An electronic newsletter of the Coalition's Center for Rehabilitation and Recovery
The Center for Rehabilitation and Recovery provides assistance to the New York City mental health provider community through expert trainings, focused technical assistance, evaluation, information dissemination and special projects.
Dostoyevsky says, "The degree of civilization in a society can be judged by entering its prisons." Perhaps society can also be judged by its alternatives to prison, and how well it welcomes back those who serve their time. After all, apart from humanitarian considerations, it is to everyone’s advantage to reduce recidivism.
In this issue, we present the case for integrating formerly incarcerated peers (people with a psychiatric diagnosis) into society, what providers can do to facilitate that process, and a few resources to help them.
The growing attention paid to the disproportionate percentage of mentally ill individuals entangled in the criminal justice system is long overdue. It cries out for remedy. New York City is taking major steps forward on this issue, as are many service providers.
Even when controlling for other factors, people with mental health issues stay in detention twice as long as those without mental health issues. According to a Council of State Governments report published in 2012, people with mental illnesses booked into New York City Department of Corrections had an average length of stay of 112 days, almost double that of the general jail population (61 days).
As we reduce the overall jail population, the proportion of people with mental health issues becomes larger. In FY 2010, people with mental illness were only 29% of the NYC jail population; today they represent 38% of the overall jail population. Approximately 7% of the jail population is made up of individuals with serious mental illness. Many have only low level offenses on their record, and do not pose any serious threat to public safety.
Nationally, and in New York City and State, beds in mental health facilities have decreased as the number and percentage of those incarcerated with mental illness has increased: we have replaced one set of institutions with another, and chosen to rely on institutions set up to punish people desperately in need of treatment. To do so is a losing proposition on all fronts: it does terrible damage to those incarcerated, hurts families and communities, and causes massive harm to society financially and socially. Overreliance on incarceration has a particularly damaging impact on mentally ill youth, who pose a higher risk for suicide, and often have experienced physical, sexual, and emotional abuse; substance abuse; and mental disorders prior to incarceration.
At The Fortune Society, we developed the Better Living Center (BLC) to provide culturally competent mental health treatment at a service center that offers a full array of holistic reentry services. We have found that integrating mental health services with other services reduces stigma in a population often resistant to treatment, and has created a culture where clients openly talk about going to therapy, and support each other in doing so.
The Mayor’s Task Force on Behavioral Health and the Criminal Justice System is an excellent step forward. The Task Force sets forth a host of recommendations and interventions to prevent overreliance on incarceration in every phase of the criminal justice process. The report also states that incarceration should be a last resort, with alternatives available to bail and to sentences of incarceration.
Once in the community, those released need to be able to access community-based, mental health treatment with low threshold entry criteria and wraparound services that reduce the stigma of seeking help, provide services that attract participants, and address barriers to retention.
A 1980 graduate of Yale law School, JoAnne Page has just celebrated her 25th year as President and CEO of The Fortune Society, and is a passionate advocate for criminal justice.
What do professionals need to know to help formerly incarcerated peers?
As for what professionals need to know or do, I can’t say for sure. I know from experience that the first thing I have always had an issue with was trust. Most people are not aware of the limits to confidentiality rules. If someone is court-ordered into treatment, there is no confidentiality. Records, notes, and so on can be subject to subpoena.
Therefore, how much can a client reveal without putting him/herself at jeopardy? If a client has a relapse, can that person be honest without getting a violation? Too often, clients choose to remain silent to protect themselves, and never get the opportunity to address the issue.
Are there any other problems you had with seeing a professional?
As a formerly incarcerated person, I’ve always felt as if the professional is judging me. I felt, for the most part, that I was the subject, and the professionals were above me, looking down and shaking their heads. Most professionals have no idea what prison life is like. I think that my success as a peer helping ex-cons is a result of the fact that I truly know and understand. “Been there, done that!”
Also, I know there is a therapeutic value to discussing life behind bars, but not everyone wants to talk about it. It’s a part of my life I want to forget. Professionals need to let clients decide what they want to get off their chest.
How has treatment worked for you?
I have had great success at the place I’ve been in treatment for the past 11 years. I’ll try to explain what helped me achieve this.
First, the staff at this program works as a whole. Each client has a whole team on his or her side. The program director, a very busy man, always has time for me if I am struggling—which is always. If my primary counselor is away, someone else is assigned to fill in the gaps. Follow up calls are made within a few hours. If I don’t come in, someone wants to make sure I am ok, and I get a call.
When things started to spiral out of control, and medication was put on the table, I was so against it. But the director and the psychiatrist sat me down and explained everything I needed to know. This was critical for me, because I couldn't see what was best for me. Turns out I needed something to help me play on a level field.
Second, there is a sense of caring at the place where I go. I’m not a number, and I don’t feel like cattle being herded into groups. I am an individual who needs help, and I feel like that is the staff’s priority. Most other organizations do not operate this way. But at this program, I see it every day. I’m grateful for what I have, especially knowing what is available to most of my current clients.
John Ingenito is employed by Baltic Street to work with clients at another location.
The new 2014 Behavioral Health and the Criminal Justice System Action Plan from Mayor Bill de Blasio’s Task Force provides a good overview of the incarceration of peers throughout case processing (the formal steps of proceeding through the criminal justice system).
For specific practical legal information, and services, consult the Legal Action Center (www.lac.org). Their free downloads can help prepare your clients for job hunts by showing them how to correct mistakes on their rap sheets, get a Certificate of Good Conduct to show they have changed, respond to an illegal question from a potential employer, and more. Downloads include:
The opinions expressed in RECOVERe-works do not necessarily reflect the views of the Coalition of Behavioral Health Agencies.
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