Treat, don't jail, the mentally ill 

Arkansas has an opportunity to address our incarceration crisis, save the state money and make our communities safer by helping people with mental health problems.

Arkansas arrests and jails too many nonviolent people simply because they have an untreated mental illness. Over-representation of those with mental illness in jails has increased over the past several decades due to diminishing mental health services.

When the mentally ill lose services to help them cope with their illness, they may turn to drugs — self-medication — and actions that are outside of societal norms. That puts a costly burden on local and county law enforcement, not only in Arkansas but across the nation.

A seasoned police officer may know when a disturbance is caused by someone having difficulty with his or her thinking. The officer wants to get help for the individual. Unfortunately the officer has few choices. The officer can take the citizen to jail or to the emergency room. Neither option is appropriate. Both the officer and offender often wait long hours in the ER, if they are even seen. Alternatively, locking up a person needing mental health services is cruel and counterproductive, and often leads to a downward spiral in the person's health.

The cost of mental health treatment is a concern. However, a recent study commissioned by the Arkansas Public Policy Panel found that a year of incarceration and the associated legal costs to the state for each person are at least 20 times higher than the cost of mental health crisis treatment and ongoing counseling for mental problems. The costs of incarceration could be transferred to operating regional crisis centers.

For example, San Antonio opened a diversion crisis center that saved local jails and emergency rooms more than $50 million in the past five years. Last month, I was lucky to travel to San Antonio with an Arkansas group including a judge, six heads of Arkansas mental health centers, the head of the Arkansas Sheriff's Association and two sheriffs. We spent the day with Leon Evans, CEO of the Center for Health Care Services in Bexar County, and his staff. Evans explained that the collaboration of law enforcement, hospitals, the judicial branch, mental health providers and addiction specialists led to the array of services they offer, from a sobering unit to detox, case management and work skills. When the group identifies more needs, it develops a new program; it offers at least 14 programs now.

Communities around the country are adopting successful and cost-effective solutions. Diversion from jail to a 24/7 crisis center is a first step. Nonviolent people in emergency situations can be taken by law enforcement, family members, or on their own, for assessment and connection to services for mental health.

The second component of the solution is crisis intervention training, or CIT, for all law enforcement personnel. Developed in Memphis, CIT is now used nationwide. Officers learn to identify a person in a mental health crisis and how to help that person extract himself from the trouble his illness is causing. Once the officer has de-escalated a situation, he or she needs somewhere to take the ill person. The crisis center is the natural needed place.

Third is follow-up assistance. A community mental health center or another agency needs to provide case management by a mental health professional and/or a peer counselor. A trusting relationship can develop as medication, housing, work and other needs are addressed during weekly meetings. This prevents a revolving door and addresses problems at the root cause.

Substance abuse is a problem for the mentally ill, who may turn to alcohol and drugs as a way of handling various forms of mental instabilities. Detoxification and ongoing support services are an indispensible part of the treatment. Stable housing and job readiness also need to be addressed.

These reforms will save money for the state and municipalities while making our communities safer, enriching the lives of citizens experiencing symptoms of mental illness and relieving families of untold heartbreaks. How often do all of those benefits align?

It's time for Arkansas to look at improved mental health care and crisis intervention as one proven way to address our burdensome prison populations.

Nancy Kahanak is a member of Judicial Equality for Mental Illness, a coalition working to change the revolving door of persons with mental illness being held in jails and prisons.


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