Four decades of aggressive incarceration policies have created what many argue to be one of the greatest public health challenges of modern times. The New York Times editorial board went so far as to call it a modern epidemic, highlighting the rate of mental illness among inmates and emphasizing the important role public health professionals will play in criminal justice reform. Shortly thereafter, the Mayor’s Task Force on Behavioral Health and the Criminal Justice System released its action plan to reduce the number of inmates with mental health and substance use problems in New York City’s jails, stating that people with mental illnesses represent 38% of the overall jail population. The de Blasio Administration also announced that it will allocate $130 million over a four-year period to redress this issue.

Three experts in health and criminal justice reform led this timely conversation:

Elizabeth Glazer, Director, New York City Mayor’s Office of Criminal Justice and Co-Chair, Mayor’s Task Force on Behavioral Health and the Criminal Justice System.

David Cloud, Senior Program Associate, Substance Use and Mental Health Program, Vera Institute of Justice and author of “On Life Support: Public Health in the Age of Mass Incarceration.”

Ann-Marie Louison, Co-Director of Adult Behavioral Health Programs, Center for Alternative Sentencing and Employment Services (CASES), an organization that runs a mental health clinic for criminal justice-involved individuals.

The discussion began with panelists’ perspectives on the relationship between the criminal justice and public health systems, how these systems arrived at their present state, and examples of current activities for reform. Mr. Cloud summarized the report he authored for the Vera Institute of Justice and described the “grave disparities behind bars,” citing disproportionate numbers of incarcerated individuals who have mental health issues and chronic or infectious diseases. These individuals are frequently omitted from studies of population health, yet Mr. Cloud explained the many ways that the conditions of confinement impact both individuals’ lives and public health in broader communities.

Ms. Glazer cited statistics from the New York City Department of Health and Mental Hygiene indicating that a focused group of people have frequent interactions with the jail system in New York City: approximately 400 individuals with at least 18 arrests each account for 10,000 jail days in total. Many of these individuals are homeless and in need of mental health services, supportive housing, and other health and social services. Ms. Glazer suggested that the criminal justice and public health systems need to figure out how to intervene in a significant way to interrupt the cycle of incarceration for these individuals. Ms. Glazer stressed the need for an option beside hospitalization or arrest when the police have an encounter with a person with mental health issues. She also highlighted the need to think about public health and incarceration systemically: “No one is an island, and everybody works as an island, and that just can’t stand anymore.”

Individuals involved with the criminal justice system are often only able to access health services when they are incarcerated. The panelists discussed opportunities to identify and treat individuals with mental illness both during and after periods of incarceration and temporary involvement with fixed-term programs. Ms. Louison described how and why CASES started its own clinic through The Nathaniel Project, an alternative-to-incarceration program in New York City for people with serious mental illness and felony convictions. Ms. Louison stressed the need for increased collaboration and partnerships between the criminal justice system and social service programs. She stated, “What we found, at the moment when the people that we wanted to serve wanted to receive treatment, wanting to get access to treatment, was that the receiving entities were not opening their doors.” Dr. Janet Taylor, Ms. Louison’s colleague and a practicing psychiatrist at the CASES Nathaniel Clinic, presented a case study of a young man who had been involved with the criminal justice system and described how the Nathaniel Clinic was able to address his mental health issues through therapy.

Participants also discussed whether and to what extent reformative goals are realistic in light of the enormity of the problem and the high cost of implementing solutions. Mr. Cloud suggested that it is time to redirect existing funds because “we are already spending a lot of money on people currently in the criminal justice system, and it’s not working.” Addressing the issue of building political will to create change and invest effectively, Ms. Glazer said, “There’s a recognition now across the political spectrum, whether motivated by the cost factor or by a social justice factor… [that] we need to invest in things that are going to work.”

Concluding comments reminded the audience that significant improvements can be achieved by coordinating new and existing efforts, programming, and resources in criminal justice and mental health.


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