Will Health Care Reform Help Those Most at Risk? A Unique Perspective from the NAMI Crisis Intervention Team (CIT) Action Center
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.
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.