health condition, which represents over 7 million people. Additionally, 17% of jail inmates experience a serious mental illness.
As an example: Recent reports from Miami-Dade County in Florida revealed that a small proportion of individuals with mental health conditions were accounting for a disproportionate amount of time in jail, emergency rooms, hospitals and psychiatric facilities. Over the course of five years, 97 individuals were arrested 2,200 times and spent 27,000 days in Dade County jail.
Finding ways to divert such individuals out of criminal justice and into appropriate care—so future incarcerations are reduced or avoided—is vital. A jail diversion program was implemented in Dade County that included mental health training for police officers and 911 dispatchers. In result, jail populations were significantly reduced from over 7,000 to a little over 4,700 over the past five years.
These revealing statistics point to a public health crisis in the care and societal management of mental illness. Across the country, innocent people are cycling through “the system” with repeated arrests, and with a higher likelihood of being incarcerated than hospitalized, simply because they experience a mental health condition. There is an urgent need to address the gaps in the mental health and criminal justice systems. This is not simply an issue of societal compassion—it is a fundamental issue of equity and justice.
One factor that may be contributing to this problem is the lack of information sharing across health, social and criminal justice systems. There is a need to establish integrated data systems to maximize good outcomes and prevent people from falling through “gaps” in the system. Examples of gaps include people being incarcerated without knowledge of the person’s mental health history and treatment plan, people being released from incarceration into the community without any effort to coordinate with the mental health system to ensure follow up services, etc.
In 2012, Otsuka (ODH, Inc.) partnered with IBM and the South Florida Behavioral Health Network in Miami to implement a platform that integrated data from criminal justice and mental health, substance use and social support services. Using this data, the group found that if people living with a mental illness were provided with case management and proper services after a period of incarceration, they experienced a 50% reduction of risk for rearrest.
The collaborative work by ODH, Inc. and IBM has potential to help communities achieve the goals of reducing unnecessary incarceration of people with mental illness and ensure that people receive needed services and supports after they re-enter communities. The White House recently launched the Data-Driven Justice Initiative (DDJ) to help reduce the inappropriate and counterproductive incarceration of those experiencing mental illness. This initiative includes a bipartisan coalition of 67 governments (city, county and state) that will use data-driven strategies to divert low-risk offenders with mental illness from the criminal justice system to appropriate care. The initiative also aims to equip law enforcement officials and first responders with protocols to assess and divert people to service providers rather than the default of the criminal justice system.
The DDJ also includes specific coordination with the Department of Veteran’s Affairs (VA) to help divert veterans cycling through the criminal justice system as well. This is critical, considering that 7% of individuals in local jails are veterans, and over half of these veterans are experiencing a mental illness.
To help implement DDJ strategies, private, nonprofit and philanthropic organizations have partnered with the White House. This partnership includes help with data analytics, research, diversion and coordination of services, among other collaboration. Analytics will be used to identify individuals with mental illness who are at the greatest risk for incarceration, and who would most benefit from mental health care and other services.
The use of technology has the potential to help people experiencing mental illness throughout the country. While it is obviously not a complete solution, the hope is that technology and analytics may help guide individuals living with mental illness into appropriate, humane care—rather than costly, unproductive and harmful incarceration.
John Docherty is the Vice President of Clinical Sciences and Digital Medicine at Otsuka. John has been teaching psychiatry at Weill Cornell Medical College for the past 22 years. He received his M.D. from the University of Pennsylvania.
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