Mental Health and Criminal Justice Issues

The increasing number of individuals with mental health and substance use conditions in the criminal justice system has enormous fiscal, health, and human costs. Diverting individuals with mental health and substance use conditions away from jails and prisons and toward more appropriate and culturally competent community-based mental health care is an essential component of national, state, and local strategies to provide people the supports they need and to eliminate unnecessary involvement in the juvenile and criminal justice systems.

In order to reduce involvement, support those who need services, and promote fairness throughout the criminal justice system, leaders in the mental health system, law enforcement officers, public defenders, prosecutors, court personnel, advocates, legislators, and others in the criminal justice system must come together to create a system that will improve outcomes for all. This includes:

• Keeping people out of the juvenile and criminal justice systems;
• Supporting people with services; and
• Eliminating discriminatory practices and punishments.

Keep People Out of the Juvenile and Criminal Justice Systems

Maximum diversion of persons with serious mental illness from the criminal justice system is crucial in reducing the financial, health, and human costs of involvement and incarceration. This means creating community-based, engaging services for those who need them and engaging all involved, particularly law enforcement, to understand mental health conditions, de-escalation tools for crisis situations, and options for treatment alternatives to incarceration that are available in the community. The vast majority of children and youth in the juvenile justice system have histories of exposure to trauma and mental health conditions that go ignored, leading to worsening mental health and long-term involvement in the criminal justice system. For young people, pre-booking diversion that keeps them in school and the community is key: kids should not be in jail in the first place, especially not as a means to get them mental health services. Effective diversion is about promoting voluntary engagement and reducing coercive practices that may threaten certain treatment requirements or incarceration, as is sometimes seen in mental health courts.

MHA calls for the following changes:

• Timely and accurate mental health screening and evaluation is the single most critical element in successfully diverting individuals from the criminal justice system. Stakeholders in communities must develop services that meet the needs of mental health and substance use consumers. In addition to significant increases in public investment, services must be integrated across public and private agencies. Individual treatment plans should be focused on consumer recovery and choice and should include: mental and physical healthcare, case management, appropriate housing, supportive education, integrated substance abuse treatment, and psychosocial services, in the least restrictive environment possible.
• For youth, authorize and incentivize diversion and pre-contact early intervention including coordination with school staff, planning teams, and community providers. If a child needs to be removed from school or another community setting, every effort should be made to do so in a manner which is least disruptive to the school environment and least traumatizing to the child.
• In order to avoid potential risks in establishing mental health courts, MHA advocates that state and local affiliates be involved in the development and implementation of mental health courts from very early on. A guideline for mental health courts can be found here.

Support People with Services

Youth and adults in the juvenile and criminal justice systems have the right to access mental health services. Institutions should provide screening, information related to mental health and treatment, and adequate access to mental health professionals. Individuals also have the right to refuse treatment and to be free from harmful practices, such as solitary confinement, that have immensely damaging effects, particularly for individuals with mental health conditions. In addition to having a voice in his or her own treatment plan, those involved with the individual’s treatment should work together to create plans that support people to reintegrate into their communities and to avoid future juvenile or criminal justice involvement as they exit jail or prison.

MHA calls for the following changes:

• Advocates should work to inform members of law enforcement and correctional groups, judges and attorneys, mental health professionals and advocates, prisoners and their families, the community and the media about the excessive number of persons with mental illnesses and addictive disorders in prisons and jails and the inherent difficulties in providing decent and humane care to such persons in these settings and should develop and advocate for effective strategies addressing these problems.
• Advocates should work with prison reform groups to highlight the treatment and conditions of persons with mental health conditions in prisons and jails and to ensure that everyone with a mental health condition receives decent and humane mental health services while incarcerated.

Eliminate Discriminatory Practices and Punishments

Individuals with mental health conditions often face unfair treatment and abuse at every stage of involvement with the juvenile and criminal justice systems. From sentencing youth to life in prison without parole to holding convicted sex offenders in mental health treatment facilities indefinitely post-incarceration, there are many instances where practices in the juvenile and criminal justice systems can cause serious harm. The issues faced by individuals with mental health conditions is particularly profound in terms of variations of the insanity defense and the use of the death penalty for individuals with serious mental illnesses. In order to ensure that the criminal justice system truly aims for justice, we must consider cases in their context and the ways in which legal practices disproportionately impact individuals with mental health conditions at each stage in involvement.

MHA calls for the following changes:

• Allies should work to appeal laws in those states which permit a sentence of life without parole and to eliminate sentences of life imprisonment for juveniles or any other extremely lengthy sentence which fails to recognize that juvenile offenders differ from adults.
• States should provide a full insanity defense. When defendants’ mental illnesses prevent them from understanding the wrongfulness of the act or prevent them from controlling their behavior, they should be acquitted by reasons of insanity. Criminal liability in these instances is neither appropriate nor effective.
• Our current system of criminal justice inadequately addresses the complexity of cases involving criminal defendants with mental health conditions. Therefore, Mental Health America calls upon states to suspend using the death penalty until more just, accurate, and systematic ways of determining guilt and considering a defendant’s mental status are developed.

To read our full positions statements on mental health and the criminal justice system, check out Criminal Justice Issues.

To see a full list of our position statements, go to Position Statements.