Mental Health Needs in the Criminal Justice System


An important and intersecting area of criminal justice and health policy is how to better handle a person with a mental illness who becomes involved in the criminal justice system. People who are experiencing a mental health crisis are more likely to encounter police than get medical help, according to the National Alliance on Mental Illness.  As a result, 64 percent of jail inmates have a mental health problem, according to the Bureau of Justice Statistics.

Agencies and officials at many stages of the criminal justice system face the challenge of responding effectively to these needs. State legislatures are interested in how policies can achieve better results for individuals and both systems.

Law Enforcement

State lawmakers are interested in policies designed to improve initial interactions with the criminal justice system for individuals with behavioral health needs. Two significant efforts by state legislatures have been to require training for police and to establish requirements and standards for crisis intervention teams.

At least 27 states and the District of Columbia have laws requiring officers to be trained to respond to mental health, substance use and behavioral disorder issues. Laws specify which officers are to be trained, which entity is responsible for conducting the training, whether or not funding is provided, and whether or not the training is mandated. 

At least 10 states have legislatively created requirements and/or guidelines for the establishment of crisis intervention teams. These teams are formal partnerships among police departments and mental health providers that ensure responding personnel are trained to identify, assess and de-escalate crisis situations.

States also have started to look for ways to connect people with social services in lieu of initiating the criminal justice process and booking someone into jail. Recent legislation has funded or authorized innovative new pre-booking diversion programs known generally as “deflection.”

Pretrial Diversion

A defendant’s first appearance in court provides an opportunity to identify those with mental health needs who are eligible for diversion. Pretrial diversion routes defendants away from jail and traditional criminal justice processing and addresses specific underlying factors that contribute to criminal behavior.

Since 2012 nearly every state has addressed diversion and it has been a growing trend to authorize or expand diversion programming for people with mental health needs or substance use disorders. Laws in at least 20 states authorize diversion for people identified as having a mental health condition and at least 34 states have laws authorizing diversion for defendants with substance related needs.

Some of these laws allow for drug or mental health courts. Problem-solving courts are prevalent throughout the states, and a trend in sentencing and corrections policy has been to codify best practices or create state oversight for treatment-based diversion options. Collaborations between criminal justice and behavioral health systems facilitate diversion, and emphasis on evidence-based treatment programs promotes better outcomes.

Corrections and Reentry

While there is a high prevalence of mental health problems among prison and jail inmates, only about 1 in 3 state prisoners and 1 in 6 jail inmates received treatment in custody. And, according to the National Institute of Corrections, prison and jail inmates who have physical health, mental health and substance abuse conditions have a harder time reintegrating after release than those without.

State legislatures have enacted policies that make access to health care a priority for those with behavioral health issues upon release from prison or jail. This includes Medicaid suspension instead of termination, and other measures to improve Medicaid enrollment upon release for offenders who have mental health needs.

Behavioral Health Services

State mental health agencies and other single state agencies are the government organizations that provide mental health and behavioral health services in the states. Their primary responsibility is for people who are not insured and/or need a high level of treatment or resources. State agencies spent more than $44 billion in 2012 on mental health services for more than 7 million people, according to the federal Substance Abuse and Mental Health Services Administration. These state agencies vary both administratively and in how they fund services, including Community Mental Health Block Grants, general state revenues and other sources. State agencies also play a role in educating the public about recent changes and coverage of mental health services as a result of the Patient Protection and Affordable Care Act (PPACA) and Medicaid expansion, which varies by state.

An NCSL LegisBrief produced in August 2015, Addressing Mental Health in the Justice System, provides more information.

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