Solutions: Fight Drug Addiction and Address Mental Illness Head On
(2) Maintain in-prison substance abuse treatment programs and expand mental health treatment services.
(1) Expand community-based substance abuse and mental health diversion opportunities. Texas must halt the wasteful expenditure of millions of dollars each year on the incarceration (and re-incarceration) of non‑violent drug users and individuals suffering from mental illness. Instead, the State should promote medical and public health responses to these issues by improving and making more widely available tailored, coordinated, and effective community-based rehabilitation and treatment diversion programs.
(a) With regards to non‑violent defendants charged with drug possession or drug use, reject the policy of incarceration and divert individuals to probation and treatment, as needed. Judges should have the discretion to place non-dangerous individuals with a first-time drug possession offense on probation and in a tailored substance abuse program, which in most cases would begin in a secure residential facility rather than prison. While judges should be allowed to incarcerate an individual if s/he determines that individual is either a threat to public safety, a drug dealer, or not amenable to treatment, this practice alone could divert 10,000 people from prison and save the state $500 million by 2012, not including potentially avoided prison construction costs.[i] Furthermore, such a practice would address the recidivism problems posed by individuals who choose incarceration over programs that force them to deal with the illness of addiction.
(i) Boost probation departments’ ability to identify and seek treatment for individuals suffering from substance abuse. It is imperative that probation departments are given the resources to hire qualified probation officers with an understanding of substance abuse and mental health problems. Specialized staffing will enable probation departments to offer early identification of probationers who suffer from drug addiction/abuse, and promptly place them in a treatment program.
Probation departments should also have access to and contract with a broad spectrum of providers and services to mitigate probationers’ criminal tendencies and reduce the likelihood of them recidivating.
(ii) Maintain the allocation of funds for the treatment of substance abuse addiction. Although federal and state funding for treatment programs outside prison walls began a drastic decline in 2003, the 80th State Legislature began to address the devastating effects of under-funded programs in Texas by providing funds for alternatives to incarceration. According to TDCJ, program expansions approved by the Legislature have increased the number of incarcerated individuals with access to treatment.
Now and in the future, the State should invest in further strengthening the treatment infrastructure to produce healthy citizens and decrease the criminal activity derived from substance abuse addiction. This, in turn, will boost the public safety of our communities most affected by drug- and alcohol-related crimes, as well as prevent costly and ineffective prison construction and maintenance. Ultimately, the social benefits to be gained by assisting those suffering with addiction outweigh the initial budgetary costs and will produce long-term savings. With a greater allocation of state funding towards substance abuse treatment, Texas will further its mission to improve public safety by producing more capable, law abiding, and productive citizens.
First and foremost, funding must be increased in efforts to reduce or eliminate current obstacles facing treatment providers and their clients. Enough funding should be allocated so that agencies and programs – not only in major metropolitan areas, but also in historically underserved areas (such as rural areas) where counseling and recovery services are scarce and desperately needed – can (a) attract qualified front-line practitioners and provide them with continuing education and other necessities, (b) enable them to conduct program evaluations, and (c) help to minimize the waiting periods and statutory barriers faced by criminal justice clients seeking treatment (this is discussed more fully in the bullet below entitled “Address treatment program backlogs for current probationers”).
Texas must also do all that it can to sustain existing treatment programs that work. Currently, there are 435 certified programs in Texas that deal with the broad range of substance abuse needs; only 28.5% identify themselves as serving criminal justice clients.[ii] Generally, these latter treatment providers have a limited amount of out-patient program availability. More problematic, they often choose to treat the clients who will pay higher rates because they must support their own program survival (as, like probation departments, their funding comes from fees). These treatment providers often accept (a) federal clients whose rates for reimbursement for substance abuse treatment services are based on a competitive bidding process (note: the reimbursement rates vary based on the type of service provided and the area of the state solicited for services), or (b) clients who fall under the Department of Health and Human Services who pay treatment fees of $74 per day for intensive residential treatment, $41 per day for supportive residential treatment, $54 per hour for individual counseling, and $17 per hour for group counseling.[iii]
Treatment providers are often less likely to serve individuals with judge-ordered drug treatment requirements because there is little financial incentive:
− providers receive an average of $43.44 per day to cover operation and treatment costs for Substance Abuse Felony Punishment Facilities(SAFPFs), which are therapeutic community programs for individuals sentenced by a judge as a condition of community supervision or parole.
− they receive an average of $32.61 per day for supportive residential Transitional Treatment Centers (TTCs), into which individuals are placed upon completion of a SAFPF program.
− they receive $54.53 per day for relapse residential TTCs.
− they receive $32.62 per day for halfway houses.[iv]
Increasing average per-day costs – while also keeping in mind relative cost of living standards throughout the state – will increase the likelihood of providers contracting with probation and parole departments (as well as the Department of Criminal Justice in general) to fulfill current treatment needs.
(iii) Ensure that SAFPFs and TTCs use effective, evidence-based treatment practices. TDCJ should be provided the resources to contract with outside correctional experts with a proven track record in best practices who can offer technical assistance on effectively implementing and tracking the success of legislated diversions and drug treatment programs (SAFPFs, TTCs, etc.) in a timely manner. Of individuals with substance abuse problems, 85% can be treated in community-based programs, but 15% will require programs like a SAFPF. All SAFPF facilities must utilize a three-pronged approach to be effective: First, substance abusers must stay in a SAFPF for 9 months instead of the current 6-month stay. Second, after a SAFPF, individuals need to be admitted to a TTC for 90 days. Finally, individuals must spend at least 9-10 months in an out-patient program. As has been demonstrated by past attempts to use a SAFPF to address drug addiction for those who cannot be treated in community-based programs, recidivism rates do not decrease without implementation of all three of these components.
Note: The State must ensure that SAFPs, TTCs, and out-patient programs have the resources to hire qualified professionals.
(iv) Address treatment program backlogs for current probationers. For individuals on probation, current treatment resources are scarce. The following chart shows the number of individuals in state SAFPFs or In-Prison Therapeutic Communities (IPTCs)[v] who have completed their terms and are awaiting TTC beds, as of the week of December 22, 2008, through December 26, 2008.
|
Facility
|
Backlogs
|
|
Facility
|
Backlogs
|
|
East Texas (SAFPF)
|
19
|
Henley (IPTC/SAFPF)
|
0
|
|
|
Estelle (SAFPF)
|
24
|
Jester I (SAFPF)
|
24
|
|
|
Glossbrenner (SAFPF)
|
139
|
Johnston (SAFPF)
|
84
|
|
|
Hackberry (SAFPF)
|
41
|
Kyle (IPTC)
|
73
|
|
|
Halbert (SAFPF/IPTC)
|
160
|
Ney (IPTC)
|
65
|
|
|
Havins (IPTC)
|
137
|
Sayle (SAFPF)
|
131
|
Essentially, these individuals are consuming much-needed beds in their respective facilities while waiting to be placed in TTCs. Note: It is likely that many of these individuals have been waiting longer than 30 days.
(v) View probation and drug treatment separately to reduce drug-related technical violations. Oftentimes, addiction to drugs causes criminal activity (such as theft), because people require funds to feed their addiction. Whereas drug treatment will best get to the root of the criminal activity – because it will address the physiological impact of the substance on the addict and help put an end to the need for criminal activity spurred by the addiction – probation will help determine if the drug treatment program is truly working for that individual. For instance, if an individual fails a drug test, his or her probation officer will be able to verify that the current treatment program is not working. This should not be a cause for probation revocation (as committing another crime, like theft, would be) – not all treatment programs work for every type of addiction and, on average, an addict relapses three times before successfully completing a treatment program. If an individual is punished with probation revocation for failing to control his or her illness, s/he will ultimately re-enter society with unmet needs and will continue to make poor life decisions and engage in unlawful activity.
(b) With regards to defendants suffering from mental illness, reject the policy of incarceration and divert individuals to mental health treatment, as needed. Prisons often take the place of mental health centers, and sadly, only 17% of prison inmates and 11% of jail inmates in need of mental health treatment actually receive it. The effectiveness of treatment on those who do receive it is undermined by long waiting lists, few incentives to follow treatment plans, and a lack of qualified mental health professionals.[vi] Like those in prison suffering from substance abuse, these individuals will also be released without the tools to effectively and healthily manage their lives – unless they are diverted to mental health facilities, where they will receive the help they need without contact with the criminal justice system.
■ Pre-booking Diversion Programs. Individuals with mental illness and/or co-occurring disorders should be identified for diversion by police before formal charges are brought. Specifically, a thorough screening – including a complete mental health assessment – should be done during intake at arrest, ensuring that pre-booking diversion occurs at the point of contact with law enforcement officers. Furthermore, to most accurately determine the best course of action, law enforcement must ensure that this screening includes the input of qualified community mental health and substance abuse service providers.
Note: Crisis Intervention Teams (CIT) have been found to be especially beneficial in dealing with the mentally ill in the criminal justice system. The Houston Police Department (HPD) has the largest CIT program in the nation, with over 1,300 CIT officers in patrol since October, 2008. HPD’s reported effects of the program have been numerous and include jail diversion efforts, increased safety, improved community relations, improved confidence of officers, and reduced liability/litigation. [vii]
■ Post-booking Diversion Programs. Post-booking diversion programs can also be implemented with success. These programs identify and divert individuals with mental illness after they have been arrested. Post-booking diversion program staff must work with prosecutors, public defenders, community-based mental health and substance abuse providers, and the courts to develop and implement a plan for diversion and linkage to an appropriate array of community-based services. To be effective, post-booking diversion programs should include some type of monitoring of compliance with treatment, though the level of supervision and the active involvement of the court can vary as needed. Charges should be reduced or dropped upon the individual’s successful program completion. In the alternative, the individual diverted should receive less or no time in jail at sentencing as a result of participating in the jail diversion program.
Note regarding military service members or veterans: We must also address a more recent and specialized population of defendants coming before the court: military service members or veterans whose criminal conduct was materially affected by brain injuries or mental illnesses (including post-traumatic stress disorder) resulting from military service. With regards to these individuals, courts should allow participation in a deferred prosecution program, and judges should recommend available treatment options to address the defendant’s brain injury or mental illness. Upon a defendant’s successful completion of the conditions imposed by the court under the program, a judge should have the authority to dismiss the criminal action against him or her. This type of program would greatly benefit the men and women who have served our country, while also increasing public safety.
(c) Fully fund specialty courts, such as drug, DWI, mental health, and re-entry courts. In addition to aiding probation officers, the State should continue to fund courts specially designed to handle cases involving individuals who abuse addictive substances. These diversion programs effectively address addiction and mental illness issues, generally by using a cooperative approach linking efforts of the judge, defense, prosecution, and treatment providers to achieve participants’ goals. They are developed at the local level to reflect the unique strengths, circumstances, and capacities of each community. By concentrating on the root causes of criminal behavior and the recovery of defendants, specialty courts better ensure public safety.
■ Specifically, drug court programs involve intensive interaction between participants and judges (including bi-weekly personal appearances before a drug court judge), more comprehensive supervision than regular probation (including personal supervision and treatment contacts three times each week), routine (even weekly) drug testing, immediate sanctions for violations, and meaningful incentives for good behavior. Drug courts have been highly successful and immensely popular in Texas, and for many reasons: they are far less expensive than incarceration (on average nearly 10 times less) and can help resolve the prison overcrowding crisis through program diversion; they successfully reduce drug abuse and recidivism (by up to 44%)[viii]; and they encourage personal responsibility by requiring participants to pay program and court costs to the extent that they are financially able to do so.
■ DWI-specific drug courts can quickly identify individuals who habitually abuse alcohol and place them under strict court monitoring and community supervision; this is coupled with long-term treatment services to address the root cause of DWIs and reduce recidivism.[ix] Only through actively and forcefully intervening and breaking the cycle of alcohol abuse and addiction will the criminal acts that result from these problems stop. Individuals with a DWI offense can be encouraged to participate through program provisions that would allow judges or magistrates to suspend any probation requirement that would prevent a participant from operating a motor vehicle without an ignition interlock device or that would require a participant to work a specified number of community service hours. Fort Bend County’s DWI court, the first of its kind in Texas, has experienced a great amount of success, serving 79 clients between 2006 and mid-2008 and maintaining a 97.5% success rate.
■ Mental health courts are a recent development and require collaboration and consideration from practitioners in both the criminal justice and mental health fields. Mental health courts typically involve judges, prosecutors, defense attorneys, and other court personnel who have expressed an interest in or possess particular mental health expertise. The courts generally deal with non-violent individuals who have been diagnosed with a mental illness. Today, eight of these courts exist in the most populous regions of Texas, and more are being planned. In order to pool resources and establish court procedures and goals, mental health court professionals should form a network in which to share experiences and collaborate with other similar organizations to strengthen their own goals.
Despite all their benefits – and the 2007 legislative mandate requiring the implementation of specialty courts in counties with populations over 200,000 – these courts still lack funding in many counties to realize their full potential. They should be fully funded and institutionalized so that the State can more effectively address addiction and mental illness issues.
(2) Maintain in-prison substance abuse treatment programs and expand mental health treatment services. In order to enhance public safety by decreasing drug use and mental health-related crime, Texas must proactively address drug dependence and mental illness. Every crime reduction strategy should include a solid drug and/or mental health treatment plan in order to break the cycle of re-offending as early as possible. Even the most expensive treatment program is less expensive – and far more effective – than the costs of building and maintaining additional prisons, which would only manage (not reduce) risk.
(a) Improve the availability of in-prison substance abuse treatment programs. A large percentage of those incarcerated in Texas prisons have a history of substance abuse problems.[x] For those already within prison walls, a transition plan should be developed to include how each individual will most successfully re-integrate into society, to include in-prison substance abuse treatment participation.
Furthermore, drug users entering the criminal justice system should be provided full access to effective, professionally supervised treatment and rehabilitation programs. Cognitive therapy, especially, should be made available to all individuals. Ultimately, during each individual’s intake process into prison, his or her history should be assessed to determine severity and evaluated to create an individualized plan best suited to respond to his or her substance abuse problems (or other issues).
Additionally, the state should expand the number of programs like the recently implemented DWI Recovery program at the East Texas Treatment Facility in Henderson, Texas, from which more than 130 individuals have graduated. The six-month program teaches DWI-convicted inmates from across Texas basic life skills, alternatives to drinking and driving, and the medical, lifestyle, and stress effects of alcohol.[xi] Regional facilities throughout the state would allow more individuals to participate, while also ensuring that participants are closer to their families and support networks.
(b) Improve the availability of in-prison mental health treatment services. As many as one in five of the 2.1 million Americans currently in jail and prison are seriously mentally ill, far outnumbering the number of individuals in mental institutions.[xii] However, as mentioned above, only 17% of prison inmates and 11% of jail inmates in need of mental health treatment actually receive it. The State must ensure that currently incarcerated individuals with special needs are being properly diagnosed and treated, or continue to waste valuable taxpayer money on their constant incarceration and re-incarceration.
(3) Ensure that programs are properly implemented by having qualified staff in the criminal justice field (including both adult and juvenile probation, parole, and in-prison program staff). In order to best ensure that individuals who enter the criminal justice system are provided effective programming and supervision, Texas must attract, recruit, train, and retain quality professionals in the field of substance abuse treatment and mental health services. Incentives for practitioners – such as loan reimbursement programs – will enhance the State’s professional pool – from the probation and parole officers who supervise individuals, to the substance abuse treatment and re-entry professionals that handle individuals with mental health and/or substance abuse issues. The better equipped these practitioners are to meet Texas’ public safety needs, the more faith the public will have in the criminal justice system, the more likely it will be for those suffering from substance abuse or mental health issues to receive quality treatment, and the greater the likelihood of those re-entering our communities to have the tools to live responsibly.
(a) Increase the number of qualified treatment professionals that focus on criminal and juvenile justice clients. High levels of debt as a result of student loans, as well as low salary pay and limited opportunity both for recognition and financial rewards for exceptional performance, ultimately discourage individuals from entering the criminal and juvenile justice field, leaving Texas with an insufficient number of qualified professionals. The State should adopt a loan reimbursement program for those obtaining social work, psychology, and/or counseling degrees who are seeking to enter the criminal or juvenile justice field.
Note: To qualify for the reimbursement program, a student should have to agree in writing to be employed for four years within an adult or juvenile probation or parole department in Texas, or within a state correctional facility. The total amount of tuition and mandatory fees that the public or private institution of higher education charges the recipient for that academic year could be reimbursed. This reimbursement should only be used towards tuition and mandatory fees for degree-specific credit hours.
In addition to the reimbursement program, individuals who have already paid their student loans and who are considered well performing employees within this field should be eligible to receive merit bonus incentives over the long term to encourage retention of the best personnel.
[i] Marc Levin, Texas Public Policy Foundation, 2009 Policy Primer, (2009), http://www.texaspolicy.com/pdf/2008-LegeEntry-PrivateSectorPublicSafety-ml.pdf.
[ii] Substance Abuse and Mental Health Services Administration; to view a full list, please go to. http://findtreatment.samhsa.gov/ufds/locstates. To qualify to be on this list, a program must either be a private or public facility that is licensed, certified, or otherwise approved for inclusion by the State Department of State Health Services, or beadministered by the Department of Veterans Affairs, the Indian Health Service or the Department of Defense.
[iii]Community Mental Health and Substance Abuse Programs Services Section, Texas Department of State Health Services. Please see Appendix E for Department of State Health Services reimbursement rates for substance abuse treatment services.
[iv] These rates were provided by TDCJ in response to an open records request. Please see Appendix F for TDCJ’s full response to the open records request submitted by TCJC in regards to per diem rates for SAFPs, Halfway Houses, and TTCs.
[v] IPTCs are intensive six-month treatment programs for eligible offenders within six months of parole release who are identified as needing substance abuse treatment.
[vi] Stephan Haimowitz, J.D., “Slowing the Revolving Door: Community Reentry of Offenders with Mental Illness,” Law and Psychiarty 55, no.4 (2004): 373-375.
[vii] Houston Police Department, About Houston Police Department Crisis Intervention Team, http://www.houstoncit.org/about.html.
[viii] National Drug Court Institute, Benefits of Drug Courts, http://www.ndci.org/courtfacts_benefits.html.
[ix] The University of New Mexico evaluated the DWI/Drug Court Program in Bernalillo County and found that only 36 of the 341 graduates had been re-arrested for DWI since the program’s inception (a recidivism rate of only 10.6%). The Kootenai County, Idaho Prosecuting Attorney’s Office and the Idaho Transportation Department’s Office of Highway Safety analyzed the county’s DUI Court: Only 4% of the 46 DUI Court graduates were arrested for a subsequent DUI versus a 14% DUI recidivism rate among a comparison group.
[x] Bureau of Justice Statistics, Substance Dependence, Abuse, and Treatment of Jail Inmates, (2002), http://www.ojp.usdoj.gov/bjs/pub/pdf/sdatji02.pdf.
[xi] Jamaal O’Neal, “Whitmire: Programs needed for nonviolent offenders,” News-Journal.com, December 16, 2008, http://www.news-journal.com/news/content/news/stories/2008/12/16/12162008_Senate_Visit_.html.
[xii] National Conference of State Legislatures, “A comprehensive study by Human Rights Watch released in October 2003 found that as many as one in five of the 2.1 million Americans in jail and prison are seriously mentally ill, far outnumbering the number of mentally ill who are in mental hospitals”