The Mental Health Justice Act of 2021 would provide state and local government funding to train and deploy mental health professionals in day-to-day response to emergencies that involve persons with mental health needs and inadvertently support the FCC's initiative to nationalize "988" as the 3 digit telephone number for citizens to speak with mental health and suicide prevention specialists. The FCC is currently working with phone service providers to transition "988" calls to the existing National Suicide Prevention Lifeline by July 16, 2022 (988 fact sheet).
In 2019 it was estimated that approximately 20 percent of all American adults suffer from mental illness. According to the Center for Disease Control, more than 47,500 people die by suicide as a result of mental illness, and more than 1 million attempt suicide on an annual basis.
Mental health considerations for incarcerated Americans
It has been long established that America's detention facilities are some of the country's largest mental health facilities. Persons with mental illness often have concurrent conditions that exponentially increase the likelihood that they will interact with law enforcement officers, such as substance abuse and homelessness. To this end, the National Alliance on Mental Illness (NAMI) estimates that approximately 2 million adults with mental health conditions are booked into jails annually.
According to NAMI, about 66 percent of all incarcerated women have a history of mental illness, and up to 70 percent of incarcerated youth report having a "diagnosable mental health condition." Overall, it is reported that around 64 percent of all inmates have mental health concerns.
Not only do these types of incarcerations represent the potential for a miscarriage of justice for those who need treatment (in 2021, the U.S. carried out 11 executions, the majority of which were reported to have been inmates with mental illnesses − a topic too expansive to cover here), but high detention rates can also represent major costs for U.S. taxpayers.
While few would argue that the financial burden of housing persons with mental illness should be the catalyst or primary consideration for policy development, it is worth highlighting these costs to appreciate why it is so important lawmakers reconsider how mental health is viewed in this country.
According to a report by NAMI in March of 2021, the cost of housing federal inmates in 2018 was approximately $102.60 per day for adults, a slight increase from 2017 data which put the cost at $94.82 per day, and $588 per day for juveniles − yes, nearly $600 per day (or $214,620 per year).
Using the lowest estimate of $94.82 per day from 2017, for 2 million adults, we're talking about tens of billions of dollars per year, or just under 70 billion dollars − the GDP of Wyoming and Vermont combined − without accounting for the costs for housing juveniles.
The average costs associated with psychiatric treatment? − between $3,616 to $8,509 (according to the same report).
The evidence begins to become overwhelming when the costs are compounded with the impact that untreated mental illness has on families, communities, and the individuals themselves. In 2020, it was estimated that persons with mental illness made up 1 out of 4 deaths caused by law enforcement officers − events that were not only traumatic for the families of the victims and likely the law enforcement officers themselves but also, and most importantly, potentially avoidable losses of life that may have been prevented with community-based care and stable housing.
The Mental Health Justice Act of 2021 (H.R. 1368)
Referred to the Subcommittee on Crime, Terrorism, and Homeland security last spring, if passed in its current draft, the Mental Health Justice Act of 2021 would include provisions that may begin to address gaps in service for persons with mental illness.
Specifically, H.R. 1368 would:
- Provide funding for state and local government to "hire, train, and dispatch mental health professionals to respond in lieu of law enforcement officers in emergencies" where a person is considered to be suffering from a mental health crisis or is suspected of having a mental illness or an intellectual or developmental disability, or is identified as under the influence of drugs
- Provide for training for mental health professionals in the principles of deescalation
- Require mental health professionals provide persons identified as suffering from substance abuse or mental illness with voluntary community-based services, and
- Provide for training of staff in dispatch centers in the techniques of de-escalation
The Act would also reward entities who can demonstrate a reduction in "the incarceration and death of persons with mental illness or an intellectual or developmental disability" or "a notable reduction in the use of force by police and a notable increase in referrals of persons with a mental illness or intellectual disability to community-based, voluntary support services."
Resistance to the bill
While it is difficult to anticipate the type of resistance the bill may face (or has faced), one perspective that comes to mind would be from advocates in the community concerned about who makes the determination that a person is suffering from a mental illness, rather than, for example, having difficulty effectively communicating with first responders, and the type of training they have completed to make that determination.
Nearly every state in the nation has some variation of a civil commitment law, which requires the involuntary institutionalization of persons that are identified as a threat to themselves or others. Institutionalization can range from 24 hours to 72 hours in most cases.
In Florida, for example, persons suffering from mental illness may be involuntarily committed under the state's Baker Act if the following criteria are met:
- There is reason to believe that the person is mentally ill
- A person suspected of having a mental illness has refused voluntary examination, or
- "Without care or treatment, the person is likely to suffer from neglect resulting in real and present threat of substantial harm that can't be avoided through the help of others [...]"
In general, whether someone meets the aforementioned criteria is typically determined by a circuit court, a law enforcement officer, or a physician, clinical psychologist, psychiatric nurse, or clinical social worker.
Pushback to the bill may exist if opponents are not sufficiently convinced that the training provided to mental health professionals (as defined in the act) tasked with responding to emergencies involving mental illness does not provide for the appropriate protections for affected persons. In Florida, the Baker Act can significantly impact the life of the person committed with unwanted medical, police, and even court records, whether the commitment was justified or not, with no procedure for removal or expungement of the record.
Granted, the bill does not appear to call for mental health professionals to act in this capacity − but understanding those concerns and how they may impact the community is important.
Looking at the language again (in reference to how entities are rewarded for adherence to the bill's intent):
"a notable reduction in the use of force by police and a notable increase in referrals of persons with a mental illness or intellectual disability to community-based, voluntary support services."
It's fairly easy to see how that language can be interpreted from several perspectives: Will services be rendered by properly qualified professionals? Who determines they are qualified? Are reported numbers real? Is there a potential for persons with disabilities to be improperly profiled?
We took another look at the bill during revisions of this article and found that the sponsors also had those concerns. In language that provides directions for reporting, and why various criteria should be met, section(e)(1)(a)(iii)(II) states that − in regards to the purposes for reporting specific data was to − "to ensure that mental health practitioners are not simply funneling individuals into other institutionalized settings."
It's great to see the sponsors are aware, but I can't help but imagine that a stronger relationship with the disability community would strengthen the language and improve future implementations of the program overall.
The bill may have also met resistance due to the vagueness of how the program will be managed, and what that care looks like from start to finish. So we're referring to voluntary programming - are there enough voluntary programs? Details, resources, implementation. Is the program intended to be similar to what Chicago began doing this summer or is it step 1 of something like the Miami Model? Is it tactical or has there been research that suggests this leads to something more comprehensive?
Still, with so much at stake for the millions of people impacted by the lack of sufficient mental health services, one has to believe that solutions can be identified.
Whether or not the bill has stalled due to divisions among mental health professionals or a lack of support among lawmakers, it hasn't moved since April − so we're on hold, for what? − who knows. Nevertheless, given the impact that COVID-19 has had on mental health, expect more conversations and proposals by lawmakers to come.
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