HJLR Nov/Dec 2018

44 NOV / DEC 2018 I  Healthcare Journal of little rock column policy For far too long, America has relied on its criminal justice system to deal with people experiencing mental health crises. Typically, when a person’s mental illness has caused behavior leading to an encounter with law enforcement, the default response has been to take the person to a jail that has historically been ill-equipped to provide the type of care a person in that situation urgently needs. A person with mental health problems, while incarcerated, may commit a more se- rious offense as a result of failing to under- stand orders, being unable to control his or her behavior, or struggling to survive in a difficult environment. After being released, the person may miss a court date leading to additional summonses. New offenses can lead to more arrests, which can lead to still more offenses as the person becomes fur- ther entangled in the criminal justice system. Studies have shown that people withmental illness spend more time in lock-up than the average person booked into jail, and that they return to jail more frequently. People who are mentally ill are also at risk behind bars. Often, they suffer physical and sexual abuse while incarcerated. They may receive little or no treatment for their mental health problems, which may be aggravated by incarceration. Ultimately, they may need health care for more severe problems than they otherwise would have experienced. Tragically, many will commit suicide. Meanwhile, our jails and prisons are struggling with overpopulation, and pro- bation and parole officers are overwhelmed with large caseloads. Arkansas officials esti- mated last year that by 2023, the state’s pris- on population will reach more than 21,000 people, an increase of nearly 20 percent. Of- ficials estimated a $653 million spending increase would be needed to accommodate prison growth if nothing is done to combat growing rates of incarceration. Studies have shown that people who are mentally ill are overrepresented in jails and prisons. According to a 2014 report by the Treatment Advocacy Center, about 35,000 Americans with severe mental illness were in state psychiatric hospitals in 2012, while more than 356,000 were incarcerated in jails or prisons. A 2017 report by the Bureau of Justice Statistics, using self-reported survey data from inmates, found that 37 percent of prison inmates and 44 percent of jail in- mates had been told in the past by a mental health professional that they had a mental disorder. Recognizing that jailing mentally ill indi- viduals often is neither beneficial to the state nor to the individuals, the Arkansas Legis- lature and Governor Asa Hutchinson ap- provedThe Criminal Justice Efficiency and Safety Act of 2017. The law authorized the creation of crisis stabilization units, or CSUs, where law enforcement officers could take nonviolent offenders experiencing mental health crises as an alternative to jail. The CSUs are aimed at easing prison overcrowd- ing, reducing recidivism, providing better care for people withmental illness, reducing avoidable utilization of medical services, and enhancing public safety. The governor initially included $5 million in his budget for the 2017-18 fiscal year to help fund three CSUs. But the state received four applications for funding, so Hutchin- son added $1.4 million to ensure four units could be established. The money is going toward operation of the facilities and crisis intervention training for law enforcement officers. The state’s first CSU, the Sebastian County Five West Crisis Stabilization Unit, opened in Fort Smith in March. The second, the Pulaski County Regional Crisis Stabi- lization Unit, opened in Little Rock in Au- gust. As this column goes to press, CSUs are planned but not yet opened in Fayetteville and Jonesboro. The 16-bed facilities will operate 24 hours a day, seven days a week. Teams of mental health professionals including physicians, psychologists, and social workers will pro- vide patients with round-the-clock care in- cluding medical assessments, stabilization, and discharge planning. Patients will be al- lowed to stay for up to 72 hours, after which they will be released with a discharge plan. In a joint news release in August, the governor’s office and The Council of State Crisis Stabilization: An Alternative to Jailing the Mentally Ill