The opportunities for identifying or establishing the resources that would provide the range of options discussed here are much greater in urban and suburban areas than they are in rural areas. In fact, in many rural areas there may be no options at all. The chief problem that rural areas encounter as it relates to viable options for those with mental illness who are in the criminal justice system is the lack of mental health professionals. For example, more than half of the 3,075 counties in the United States - all of them rural - have no practicing psychiatrists, psychologists, or psychiatric social workers. ^[1]  

The mobile units that law enforcement and mental health officials have teamed up in recent years to institute in many urban jurisdictions may hold clues for developing a model for options that can be used by courts to develop release alternatives in rural jurisdictions.  These units are designed to respond rapidly to a person in a mental health crisis so that an arrest is avoided and the person is taken to an appropriate mental health facility.  In rural areas, such mobile units may provide the courts with alternatives by bringing mental health treatment resources to those who need it. It may also be useful to make greater use of telemedicine, in which mental health professionals are available to conduct private telephone consultations with mental health patients from a remote location.

Availability of Mental Health Treatment as an Option to Courts in Rural Areas

The federal government has been attempting to address the shortage of health care workers in rural areas since 1987, when the National Advisory Committee on Rural Health (NACRH) was established within the Department of Health and Human Services (HHS) to seek solutions to health care problems in rural areas. The committee has made several recommendations, such as: increase the awareness of health care opportunities in rural areas and ensure that students are academically prepared to take advantage of these opportunities; and create incentives for health care practitioners to practice there. Such incentives include financial support for students who will commit to service in rural areas, enhancement of Medicare reimbursements for rural providers, and granting tax credits to providers who serve rural areas. Many of these recommendations have been followed and have brought some relief to the health care shortages in rural areas. ^[2]  

The U.S. Department of Justice, currently through its Bureau of Justice Assistance, also provides block grant funding to the states. In the past, block grant funds could be used for a number of different purposes, including to address alternatives to detention for those who pose no danger to the community. ^[3]  

HHS has sought to address the mental health needs of rural residents through the Mental Health Block Grant program, which provides funding to states to improve access to mental health services. ^[4]   More than $350 million is allocated to this program annually. In order to receive their block grant funds, states must submit plans to address the mental health needs of various state ubpopulations, including those who live in rural areas. ^[5]  

State and local officials should work together to ensure a coordinated use of block grant funds from the Departments of Justice and HHS to address the mental health treatment needs of people who have been charged with criminal offenses in rural areas.