CONYERS, GA—May is Mental Health Month in the United States. In recent years, mental health awareness has grown as a major public health issue, with suicide being one of the leading causes of death in the country. The 2023 theme is “More Than Enough” focusing on the opportunity for all of us to come together and remember the inherent value we each hold — no matter our diagnosis, appearance, socioeconomic status, background, or ability.
While the theme’s focus is accurate, it does not convey the urgency communities are experiencing with the overwhelming level of individuals affected by mental health. For example, data demonstrates that over 27 percent of adults suffer from anxiety, and 23 percent suffer from depression. These observations will compound the notion that 32 percent of adults suffer from both, known as co-occurring disorders.
However, the emphasis may require communities to realize the potential lethality of mental health. Yes, it has become commonplace for every shooting, mass violence, or individual killed by police to blame mental health for deviant behaviors. Mental health has played a role, and there are current efforts to intervene. But the real killer associated with mental health is suicide, the 2nd leading cause of death among children between ages 10 and 14. It is the second leading cause of death for college students, behind alcohol. And there is a great deal of concern about the impact of the pandemic on mental health regarding children, students, and adults.
Organizations such as Community Anti-Drug Coalitions of America (CADCA) are working to make communities safe, healthy, and drug-free, such as the Rockdale Drug Free Community program. CADCA provides expertise in building coalitions to address local conditions influencing the youth and mental health. They focus on 1) Underage and binge drinking, 2) Youth tobacco use, 3) Illicit drug use, and 4) Abuse of over the counter and prescription medicines.
A nonprofit organization dedicated to utilizing the student voice to raise mental health awareness among college students is Active Minds. The organization helps empower students to speak openly about mental health to educate others and encourage help-seeking while also providing expertise in college mental health promotion and suicide prevention.
Even local governments in rural areas are providing community education to reduce the stigma surrounding mental health conditions and promote a positive mental health environment. Training sessions can be formal classes regarding constructive mental health promotion or informal conversations between community members and information on local services that are available to help.
Similarly, the criminal justice system is desperately searching for methods and programs to reduce the impact of mental health. This concern has been ongoing before the rise of perceived influence on shootings, mass violence, and incidents involving officers shooting individuals. The question is “What to do with mental health cases have clogged court dockets, jails, and call volume for first responders?”
One program focusing on addressing the needs of the individual entering the criminal justice system is the courts by implementing Accountability Courts. In Georgia, the push occurred under Governor Nathan Deal’s crime reform initiative. Based on the crime and assessment, a defendant may voluntarily enter a DUI, Drug, Mental Health, Juvenile Drug, and Veteran Court. The length of a sentence is 24 months or longer. The program includes treatment, random testing, meetings, compliance surveillance, and weekly court hearings. Additional services may include employment assistance, emergency housing, and education opportunities. While it may surprise many, many defendants decline the program and choose time to serve because they know the program is demanding and hard.
But a perceived view of the citizenry is the program is “soft” on crime and expensive. No, it is not easy and still involves the potential of jail time. The other belief is the program is costly. Yes, it is. But it works!
A review of five independent meta‐analyses concluded that drug courts significantly reduce crime by an average of 26 percentage points; well‐administered drug courts reduce crime rates by as much as 35 percent compared to traditional case dispositions. Additionally, drug court participants after the first year of completing the program, drug court participants possess a recidivism rate of 23 percent compared to the 58 percent recidivism rate for those defendants who did not participate.
Suppose a reduction of crime by 69% is not enough. Then look at the money. An analysis found that accountability courts in Georgia were estimated to have generated $41.3 million in economic benefits! Better yet, the return on investment (ROI) for every dollar spent on the court programs is $28. Another view is the annual expense of a court participant is $6,528 compared to $24,090 for jail expenses. Judge Nancy Bills, Rockdale County Superior Court, has supervised a DUI and Drug Court program. She continuously tells civic organizations that the accountability courts enjoy a government initiative that works and saves tax dollars.
The court programs’ success and the growing number of calls to law enforcement to respond to individuals in crisis provided an opportunity to reevaluate how the community and public safety agencies can do more. Better yet, how can officers maintain safety while diverting the individual in need to a service instead of a jail cell?
One concern to address is the safety element for the individual in crisis and the officers responding. In the past, a normal response was to utilize arrest as the safest means for the individual and officer. However, it has become routine with incidents involving an officer shooting resulting from officers attempting to place the individual in crisis under arrest and ending with one or both parties being injured or killed.
The second consideration is cost and whether we can do more with the community’s tax dollars. “There’s always this discussion between spending on mental health versus safety,” said Sarah Desmarais, an assistant professor of psychology at NC State. But jail is the answer according to a Department of Justice report estimating American taxpayers’ pay $48,980 annually to house individuals with mental illnesses in prisons and jails.
Then the “$64,000 question” is what we do as a public safety response. The answer is not revolutionary because communities already utilize the practice of “least restrictive environments” to reduce costs to government entities. “Medication and routine outpatient services make a huge difference,” said Desmarais. She continues with her observation that treatment is very expensive and that routine care through Medicaid is also costly. Still, the difference is enormous when the costs of giving medication and outpatient services to the mentally ill in comparison to the cost of processing them through the criminal justice system. Treatment and medication are far cheaper than $48,980.
A criminal justice co-responder model pairs a law enforcement officer with a mental health clinician to respond to emergency calls suspected to be related to behavioral health problems. The significant benefit of this model is that it utilizes the combined and varied expertise both individuals possess.
Law enforcement service calls involving mental illness are increasingly diverting resources from other community safety needs by requiring officers to spend significant amounts of time transporting and remaining with acutely ill individuals in hospital emergency rooms based on a nationwide survey report of law enforcement executives.
Do these programs save money? YES, they do. “The results confirmed that treating the mentally ill is less expensive,” said Desmarais. “And routine outpatient care seems to have a preventative effect against incarceration costs as low as $10 per day.”
If you believe that is expensive, imagine the monetary cost of juvenile detention is staggering: $588 per day per youth or $214,620 a year. The average cost for psychiatric treatment in a community hospital ranges from $3,616 to $8,509, depending on the type of treatment.
Remember, law enforcement officers are often called upon to respond to people who are having a mental health crisis, are intoxicated, experiencing homelessness, or have other health and social service challenges. The graph below demonstrates the need to divert these individuals to a service, not jail.
It becomes apparent a percentage of the individuals being encountered and arrested for minor crimes contain a population with 35% enduring a serious mental illness and 79% being diagnosed with co-occurring disorders. In essence, they have a disorder and attempt to self-medicate with substance abuse. Many believe that jail is the best and safest place for these individual. Jail will allow them to “dry out” and simply get out of jail on bond with a “better mindset.”
But these perceptions lead individuals enduring a mental illness to remain in custody longer before they go to court or have a final disposition of their case. The same individuals receive longer sentences because their attorneys, the prosecutors, and the judges do not have options for what to do with the accused regarding a sentence or referral, generating an expense of $48,000 a year. However, there are more potential costs.
According to the latest Bureau of Justice Statistics report, suicides were the leading cause of jail deaths between 2000 and 2019, totaling 6,217 — 30 percent of all deaths in local jails. In 2019, the suicide rate in jails was over twice that of the public.
Jail deaths have risen 11 percent since 2000 when the U.S. Department of Justice began tallying these deaths.
As our community quickly learned, with two individuals committing suicide in our jail, lawsuits are the real expense. Since November 2020, Georgia has paid nearly $4.3 million to settle four cases stemming from prison suicides, records obtained by the AJC show. The settlements suggest that the state has acknowledged, at least tacitly, its failures in preventing those deaths.
The co-responder teams’ efforts for diverting the number of individuals with mental health needs from jail is even more critical. The reason for the urgency is 77 percent of those who died by suicide in local jails between 2000 and 2019 had not been convicted of any crime, according to the Bureau of Justice Statistics (BJS). In addition, despite the high percentage of pretrial suicides reported in mortality data released by BJS, many jail populations are confined until their trial because they cannot make bail or are judged to be a flight risk.
Yes, co-responder teams coupled with jail and court mental health initiatives work. They save tax dollars, create a positive economic impact, and save lives.
Vince Evans, Mayor of Conyers, GA, says it is an easy decision when you look at the data presented by the Chief of Police. He observes, “The amount of money we save with officer calls, the courts, the probation, and the liability can only make one understand the need to put more clinicians in the budget.” Mayor Evans concludes with “All you have to do is see a picture of a clinician talking an individual from jumping off a bridge with officers in the background to see that we are saving lives.”
The picture above shows one of the community clinicians in her vest who serves with the co-respond team.
Many believe the practices of aggressively attempting to divert individuals from jail, jails, and court services striving to provide effective referrals to individuals and communities collaborating to aid individuals encountering first responders is a liberal, take-it-easy-on-the individual mindset. But law enforcement, prosecutors, and judges do not agree. Because the practices are reducing the number of calls, the difficulty to determine actions to be taken while enhancing the safety of the responding officers and individuals in crisis. Jail administrators love the program because it reduces the required jail beds, inmate costs, and lessens the potential for suicides. Even conservatives demanding lower expenses over a more extended period and a positive return on investment agree with these proven programs.
So, what is your community waiting on? It is time for your local government to act. It is hard work with tough conversations and difficult decisions, but you do not have to act alone. We will gladly help and point any community in the right direction.
Marchman Consulting helps communities make an impact with data analysis, grant development, implementation, and evaluation for sustainability efforts for a variety of programs. An example is the alcohol risk management (ARM) measures, such as Marchman’s award-winning RASS training program. Validation of his success, Marchman was the recipient of the Office of Victims of Crime 2022 Victims’ Rights Award presented by U.S. Attorney General Merrick Garland on the Washington Mall. More information of his services is available at www.marchmanconsulting.com.