Cheri Andes: A Massachusetts model for criminal justice reform

BOSTON — As Massachusetts considers a sweeping criminal justice bill, it is imperative that legislators take into consideration evidence-based programs that are successfully diverting individuals with mental health and substance abuse conditions from the criminal justice system and preventing 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 53 percent of individuals incarcerated in Massachusetts prisons and jails have been previously diagnosed with a behavioral health condition. The cost of treating just those with serious mental illness, nearly 3,000 prisoners, is upwards of $300 million annually. Yet most of these imprisoned individuals do not receive proper treatment for the severity of their disease, and many are repeatedly and chronically involved in our criminal justice system.

If these problems are addressed, the Commonwealth could save millions of dollars and improve the lives of thousands of its citizens.

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, pre-arrest diversion has been shown to be successful when law enforcement and mental health professionals respond together to identified behavioral health emergencies. Often called Crisis Intervention Teams (CITs), these teams receive training that focuses on de-escalation and redirection to mental health treatment services. In Bexar County, TX, the CIT teams 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, $1.5 million in mental health services, and $1 million in emergency room costs. A similar program in Minneapolis saved $2.16 for every dollar spent on its triage center, and one in Salt Lake City led to a 90 percent decrease in ER visits by patients with psychiatric conditions.

Here in Massachusetts, the National Association of Mental Illness-Massachusetts Criminal Justice Diversion Project (CJDP) works to prevent the unnecessary arrest and detention of individuals with mental illness. The CJDP achieves this goal by supporting and educating police departments and other first responders in engaging with individuals experiencing mental health crisis, and fostering connections between law enforcement, behavioral health providers, and other community stakeholders. Through police education and support programs, CJDP has diverted some 200 individuals from the criminal justice system at a savings of $1.3 million in ER and jail related costs. Massachusetts' hospitals and emergency departments could benefit from the relief of those presenting with behavioral health conditions, and these individuals would certainly benefit from more appropriate care and avoiding incarceration.

The Massachusetts criminal justice reform legislation is rightfully focused on the reduction of recidivism, but we cannot discuss recidivism reduction without discussing issues of mental health, nor can we focus on recidivism reduction without the proper investment in criminal diversion. The best way to keep from reoffending is to not have been incarcerated in the first place. Massachusetts cannot afford to be pennywise and pound foolish; programs such as the Crisis Care Center and the Criminal Justice Diversion Project are worth the return on investment. It is our hope that legislators take these into consideration as they move through the reform process.

Cheri Andes is executive director of National Association of Mental Illness-Massachusetts.


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