States’ shortcomings drive reincarceration rates

States are falling short in providing adequate care for individuals with serious mental illness who have committed major crimes, driving up rearrest rates and draining public resources as a result, according to a report published this week by the Treatment Advocacy Center.

The national not-for-profit group evaluated all 50 states in 10 areas of practice known to reduce reincarceration. No state received an “A” grade, while 21 received either “D” or “F” grades, showing little or no effort to use best treatment practices.  (Grades for all states are listed in the chart below.)

John Snook, executive director of the Treatment Advocacy Center, says the results are disappointing, but not surprising.

“We hear far too often from law enforcement officers, families and people with mental illness that they too often are set up to fail,” Snook tells Behavioral Healthcare Executive. “Research shows us what we need to do to ensure people are successful when they are released from these facilities, and we simply aren’t doing it. We aren’t paying attention to this population in the way that we should, so we can’t really be surprised when they are getting caught back up in the system, and being re-arrested and rehospitalized and being caught in this revolving door.”

For the purposes of the report, major crimes are defined as “felony and misdemeanor crimes posing a potential threat to the individual or public safety.” The study notes that the reoffending rate for those with serious mental illness is higher than for those without. For individuals who have committed major crimes and have a psychotic disorder, the reoffending rate in the U.S. is twice as high as nine other countries with similar data.

Evidence-based programs for treating individuals with serious mental illness, meanwhile, have been found to reduce rearrest rates from 40% to 60%, to 10% or less, the study notes. Failing to provide such treatment for individuals with mental illness portends shortcomings with additional populations, Snook says.

“We know what works. We know what this population needs,” Snook says. “You can consider these folks the canary in the coal mine. If we can’t prioritize and focus on that population, what are we doing for all of the other folks who might not have already had this kind of situation? How bad is the system for them? Not only are we failing this population, we are failing most populations who need care.”

While most of the recommendations in the Treatment Advocacy Center’s report are aimed at policy makers, Snook says providers can make a difference by focusing their efforts on breaking down the silos of mental health services, departments of corrections and the criminal justice system.

“Too often, these individuals being lost to the mental health system actually look good on the books,” Snook says. “[If a] person wasn’t rehospitalized, we’re not spending as much on care—those sorts of things. But at the end of the day, that person isn’t going away. That person is still sick, they’re just getting care in a system that doesn’t make sense for them or provide the right level of care.”