Using Opioid Settlement Funds To Repair Our Mental Health System
The 1963 President’s Commission on Mental Health launched a nationwide campaign to get the mentally ill out of asylums and into community treatment. By 1971, this movement was in full swing, and psychiatric hospitals across the country were shuttered. Yet the mentally ill were released from supervision into communities that were severely underfunded and unprepared for the population surge. Community mental health centers were promised federal money to treat long-term mental health needs in the community–but those dollars never materialized.
Instead, the criminal justice system has become the de facto asylum for those with a chronic mental illness. Half of the psychiatric beds in the United States are in prisons and other correctional facilities, and patients only occupy these beds after run-ins with law enforcement for crimes such as trespassing and public disorder. The criminal justice system has tried to create tailored responses (think crisis intervention teams, mental health courts, and diversion programs) to avoid incarcerating the mentally ill and move them into more appropriate treatment settings.
Yet, community-based treatment has been met with challenges. Community providers are often unable or unwilling to partner with a criminal justice system they perceive as punitive to address the problem of a mentally ill offender who has extra challenges when it comes to attaining a job or housing. This dynamic then goes on to further exacerbate the U.S. homelessness problem.
More disturbing is the fact that we do not have a good accounting of the population or severity of mentally ill inmates. Instead, most of the available data is based on an offender’s self-reporting of receiving psychiatric care and not on an official assessment by a certified mental healthcare professional.
In the 1980s, the War on Drugs mobilized a criminal justice system response—often unwittingly absorbing a mentally ill person who had been newly released from a shuttered institution—through minor crimes such as drug possession. Along with changes in sentencing attitudes, this led to harsher punishments for substance abuse while simultaneously ignoring the underlying causes of that abuse. The mental healthcare system, largely unprepared to address the influx of the mentally ill into communities, was unable (and sometimes unwilling) to dedicate its resources to a cohesive response, which made the problem worse.
The increased case volume resulting from “tough on crime” drug laws has further strained financial and personnel resources across the criminal justice system, which no longer has the capacity to thoroughly evaluate mental health cases. Furthermore, risk-needs assessments typically focus on past criminality and current dangerousness rather than the underlying conditions that led to crime.
Fortunately, states are now able to change this. Recently, states have been awarded funding from an opioid settlement that provides a substantial sum earmarked for opioid remediation. Some of the specific stipulations of the settlement are that states can pick from a list of remediation strategies such as medication-assisted treatment (MAT), expanding “warm hand-off” (i.e., continuum of care) programs and recovery services, treating incarcerated populations, investing in prevention, and evidence-based data collection. These stipulations and the settlement funds themselves provide an excellent opportunity for the states to apply money to a defunct deinstitutionalization program by providing assessment, treatment, and continuity of care.
States now have the opportunity to get a true understanding of the breadth and depth of mental illness’ impact on the criminal justice system through comprehensive psychiatric assessment programs. By applying evidence-based practices that address the dual presence of severe mental illness and chronic substance abuse needs based on these assessments, states have the opportunity and funding to create meaningful partnerships with treatment providers to truly address the needs of a significant portion of the incarcerated population. Finally, states can conduct program and process evaluations to evaluate how well they address and mitigate the social determinants of health that lead to recidivism. In short, the opioid settlement funds provide a rare opportunity for states to address the challenges of deinstitutionalization—a movement that was always doomed to fail. By strategically looking at how these settlement funds can be used to reduce the number of mentally ill offenders in prisons and jails by diverting them to community-based treatment and basing program funding on achieved outcomes, such as reduced substance abuse and criminality, states can create safer communities and help those with mental severe mental illness to get the help they truly need.