Deputy Attorney General Sally Q. Yates Delivers Remarks at the Stepping Up: National Summit

Thank you, Dr. [Renee] Binder for that kind introduction.  And thanks also to the National Association of Counties, the CSG [Council on State Governments] Justice Center and the APA [American Psychiatric Association] Foundation, who have made this summit possible.  The Department of Justice (DOJ), and in particular our Bureau of Justice Assistance (BJA), is proud to support you in these efforts.

And I’m proud to be with you today.  You, by your participation here, have demonstrated that you not only recognize the seriousness of the mental health crisis, you’re actually doing something about it.  You all know better than do I the factors that led to our current mental health crisis, including the failure to replace shuttered state-run psychiatric facilities with adequate community-based mental health services.  This has left far too many of our fellow citizens to fend for themselves, particularly those citizens without the means to afford mental health treatment.  As a result, it’s no surprise, for example, that the LA County Jail and Rikers Island now house more people with mental illness than any psychiatric facility in the United States.  But our criminal justice system is not equipped to deal with what is fundamentally a health crisis.  Requiring our strained criminal justice system to do double duty as front line mental health facilities is not only inefficient, it is totally inconsistent with our values and who we are as a country.  This is not the treatment our fellow citizens deserve.

While fortunately the Affordable Care Act has made mental health treatment available to more Americans, we still need comprehensive mental health reform to meaningfully address the intersection of mental illness with the criminal justice system.  Rather than waiting for congressional action, however, you all have “stepped up” to meet the needs of your communities and the citizens you serve.  And I’m confident that your efforts will make real and measurable change in your home communities and, importantly, build momentum for change nationwide.    

Attitudes toward mental illness have come a long way, but far too many people still stigmatize mental illness, limiting our ability to tackle the challenge head on.  Mental illness is not the result of personal weakness or lack of character.  Individuals living with mental health conditions are more than their diagnosis; they are our colleagues and our college roommates; our children and our friends.  And they should not struggle alone.  With appropriate treatment and support, we can address the mental health needs of the community.  But far too many have fallen through cracks that have become canyons, landing in a criminal justice system that is often ill-equipped to provide the services they need. 

Our current system is both unfair to those struggling with mental illness and unfair to law enforcement and correctional personnel who lack the expertise or the resources to address these situations. 

This is taking a huge toll on our communities.  In 2009, the Council of State Governments Justice Center estimated that 2 million adults with serious mental illness enter American jails over the course of a year.  Once incarcerated, inmates with severe mental illness are likely to spend significantly more time behind bars than inmates who do not face such issues.  All of this inevitably takes a toll on the inmates themselves, who must navigate the many challenges of incarceration while also coping with the daily struggle of mental illness.  And, our correctional facilities, with resources already stretched thin, end up having to manage inmates with mental health conditions rather than treat them.  And so the vicious cycle continues. 

Over the last two days, you have heard from people working on the front lines to address mental illness and the criminal justice system.  We recognize at DOJ that we need to be doing far more to address this critical issue.  That’s why summits like this are so important.  Not only have all of you had an opportunity to get real on-the-ground training about how to address mental illness in your home community, but this summit has also been a learning experience for those of us at DOJ as well.  It gives us an opportunity to hear from you first-hand about the challenges that you are facing, and what you need most from us.  After the summit, I look forward to hearing what our DOJ folks learned about how we can better assist you.

We are sharpening our focus on mental health at DOJ, both to improve the work that we do on the federal level and to provide additional resources to our state and local partners.  And while we have more to learn, there are some things that we know you need and that we’re trying to address.  We have been looking at the intersection of mental health with the criminal justice system in three buckets or phases—interaction of the mentally ill with law enforcement in the community; diversion to mental health treatment rather than prison; and treatment while incarcerated.  In other words, we’re looking at how the criminal justice system interacts with the mentally ill in three different places—the street corner, the courtroom and the cellblock

First, the street corner.  A critical place to start is out in the community, where people with mental illness first come into contact with the criminal justice system.  We are working to train law enforcement officers on identifying signs of mental illness and responding appropriately, so they can de-escalate police encounters and limit the likelihood that an individual with mental illness enters the criminal justice system.  We all know that when an officer responds to a scene, it sometimes can be difficult to determine whether a disruptive individual poses a genuine threat to the officer or is simply showing the signs of an untreated mental illness.  Sometimes it’s both.  And when I speak to our counterparts in state and local law enforcement, they cite this as one of the greatest challenges they face.  We are working to educate officers on how to handle these difficult situations, so hopefully it will be easier for them to do their jobs safely and effectively, and we can increase the likelihood that an individual with mental illness is diverted to the services he or she needs.

There is, of course, no one-size-fits-all solution that will work in every town and every county.  One of the most important insights over the past 30 years is that we need to customize our efforts to match the needs of law enforcement with the mental health resources available in a particular jurisdiction.  Across the country, communities are developing Crisis Intervention Teams, or CITs, that link specially trained patrol officers with a network of mental health professionals in their area who can provide support when a crisis arises.

I’m reminded of a case from Portland, Oregon, several years ago.  Following an investigation by our Civil Rights Division, the Portland Police Department agreed to overhaul the way its officers interacted with individuals suffering from mental illness, and these reforms included the creation of a Crisis Intervention Team.  One morning a short time later, officers in Portland’s Central Precinct responded to a call about a naked man armed with a knife, who was threatening to jump off a parking garage in the city’s downtown.  Upon arriving at the scene, it quickly became clear that the individual was cutting himself with the knife and experiencing a mental health crisis.  One of the responding officers was a member of the city’s CIT and specially trained to address such situations.  Rather than responding with force, the officer engaged the man in conversation.  It turned out he was hungry.  Another officer brought a sandwich from a nearby hotel, and they were able to talk the man off the ledge and into custody. 

It’s an example of how proper training—combined with some quick thinking—can de-escalate a dangerous situation.  We want to help more communities undertake similar evidence-based programs.  And so as we speak, our Bureau of Justice Assistance is working with its partners to develop a new, customizable curriculum that will help jurisdictions develop CIT programs of their own.  The idea is to create a number of different training “modules” that include a range of best practices, so individual communities can build their own program based on the mental health services available in their area.  We hope to launch a pilot training program in select jurisdictions this summer.

This is just one of many projects underway at BJA.  Since 2004, when Congress authorized the Justice and Mental Health Collaboration Program, BJA has distributed more than $80 million in grants to support mental health and substance abuse treatment initiatives across 49 states and the District of Columbia.   We look forward to continuing this support in the future.

Now one way to divert the mentally ill from incarceration to treatment is as I just described—through police officers’ recognizing when someone is mentally ill and referring that individual to treatment rather than arresting him.  But for those individuals who need to be arrested after committing a serious crime, there are several post-arrest diversion strategies to offer.  That brings us to our second place—the courtroom.  In some, the courts employ mental health workers who screen individuals after arrest, either in local jails or at  courthouses.  These mental health practitioners then advise the courts about the possible presence of mental illness and suggest options for assessment and treatment, which could  include diversion alternatives or treatment as a condition of probation.  Alternatively, some courts have developed collaborative relationships with the public mental health system, which provides staff to conduct assessments and facilitate links to community service providers.  A third approach is the establishment of a separate docket or court program specifically to address the needs of individuals with mental illness who come before the criminal court.  These special jurisdiction courts—mental health courts—limit punishment and instead focus on linking defendants to community-based treatment and other problem-solving strategies to help prevent those individuals from committing future crimes and being further involved in the criminal justice system.

Mental health courts, when done right, have proven results.  Take the Bronx Mental Health Court in New York City.  There, defendants are referred to the program, screened for eligibility, enter the court through a formal plea process, are matched with community-based treatment and then participate in court monitoring, case management and intensive mental health treatment services.  The length of treatment varies from six months for someone who commits a misdemeanor, to 18 to 24 months for someone who commits a felony.  A recent outside academic study of this court has found that participants are less like to be re-arrested than individuals with mental illness who proceed normally through the criminal justice system.  And they are significantly less likely to be arrested for a serious or violent crime than similar individuals who did not go through the mental health court.  It is incumbent upon all of us to support initiatives like these that successfully treat our mentally ill citizens and prevent future crimes by reducing recidivism.

We recognize, however, that even the best diversion and de-escalation programs won’t free our prisons and jails of inmates with mental illness.  That’s why the third place we’re focused on is the cellblock.  Our correctional facilities will always have some inmates who enter prison with a mental illness or develop one while incarcerated.  It’s our responsibility to give inmates the treatment and tools they need to successfully re-enter the community when they leave prison.   

The Bureau of Prisons has been reviewing and revising its standards for the treatment and care of inmates with mental illness.  While there is still more to be done, the project resulted in several important changes and laid the groundwork for additional revisions to come.  But providing the necessary treatment is going to require more resources.  Over the past several decades, in federal prisons, just like many state prisons, the number of inmates has grown at a far faster rate than the number of correctional staff, and this increase has put particular strain on our mental health specialists.  There is much we are trying to accomplish with limited resources, but as you all know, providing effective mental health treatment requires trained specialists.  We hope to continue working with Congress to obtain the funds we need to improve our mental health services, and we will continue to advocate for similar support for state and local efforts.   

But make no mistake: we have our work cut out for us.  I so admire your initiative and determination to do something about this shameful situation.  Collectively, we must do better – better on our street corners, better in our courtrooms and better in our cellblocks.  The mentally ill, and particularly inmates who are mentally ill, are not exactly a powerful constituency.  They don’t have a lot of juice.  But how we as a society treat our most vulnerable, the most powerless among us, this is what defines who we are.  Thank you for stepping up to meet that challenge.  And you have my commitment that the Department of Justice will be right beside you every step of the way.