Decriminalizing Mental Illness

On any given day, more people with serious mental illnesses are incarcerated in large urban jails than in any psychiatric hospitals. The U.S. Department of Justice estimates that at least 16% of all jail and prison inmates in the country - more than 300,000 people - suffer from serious mental illnesses. Rates of serious mental illnesses in juvenile justice systems are even higher – research reveals that one out of every five individuals in juvenile justice facilities suffers from a serious mental illness. Many of these individuals also have co-occurring substance abuse disorders.

In a time of severe state and local budget crisis, a disproportionate amount of public resources are being used to respond to people with serious mental illnesses in the criminal justice system. These resources would be better spent in developing and implementing treatment alternatives that would significantly reduce the number of people with serious mental illnesses from entering or re-entering these systems.

What can be done at the federal level to foster these promising alternatives to incarceration for individuals with serious mental illnesses?

1. Pass the "Mentally Ill Offender and Crime Reduction Act" (S 1194; HR 2387)

In June, 2003, Senator Mike DeWine (R-Ohio) introduced S 1194, a bill establishing a grant program at the U.S. Department of Justice for jail diversion, treatment for individuals with mental illnesses who are incarcerated, community re-entry services, or cross-training of criminal justice, law enforcement and mental health personnel. Co-sponsored by a bipartisan group of Senators, S. 1194 was passed by the full Senate in October, 2003. HR 2387 is still pending in the House.

Passing S 1194/HR 2387 is good public policy for the following reasons:

• Treatment and services prevent juveniles and adults with serious mental illnesses from getting involved with criminal justice systems. Most of these individuals are not hardened criminals, but have committed minor offenses directly resulting from a lack of treatment.

• Jail diversion and enhanced mental health treatment programs have proven effective in freeing up criminal justice systems to focus on preventing and fighting crime. A disproportionate amount of resources are currently used by these systems to function as "de-facto" mental health systems, roles they are ill-equipped for and unenthusiastic about fulfilling.

• Many communities already have the infrastructures, partnerships, and plans in place to effectively use the resources available through this program in a way that will benefit youth and adults with serious mental illnesses, as well as the community as a whole.

2. Restore Federal Funding for Mental Health Courts

In 2000, Congress enacted "America’s Law Enforcement and Mental Health Project" (PL 106-515), a program authorizing $10 million per year to fund court-based programs involving continuing judicial supervision for low level, non-violent offenders with mental illnesses.

In FY 2002, $5 million was appropriated for this program, out of which grants were awarded to 23 communities to build or improve mental health courts. In FY 2003, $4 million was appropriated for this program, out of which grants were awarded to 14 communities to build or improve mental health courts. In FY 2004, despite the rapid growth and proven success of mental health courts throughout the country, Congress did not appropriate any money for this program.

Action Needed: Please allocate the full $10 million of funding for this important program.

Federal support for Mental Health Courts is good public policy for the following reasons:

• There are currently more than 80 Mental Health Courts in existence throughout the country. Research shows that these courts have achieved significant success in reducing criminal justice involvement and enhancing treatment outcomes in their communities. See www.mentalhealthcourtsurvey.com, for information about the various Courts that have been established throughout the country. See http://consensusproject.org/topics/infocenter/research/mhcourts, for research and data that has been compiled on mental health courts.
• Budgetary shortfalls at state and local levels have delayed implementation of Mental Health Courts in many additional communities and increased the importance of continuing federal "seed grants" for establishing them.

3. Maintain Federal Funding for the SAMHSA Jail Diversion Grant Program

   In 2000, Congress authorized $10 million for grants to help communities build capacity to divert individuals with mental illnesses from the criminal justice system to community based mental health and supportive services, such as assertive community treatment (ACT) programs, medication management, housing, psychiatric rehabilitation, and integrated treatment for individuals with co-occurring mental illnesses and substance abuse disorders.

   In FY 2004, $7 million was appropriated for this program. NAMI strongly recommends that federal support should continue for this important program.

4. Amend Federal Law to Ensure Prompt Reinstatement of Federal DisabilityBenefits to Individuals with Serious Mental Illnesses Released from Jails or Prison

Delays in restoring Supplemental Security Income (SSI), Social Security Disability Insurance (SSDI) or Medicaid benefits to individuals with mental illnesses released from jails or prisons are pervasive and can make the difference between successful community reentry or recidivism. Without resources or the means to access medication and other treatment, successful community reentry is nearly impossible.

This problem can be simply addressed by requiring restoration of SSI and SSDI disability payments at previous payment levels for individuals whose payments were suspended during incarceration, and establishing provisional payment mechanisms (pending proof of continuing disability and economic need) for individuals whose benefits were terminated due to length of incarceration.

Additionally, while decisions about Medicaid policy are made at the state level, the issuance of policy guidance to states clarifying Medicaid policy with respect to individuals incarcerated in correctional facilities would be helpful in facilitating the timely restoration of these benefits upon release.

January 2004

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