|Laura Usher, |
NAMI Crisis Intervention Team (CIT) Coordinator
A few of the provisions have gone into effect this fall, but the majority of reforms won’t be implemented until 2014. Here at NAMI, we have been asking, will health care reform help some of our most vulnerable members—those who are at risk of involvement with the criminal justice system?
The reforms are not likely to have an effect on individuals currently in jail or prison; these individuals are considered exempt from the health care reform law. People who are incarcerated have a limited right to health and mental health care protected by the Constitution.
This is important to NAMI because more than 450,000 Americans with a recent history of mental illness are incarcerated in U.S. jails and prisons. In one study, 28 percent of people with serious mental illness were arrested at least one time in a 10-year period. The majority of these arrests were for non-violent crimes like crimes against the public order or a property offense.
Thus, even a minor offense can change the course of person’s life: a criminal record means more trouble getting housing or services, more likelihood of experiencing violence or trauma as well as estrangement from family and community supports. For many, this tragic situation begins because they do not have access to quality treatment and services. Health care reform may improve access to care for people living with mental illness, breaking the cycle of incarceration for those re-entering society or preventing it from starting for those who are at risk of encountering the police. The new law will provide access to health care for many who desperately need it—by 2014, approximately 94 percent of Americans will have some kind of health insurance coverage. It is hoped that the improved access will translate into improved services for people living with mental illness, many of whom currently go without the treatment and services they need.
Coverage expansion comes in a variety of forms—increased funding for Medicaid and Children’s Health Insurance Program (CHIP) programs; stricter rules for private insurance which will prevent them denying coverage based on pre-existing conditions or cancelling coverage due to illness as well as subsidies for low-income people to help them buy coverage in state-regulated exchanges.
We also know that there will be a required benefits package, which will include basic mental health and substance abuse treatment, for all Medicaid and private insurance plans.
In addition to increased access, the health reform law offers some opportunities for integration of primary care, mental health and substance abuse treatment— which we know is important, since most people living with mental illness in the criminal justice system also have co-occurring disorders. However, this push towards integration will not help everyone— states will have an option to include it in their Medicaid programs in addition to a new federal grant program to allow community mental health centers to locate primary and specialty care services in the same facility.
Are improved access to care and limited integration of care enough to help people with serious mental illness stay out of the criminal justice system? I am hopeful that, for many individuals, they will be. But we know that people living with mental illness who are involved with the justice system face a variety of challenges. For example, a high percentage lives with a co-occurring substance use disorder.
We know that involvement with the justice system often starts early in life, with more than two-thirds of children in the juvenile justice system having at least one diagnosable mental disorder. The intersection of mental illness and the justice system can exacerbate an individual’s problems on many levels. People who are incarcerated and live with mental illness tend to experience higher rates of sexual and physical abuse and unemployment than other inmates.
We also know that people living with mental illness who are involved with the justice system often get trapped in cycles of crisis, alternating between jails, homelessness, shelters and emergency rooms. Once someone has been in jail, he or she often has trouble connecting or reconnecting with life-saving services like income supports, Medicaid and housing.
I think the health care reform law will be good for some people; for many people access to care will be life-changing. But we will need to continue to advocate for a variety of services and supports—such as Assertive Community Treatment (ACT), supportive housing, employment and education assistance—to help people achieve the recovery needed to stay out of the justice system. And since many people living with mental illness are already entangled with the justice system, we will need to continue to fight for cross-system collaborations like crisis intervention teams (CIT) that bring together mental health systems, criminal justice systems and advocates to find creative solutions.
Finally, NAMI State Organizations and NAMI Affiliates will need to stay engaged to shape how health care reform is implemented. Major decisions about the content of benefits packages and other important issues are still on the table, and our voices must be heard to ensure that people living with mental illness get the comprehensive services and supports they need.
What do you think? Will access to health care help you or your loved one who is at risk stay out of jail? Or do you think that the challenges facing people who at risk of involvement with the justice system are too great?
As NAMI develops more resources to assist advocates, you can find them on our website at: www.nami.org/healthcare.Fact sheets are also available and offer a general overview of the health care reform legislation. Learn more about NAMI’s CIT Action Center or NAMI’s efforts to address criminalization and people living with mental illness.