Improve Recovery Support for People in the Criminal Justice System

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Brief Description

Substance use is common among justice-involved individuals and more than half of those In US prisons and jails meet the criteria for Substance Use Disorders (SUDs). As the opioid epidemic unfolds, correctional institutions are looking for best practices that they can use to help handle the increased demand for substance abuse and addiction treatment including diversion, treatment/drug courts, treatment while incarcerated and re-entry services and resources

Ongoing research has suggested that substance use can be associated with poorer outcomes among individuals who have been incarcerated including those under supervision in the community due to involvement in the justice system. A 2014 Pew Trusts study has shown more imprisonment does not reduce drug related issues. This study reinforces a large body of prior research that cast doubt on the theory that tough prison terms deter drug misuse, distribution, and other drug-law violations. The evidence strongly suggests that policymakers should pursue alternative strategies that research shows work better. Many states are revising their drug penalties and focusing on prevention, treatment, and recovery to address individuals and communities with integrating evidenced based practices for treatment and recovery.Integratinginformed practices that are evidenced based allows criminal justice agencies and communities to work together to save lives and decrease costs associated with criminal justice system and healthcare system involvement. [1]

Many individuals return to communities, social networks and families and require community-based mental and/or physical health care services. Community-based behavioral health providers and systems have an essential role in serving individuals with mental and substance use disorders who are currently or formerly involved with the criminal justice system. These individuals are a part of every community and providing resources to a person with a SUD can help lead to a life in recovery as opposed to a life in long-term incarceration.  

Key Information

Community based behavioral health providers play a key role in ensuring that every individual they serve has the treatment, support, skills, and opportunity for recovery and lives productively with dignity and respect. People who need access to quality community-based care may be arrested instead. In many communities, people with behavioral health disorders cannot access adequate community-based services and find themselves channeled into the justice system. This may happen when a person is arrested for behaviors or actions related to his or her untreated mental illness. Additionally, some law enforcement officers use discretion to arrest when they believe a person needs health care services that are provided in the jail. Arrest and incarceration often destabilize an individual’s life, including their housing, health care, employment, and social connectedness. Researchers have found that even brief incarceration leads to adverse consequences, including loss of employment and future employment opportunities, poorer physical and behavioral health due to breaks in health care services and treatment, loss of housing and future housing opportunities, and disruptions in family life and social connections. Once in the criminal justice system, individuals with mental and substance use disorders stay in jails longer, have an increased risk for self-harm, and receive more frequent punitive responses to infractions. Due to funding and staffing limitations, many people with mental illnesses do not receive the services they need, and their conditions often worsen inside jail settings. For individuals already receiving medications and treatment in the community, these services may be interrupted during incarceration, creating lapses in treatment and difficulties in resuming treatment upon release and reentry to the community. Without continuous coordinated care throughout and following incarceration, these individuals are at risk for re-incarceration.

Programs to improve outcomes of those in recovery and within the criminal justice system includes community-based diversion programs, drug/treatment courts, treatment while incarcerated and re-entry resources and services.

The Substance Abuse and Mental Health Services Administration (SAMHSA) put together 8 principles to assist community-based behavioral health providers and criminal justice professionals bridge the gap and provide a strong foundation for community- based care for those with a history of involvement in the adult criminal justice system. Additionally, community guidance and FAQs were outlined by SAMSHA including understanding re-entry programs, the need for collaboration among clinical are and case management with criminal justice professionals, evidence-based practices, the risk of recidivism, pre-arrest and diversion programs, medication assisted therapy and understanding of trauma.

SAMHSA 8 Principles:

1)Community providers are knowledgeable about the criminal justice system. This includes the sequence of events, terminology, and processes of the criminal justice system, as well as the practices of criminal justice professionals.

2) Community providers collaborate with criminal justice professionals to improve public health, public safety, and individual behavioral health outcomes.

3) Evidence-based and promising programs and practices in behavioral health treatment services are used to provide high quality clinical care for justice-involved individuals.

4) Community providers understand and address criminogenic risk and need factors as part of a comprehensive treatment plan for justice-involved individuals.

5) Integrated physical and behavioral health care is part of a comprehensive treatment plan for justice-involved individuals.

6) Services and workplaces are trauma-informed to support the health and safety of both justice-involved individuals and community providers.

7) Case management for justice-involved individuals incorporates treatment, social services, and social supports that address prior and current involvement with the criminal justice system and reduce the likelihood of recidivism

8) Community providers recognize and address issues that may contribute to disparities in both behavioral health care and the criminal justice system. [2]

 

Drug Treatment & Specialty Courts

In the late 1980s alternatives such as drug courts emerged as an innovative approach when professionals recognized the importance of treating substance use and mental health to prevent relapse and recidivism. Drug courts aim to reduce drug use relapse and criminal recidivism through a variety of services. These services include risk and needs assessment, judicial interaction, monitoring and supervision, graduated sanctions and incentives, treatment, and various rehabilitation services. [3]

As of today, there are more than3,000 drug courts across the United States. Drug courts consist of juvenile, adult, and family treatment (aimed at family parenting and reunification of families). There are also Veteran Treatment Courts aimed at working with veterans and are served by judges who understand veteran behavioral health challenges and are familiar with the Veterans Health Administration.https://justiceforvets.org/what-is-a-veterans-treatment-court/

Overall, the drug court approach intends to reduce time in the criminal just system and provide treatment to individuals instead of punishment. [4]

Pre-Arrest Diversion

Pre-arrest diversion programs are designed to reduce the number of persons who are arrested and placed in jail because of a mental health problem, these programs shift responsibility for rehabilitation from the criminal justice system to the mental health system. [5]

Early diversion programs provide an alternative to arrest for individuals with substance use and/or mental health disorders, as well as for low-risk offenders, and allow these individuals to avoid the collateral consequences that result from arrest and contact with the criminal justice system. This movement is data-driven and is grounded in the belief that public safety and public health approaches must work in tandem to support vulnerable individuals with substance use disorder (SUD) and/or mental illness (MI). Instead of shifting responsibility or cost from one system actor to another, this collaborative approach creates additional tools and supports for those on the front line, appropriate treatment for eligible individuals with SUD and/or MI, and opportunities for systemic change for leaders looking for creative solutions to complicated problems. [6]

In addition, these programs serve the best interest of the community, individual, and taxpayers. Pre-arrest diversion and deflection programs have the added benefits of:

Breaking the costly cycle of justice system involvement for eligible individuals.
Increasing cross-sector collaboration to create new pathways to community-based behavioral health services.
Enhancing relations between community members and law enforcement.
Decreasing crime, incarceration, and recidivism rates.
Lessening the burden on justice systems.
Improving public health and safety.
Reducing the burden on individuals who commit non-violent, low-level offenses.
Ensuring equal access to pre-arrest diversion regardless of race, income, or geography; and
Saving taxpayer dollars [7]

Sequential Intercept Model (SIM) 

The SIM helps communities identify resources and gaps in services at each intercept and develop local strategic action plans. The SIM mapping process brings together leaders and different agencies and systems to work together to identify strategies to divert people with mental and substance use disorders away from the justice system into treatment. [8]

The SIM includes:

Intercept 0: Community Services

Involves opportunities to divert people into local crisis care services. Resources are available without requiring people in crisis to call 911, but sometimes 911 and law enforcement are the only resources available. Connects people with treatment or services instead of arresting or charging them with a crime.
Intercept 1: Law Enforcement

Involves diversion performed by law enforcement and other emergency service providers who respond to people with mental and substance use disorders. Allows people to be diverted to treatment instead of being arrested or booked into jail.
Intercept 2: Initial Court Hearings/Initial Detention

Involves diversion to community-based treatment by jail clinicians, social workers, or court officials during jail intake, booking, or initial hearing.
Intercept 3: Jails/Courts

Involves diversion to community-based services through jail or court processes and programs after a person has been booked into jail. Includes services that prevent the worsening of a person’s illness during their stay in jail or prison.
Intercept 4: Reentry

Involves supported reentry back into the community after jail or prison to reduce further justice involve of people with mental and substance use disorders. Involves reentry coordinators, peer support staff, or community in-reach to link people with proper mental health and substance use treatment services.
Intercept 5: Community Corrections

Involves community-based criminal justice supervision with added supports for people with mental and substance use disorders to prevent violations or offenses that may result in another jail or prison stay.


Medication-assisted treatment (MAT)

Medication-assisted therapy is treatment utilized for drug-dependent individuals within the criminal justice populations. Currently MAT is used primarily for pregnant women to detoxify within the criminal justice system and is minimally used for reentry. There are ongoing studies surrounding MAT as well as efforts to expand the use of MAT within the current correctional infrastructure. Efforts to expand MAT include training, education, reducing stigma and increasing funding resources. Expansion of MAT within community correctional settings will also require increased collaboration with community providers in order to enhance the appropriate pharmacotherapy for individuals under community correction supervision. Concerns of correctional facilities surrounding MAT have included liability, staffing, regulation and funding. CJ-DATS is working collaboratively to increase information and linkage to community MAT for those within the criminal justice system. [9]

Tools and Resources

 

Promising Practices and Case Studies

Examples from communities that have implemented tools focused on this objective

Scorecard Building

Possible Objective Details

Possible Measures

Actions to Take

Actions for Coalitions

Actions for Individuals

Sources

  1. ^ https://www.pewtrusts.org/en/research-and-analysis/issue-briefs/2018/03/more-imprisonment-does-not-reduce-state-drug-problems?hd&utm_campaign=2018-03-14+PNN&utm_medium=email&utm_source=Pew
  2. ^ https://store.samhsa.gov/product/Principles-of-Community-based-Behavioral-Health-Services-for-Justice-involved-Individuals-A-Research-based-Guide/SMA19-5097
  3. ^ http://ifi-wikis.com/IFI-OpioidCrisis/Expand_and_Enhance_Speciality_Courts
  4. ^ https://www.nadcp.org/treatment-courts-work/
  5. ^ http://ifi-wikis.com/IFI-OpioidCrisis/Expand_Pre-Arrest_Diversion_and_Deflection_Programs
  6. ^ https://secureservercdn.net/198.71.233.33/lpo.969.myftpupload.com/wp-content/uploads/2019/06/SAFE-Pre-Arrest-Guide_Final-.pdf
  7. ^ http://www.centerforhealthandjustice.org/chjweb/tertiary_page.aspx?id=73&title=The-Police,-Treatment-and-Community-Collaborative-(PTACC)
  8. ^ Sequential Intercept Model (SIM) https://www.samhsa.gov/criminal-juvenile-justice/sim-overview
  9. ^ http://ifi-wikis.com/IFI-OpioidCrisis/Expand_the_Use_of_MAT_in_Correctional_Facilities\
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