Fact Sheet #11
Resource Issues
Funding is always an issue. It takes money to develop new initiatives
to divert people with serious mental illnesses from jail or prison or to help
them re-enter the community successfully, and new resources for community mental
health services are not easy to secure. However, policymakers can consider the
following factors:
- Current resources can often be used more effectively.
- Evidence-based and best-practice services will be cost-effective for the
state or locality because they can be included in the state's Medicaid program
and thus generate federal matching funds.
- There are significant cost benefits to diverting people from jail and prison.
- A new approach can greatly benefit the community if it leads to better outcomes
for individuals, with improved quality of life and greater public safety.
Key actions:
- Fund case managers to act as boundary spanners (individuals work within
both the mental health and the criminal justice systems).
- Set up a process of collaboration across systems to eliminate wasted efforts.
- Pay for time commitments by key players to create and support these collaborations
so they can be successful.
Blend resources for more efficient use.
- Spend on evaluation and dissemination of results.
Seminole County, Florida has established a post-booking diversion
program for nonviolent misdemeanants by using inmate phone revenues to contract
for in-jail mental health and substance abuse services from the local community
mental health center.
Cost benefits: Many of the program examples in these fact
sheets show the cost benefit of investing in jail diversion and/or re-entry
programs. Localities can also make their own calculations, as Albany New York
as done:
- Albany jail costs $32,000 a year to house an inmate. 489 of its beds are
set aside for those with mental illnesses, for a total of $1.5 million a year.
- The jail spends another $100,000 a year in overtime pay for staff on suicide
watch.
- Community mental health services (including housing, treatment and employment
training) costs the community $45,000 a year.
More effective use of current resources: King County, Washington,
found ways to initiate programs of diversion that made more effective use of
the county's existing human and fiscal resources. Sharing funds, co-funding
staff, sharing space and making a commitment to create a changed policy allowed
several steps to be taken to improve the handling of cases involving persons
with serious mental illness. For example:
- A police CIT unit was established with 100 volunteers.
- CIT officers are trained by mental health system providers, consumers and
families.
- A triage unit to accept pre-booking diversions was created by a local hospital
emergency room.
- The district court addresses offenders' needs and has dedicated staff (prosecution,
public defender, probation).
- The court's need for mental health expertise is met by mental health system
staff.
The county also used a portion of the funds "saved"
through initiation of a managed care system to reinvest funds previously spent
on institutional and other high-cost or unnecessary services into services for
those diverted from the criminal justice system. The managed care entity was
also required under its contract to treat individuals who had been diverted
and its performance measures were related to this problem.
Best practice: Effective mental health services for individuals
in contact with the criminal justice system should emphasize evidence-based
services and best practices. The following services are considered best practices
and can be covered under the state's Medicaid plan, thus securing federal matching
funds.
- psychiatric rehabilitation—building social skills and skills for daily
living
- assertive community treatment
- integrated treatment for those with co-occurring disorders
- supported employment
- disability management
- family psychoeducation
- peer services
Finally, communities can begin with small initiatives, with maximum
payoff, and expand over time once programs prove successful. Establishing a
CIT program through the police department, or collaborative mental health-law
enforcement teams to help people in crisis, can begin to address the problem
for many. Later, a community with CIT may wish to move on to a jail- or court-based
diversion model that can assist individuals who are charged with more serious
crimes.
There is significant value for the community in investing in a
new approach for people with mental illnesses in the criminal justice system.
Adequate access to appropriate services will lead to better outcomes for individuals,
improved quality of life in the community and greater public safety.
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