As Massachusetts considers a sweeping criminal justice bill, it is imperative that legislators consider evidence-based programs that are successfully diverting individuals with mental health and substance abuse conditions from the criminal justice system and preventing recidivism.
The bill currently does not include reentry services for those released from incarceration, which we have found is a critical service that helps assure a successful transition and dramatically reduces recidivism.
Individuals with behavioral health conditions are vastly overrepresented in the Massachusetts criminal justice system and at every stage of the judicial process at great cost to the Commonwealth. More than 42 percent of individuals incarcerated in Massachusetts prisons and jails have been previously diagnosed with a behavioral health condition, and many are chronically involved in our criminal justice system. Prisons and jails were never meant to be our society’s de facto institutions for treating individuals with mental illness, and despite filling that role now, they remain under-resourced and ill-equipped to provide imprisoned individuals with proper treatment for the severity of their conditions.
There are proven ways to interrupt the cycle of recidivism among this population and even prevent individuals struggling with behavioral health conditions from entering the system in the first place. Evidence-based programs from across the country – including several here in Massachusetts – implement interventions at specific inflection points that have shown significant success at improving criminal diversion, community re-entry, and recidivism rates.
For example, the Worcester Initiative for Supported Reentry (WISR), a partnership-based program led by Advocates with funding from The Health Foundation of Central Massachusetts, intervenes at the critical point when an individual is returning to the community from incarceration. WISR identifies medium and high-risk prison and jail inmates and provides comprehensive pre- and post-release reentry navigation and intensive transition case management services to help them successfully reenter the community. WISR supported participants in securing housing, employment, health care and other key needs.
Brandeis University’s evaluation of WISR found that the program successfully addressed the primary factors that can lead to recidivism. More than nine out of ten participants within WISR’s transition case management program accessed MassHealth (Medicaid), primary care physicians, and substance use disorder treatment. Additionally, three out of four participants who needed mental health services accessed those services. Importantly, all WISR participants accessed housing in the community within one day of release. WISR achieved a 47 percent reduction in recidivism three years post-release compared to its control group. If scaled up statewide, this could result in an estimated savings for the criminal justice system of $375,000 for every 100 individuals who are averted from future incarceration.
Pre-arrest diversion also has been shown to be successful when law enforcement and mental health professionals respond together to behavioral health emergencies. Individuals are more often referred to the services and treatment that they need, rather than enter the criminal justice system as an offender. This co-responder model has delivered great results in Massachusetts to date. Programs run by Advocates, a human services agency, in partnership with several police departments in Middlesex County and funded in part by the Department of Mental Health have generated over 4,000 diversions and $11 million in savings since 2003.
Diversion initiatives outside of Massachusetts are bearing fruit as well. Police-based Crisis Intervention Teams (CITs), which include specially trained officers who focus on de-escalation and redirection to mental health treatment services, are improving lives and lowering costs. In Bexar County, Texas, CITs have access to a 24-hour Crisis Care Center which treats individuals within an hour of arrival, saving $2.4 million in jail costs tied to public intoxication and $1 million in emergency room costs in the first year. Similar programs in Minneapolis and Salt Lake City have led to comparable results, including a 90 percent decrease in ER visits in Salt Lake City by individuals with psychiatric conditions.
Massachusetts’ hospitals and emergency departments could benefit from the relief of those presenting with behavioral health conditions who could be served in less acute settings, and these individuals would certainly benefit from more appropriate care and avoiding incarceration.
The Massachusetts criminal justice reform legislation is a potentially once-in-a-lifetime opportunity to institute programs proven at diverting individuals with mental health and substance abuse conditions from the criminal justice system and preventing recidivism.
Programs that divert individuals from deeper involvement in the criminal justice system and support their reintegration into the community improve public safety, save the Commonwealth money and restore lives. Massachusetts cannot afford to be shortsighted. These programs are worth the return on investment. Legislators should consider this as they move through the reform process.