In recent months, the Biden Administration has taken historical steps to address mental illness in America, awarding $103 million in American Rescue Plan funds to boost health care workers’ mental health and pushing health insurance providers to ensure mental health parity in their benefit plans. Yet, despite these strides, the U.S. continues to use its jails as warehouses for people experiencing mental illness.
The latest research shows that a staggering 80% of the 11.2 million people currently incarcerated in the U.S. have unmet mental health and substance use treatment needs, making jails one of the nation’s largest mental health care providers. To champion mental health, the Biden Administration must broaden its understanding of what constitutes mental health care and who is being left out, including the millions of men and women incarcerated or cycling through our jails and prisons
To begin with, we need to stop incarcerating people who are arrested for substance use or a mental health crisis and get them in treatment instead. Life-saving medication and therapy is just the starting point. Supplementing these treatments with a holistic package of basic services – such as housing, employment and social support – aimed at supporting those with mental illness would help people lead healthy, meaningful lives, rather than condemn them to locked cells.
Helping clients find work is especially important, since unemployment takes a significant toll on mental health, much like the grief of unemployment or the pain of losing a loved one. When we connect our clients to employment resources such as job fairs, resume workshops, or lists of employers willing to hire people who have been involved in the legal system, we help them financially and boost their mental health. Our team also connects people with public benefits and helps them access local food pantries.
As Partners for Justice advocates embedded in the offices of public defenders, we work to connect clients to resources that help them avoid or recover from mental health struggles. In turn, our clients have taught us that to heal this nation, we must learn to respond to social harms and injustice with mercy and an interest in solving problems, rather than exacting punishment.
The U.S. imprisons more people per capita than any other country on earth, but does very little to prevent or treat mental illness among incarcerated people. Many jail policies make matters worse. Example: People believed to be at risk of sucide are often placed into isolation cells, compounding their anxiety and despair. People assigned to mental health units often get less time outside of their cell, less time outdoors, and fewer privileges.
Elizabeth Stroud, an advocate for the Tribal Defender’s Office in Pablo, Montana, spent several days trying to get one client referred to a medication-assisted treatment program, but the doctor initially refused to prescribe Suboxone, the most widely used medication for people addicted to opioids. The doctor said she didn’t want him to be around drug-using friends and be on that medication. It took a month to provide the client with medication, during which time his mental health took a nosedive.
For mentally ill clients, being entangled in the legal system worsens their condition. Jails and prisons are violent places that re-traumatize and boost anxiety, says Davis Rich, a client advocate in Delaware. Even clients who never step foot in prison may experience a downturn in their mental health from the constant surveillance by police or probation and fear that grows with every court date.
The more a client interacts with the system, the greater the damage to their sense of agency and self-esteem. “They start to see themselves as the system intends to treat or portray them,” said Thierry Siewe, an advocate working at the Houston Public Defender’s Office, as “an animal, a thing, a number, basically anything other than a human.”
Even when our clients are connected with mental health care in the community rather than being sent to jail, they sometimes encounter the same attitudes they might in the criminal legal system. Many of our clients express frustration with treatment that focuses too narrowly on their allegedly problematic behavior and fails to take into account their needs and strengths.
We frequently see client mental health records which go on for pages about a client’s “criminogenic thinking” but fail to mention factors such as a client’s lack of access to housing, meaningful work, or social support.
One solution is investing in collaborative defense teams – like the ones we work with at Partners for Justice – that offer the sort of wraparound support people in the criminal justice system urgently need to improve their mental health.
When our clients come to us in moments of crisis, we are able to quite literally put a roof over their heads by helping find them placement in emergency shelters. However, we still rely on an often limited supply of resources. These resources are also critical as we work to help place our clients in transitional and sober living homes that can give them a place to stay, freeing them to devote time and energy to getting treatment and addressing their mental health needs.
Helping clients find work is also crucial, so we work to connect them to employment resources such as job fairs, resume workshops, or employers willing to hire people who have been involved in the legal system. Our team also connects people with public benefits and to access local food pantries.
Those in power need to realize that housing, employment and public benefits are all forms of mental health care, boosting clients’ wellbeing and easing their stress and isolation. Reforms need to support the unmet mental health needs of people involved in the criminal justice system and to provide resources beyond medication and therapy. As Alameda County advocate Sophia Helfand says, “It’s really hard to engage in counseling or maintain appointments when you don’t know where you’re going to sleep at night.”
Carolina Arango and Carly Frieders are Partners for Justice client advocates with the Delaware Office of Defense Services.