Publication: Corrections Today
Date published:
Language: English
PMID: 17495
ISSN: 01902563
Journal code: PCOR

Editor's Note: The following is adapted from remarks by Laurie Robinson, assistant attorney general of the Office of Justice Programs for the U.S. Department of Justice, to ACA's Healthcare Professional Interest Section on Jan. 23.

Ninety-five percent of all inmates will eventually be released, so the health of incarcerated offenders has a direct impact on public health. The Department of Justice and its Office of Justice Programs (OJP) are involved in three critical areas of correctional health care - substance abuse treatment, treatment of mentally ill offenders, and reduction of sexual violence in prisons.

Substance Abuse Treatment

Data from the Bureau of Justice Statistics tell us that more than half of all state inmates were abusing or dependent on drugs in the year before their admission to prison. By way of comparison, the last published National Survey on Drug Abuse and Health from the Substance Abuse and Mental Health Services Administration found that 9 percent of the general population was classified with substance dependence or abuse in the past year.

There is no question that substance abuse and crime are strongly connected, and we are working to address this link on both the front and back ends. On the front end, we are supporting alternatives to incarceration, in particular, drug courts. Drug courts use the monitoring and coercive power of the judicial system to provide treatment to drug-involved offenders. I'm encouraged by the bipartisan support for this approach, and that both President Obama and the attorney general are strong backers of drug courts. Studies have found them to be very effective, not only in reducing recidivism, but in saving taxpayer dollars.

There are other models that recognize the importance of treatment. The Hawaii State Judiciary operates a program called Hawaii's Opportunity Probation with Enforcement (HOPE). HOPE focuses on probationers, and it relies on swift, certain and proportionate sanctions for probation violators. If someone violates a term of his probation - say, by failing a drug test - he goes to jail within 48 hours. The first time, the sentence is short - a weekend or maybe a week - but it lengthens for each successive sentence. It also uses a triage approach. Sanctions alone work in keeping some offenders off drugs, and HOPE accounts for that. But offenders who cannot stay off drugs and who keep coming back will get referred to intensive treatment. Our National Institute of Justice funded an evaluation of HOPE and found that it has been very effective in reducing positive drug tests. For 685 probationers who were in the program for at least three months, the missed appointment rate fell from 13.3 percent to 2.6 percent, and "dirty" drug tests fell from 49.3 percent to 6.5 percent. HOPE and drug courts are models that should always be kept in front of us. They can, and should, be part of the solution to some of the problems we are facing in institutional corrections.

In terms of institution-based treatment, OJP supports the Residential Substance Abuse Treatment (RSAT) program. RSAT provides intensive drug treatment in prison, and it has been effective in treating offenders with substance abuse disorders and preparing them for reentry. Follow-up studies on RSAT programs have shown that graduates relapse and recidivate at lower rates. I am pleased that this year we were able to triple our funding of RSAT from last year, to $30 million.

From the RSAT evaluations, we have found that programs are most effective when they are used both inside the walls and outside in the community. Community matters. We also know they are most effective when they address other, nonsubstance abuse issues, like mental health disorders.

The Menially ěli Offender

People with mental illness are overrepresented in jails and prisons. A recent report from the Council of State Governments and Policy Research Associates suggests that almost 17 percent of jail inmates have a serious mental illness. That is three to six times higher than the general population, and it means that as many as two million bookings of people with serious mental illness may occur every year. We have been hearing for more than a decade that prisons and jails have, practically speaking, become a core element in the mental health system.

As in the case of substance abuse, we are working to address this on the front end, by training law enforcement to work more closely with mental health providers during encounters with the mentally ill, and also through mental health courts, which apply the same problem-solving principles as drug courts. We fund some of these through the Bureau of Justice Assistance (BJA) Justice and Mental Health Collaboration Program, and we will have $12 million for mental health courts this fiscal year. But the fact remains that until these approaches are taken to scale, people with mental illness will continue to come into the correctional system in large numbers. And we need to be prepared to deal with them. Part of this is adopting the philosophy that reentry back into the community begins the moment an offender enters the system. This applies doubly for those with mental illness.

Life behind bars can, of course, take a disproportionate psychological and emotional toll on a person with mental illness. And there are other concerns. For example, we know that benefit programs may be suspended or terminated, and this can be very difficult, especially for mentally ill individuals who are often poor and rely on these programs for medication and treatment. When they come out of the system, they have to reapply for those benefits, and that can take weeks or months. In some cases, they are not reinstated at all.

For this reason, we know that partnerships are critically important. Corrections officials can link mentally ill inmates with appropriate treatment services while in jail or prison, and they can begin looking ahead the moment the offender arrives to start planning for what will happen once they are released. This means reaching out to treatment services, to housing agencies, even to Social Security offices.

There are other issues related to mental illness in the justice system. There is more than twice the percentage of female offenders suffering from serious mental illness than male offenders, according to the Council of State Governments. There is the issue of juvenile offenders with mental illness. The National Center for Mental Health and Juvenile Justice found that 70 percent of youths in the juvenile justice system suffer from mental health disorders. And there are unique challenges to this group that demand increased attention to partnerships - with schools and foster care, for example.

Finally, there is the cost. As state budgets shrink, the amount that states are spending on mental health treatment is going down. Add to that the fact that some studies show that offenders with serious mental illnesses are incarcerated longer than other inmates, and that the daily cost of their incarceration can be significantly higher than the general inmate population. And, of course, there are the costs associated with repeated responses to individuals whose mental illnesses continue to go untreated.

BJA is working with the Council of State Governments on an initiative called Justice Reinvestment. Justice Reinvestment is designed to help states use a data-analysis approach to figure out how to lower corrections costs and reinvest those savings in the front end of the system (i.e., prevention, intervention and treatment) without sacrificing public safety. While state spending on mental health treatment has gone down, spending on corrections has gone up faster than just about any other budget item. But that is no longer sustainable. This is one of those smart-on-crime approaches that Attorney General Eric Holder talks about frequently, and it goes hand-in-hand with his emphasis on evidence-based approaches. This is a top priority of mine at OJP.

I have launched an agencywide effort at the Department of Justice called the Evidence Integration Initiative. Through this initiative, we are assessing the state of our understanding about what works in reducing and preventing crime, and figuring out ways to use that information to help states and communities fight crime more effectively. ACA has been a leader in integrating data- and evidence-based approaches in corrections, and I look forward to sharing more about this effort as we move ahead.

Sexual Assault

The subject of sexual assault in correctional facilities has received a great deal of attention lately. A recent report from the Bureau of Justice Statistics (BJS) in January 2010 found that 12 percent of adjudicated youths in state-operated and large local and private juvenile facilities have been sexually victimized. We all agree that sexual assault, whether it involves juveniles or adults, is a very serious problem that we need to aggressively address.

Correctional administrators understandably have practical concerns about some of the recommendations in the Prison Rape Elimination Act (PREA) Commission Report. Attorney General Holder understands the challenges that corrections officials are facing, and he wants to work with them to figure out how this problem can be best addressed. He is personally overseeing the DOJ's review of the PREA Commission's recommendations, and he is seeking input from all interested stakeholders. We are holding listening sessions as part of the department's PREA Working Group, and there will be opportunities for formal written comment on the proposed regulations.

I also recently made three appointments to the PREA Review Panel. The purpose of this panel is to take a look at facilities with low and high incidences of sexual assault. Information from those hearings is used to aid BJS in identifying common characteristics of victims, perpetrators and facilities. I have appointed Reggie Wilkinson, the former long-time director of Ohio's corrections system and a past president of ACA. I have also appointed Sharon English, a victim advocate and former deputy director for the California Youth Authority. And I have reappointed Gwen Chunn, who is also a past president of ACA and now heads the Juvenile Justice Institute at North Carolina Central University. All three members of the panel have a strong background in corrections, and they understand the challenges that corrections officials are facing.

PREA is a good example of one of those difficult challenges. But it is also an example of how the U.S. Department of Justice wants to work with corrections officials to meet those challenges. The health and mental health of inmates is an issue that merits our closest collaboration, both because it is the humane thing to do, and because it has such a strong impact on community safety generally. I am confident that, by continuing to work together, we can find ways to ensure comprehensive care for offenders and better public safety outcomes for all of America.

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