Criminal Justice System Should Be Delinked From MH System, Says Expert
Abstract
Prisoners are sicker in every way—including psychiatrically—than people on the outside.
“Why do we use the criminal justice system rather than other social institutions like the health system to deal with mental illness and substance abuse?” asks sociologist R. Hugh Potter, Ph.D., a professor and director of research in the Department of Criminal Justice and Legal Studies at the University of Central Florida in Orlando.
Sociologist R. Hugh Potter, Ph.D., says that new leadership is needed that appreciates non-criminal justice agencies—ones concerned with health, mental illness, and social well-being.
People with purely criminal behavior and no mental illness should indeed fall into the domain of the criminal justice system, where evidence-based interventions can address their criminogenic risk factors: prior criminal history, antisocial behavior, family instability, unemployment, poor social skills, anger, and substance abuse.
“But people whose criminality is due only to their possession of drugs or having a mental illness probably shouldn’t be dealt with in jails and prisons,” said Potter at a conference on “Ethical Challenges in Correctional Mental Health Care” in Philadelphia in October.
The conference was sponsored by the Thomas Scattergood Behavioral Health Foundation, the Leonard Davis Institute at the University of Pennsylvania, and the Lindy Institute for Urban Innovation at Drexel University.
Potter also sees structural problems.
“Most police departments are small, but they are larger than the local health department,” he said. “So where do you turn to handle a crisis? Probably law enforcement.”
Inevitably, police take the individual to the local jail, especially if no mental health facility is available.
“We complain about the criminal justice system, but who will respond if we take it out of the mix?” he said. “Most nonurban counties don’t even have a psychiatrist.”
Creating alternatives is not easy. About 3,000 police departments, including most larger ones, have received Crisis Intervention Training (CIT) to help officers manage people with suspected mental illness. However, that leaves another 12,000 departments, mostly small ones, without CIT training.
Yet another crisis awaits at the cell door. Overall, people in jails and prisons are sicker, have more mental illness, and are more disabled that those on the outside.
Bureau of Justice Statistics figures show higher rates of self-reported illness in correctional populations compared with the general population, with the rate of mental illnesses four to five times higher than that found outside the walls, said Potter.
About 40 percent of jail inmates and 30 percent of prisoners report at least one disability, and women have even higher rates. Mentally ill prisoners also report higher rates of victimization by staff and other prisoners.
And that’s not the full picture, said Potter. Only 7 percent of people booked into jails end up in prison, and 70 percent of those charged with felonies spend no more than 48 hours in jail.
“So the people who stay in jail are homeless, mentally ill, or disabled or don’t have the money for bail,” he said. There are no good statistics on what happens to the 6 million people a year who are released. No one knows how many might have a mental illness or if they get any treatment.
If the resort to law enforcement to manage people with mental illness seems undesirable, Potter asked, then who will respond, how will due process be guaranteed, and who will pay for any intervention?
To Potter, the starting point lies in separating criminogenic risk from mental health issues.
“We need a workforce that is cross-trained in mental health interventions and constitutional rights, not one or the other, and not in opposition to each other,” he said. “We need real attention on communities rather than formal governmental institutions.” ■
