Introduction: Involvement with the Mental Health System
Law enforcement officers, prosecutors, defenders, and
judges - people on the front lines every day - believe too many people with
mental illness become involved in the criminal justice system because the
mental health system has somehow failed. They believe that if many of the
people with mental illness received the services they needed, they would not
end up under arrest, in jail, or facing charges in court. Mental health
advocates, service providers, and administrators do not necessarily disagree.
Like their counterparts in the criminal justice system, they believe that the
ideal mechanism to prevent people with mental illness from entering the
criminal justice system is the mental health system itself - if
it can be counted on to function effectively. They also know that in most
places the current system is overwhelmed and performing this preventive
function poorly.
Policy Statement 1 and the recommendations that follow
describe the role that the mental health system should play in helping people with mental illness avoid
inappropriate contact with the criminal justice system. For the most part, they
reflect general principles and do not delve into areas of detail similar to
those found elsewhere in the report.
Readers may know whether the services described in this section are
available in their communities; if large numbers of people with mental illness
are in contact with the criminal justice system, it is likely that necessary
services are lacking.
Chapter VII contains a comprehensive examination of the elements
of an effective mental health system, upon which implementation of many of the
policy statements throughout the report depend.
1. Involvement with the Mental Health System
There are communities across the country where appropriate
and necessary mental health services were never developed, have closed down, or
for some other reason are not available. In large cities, the wait for an
appointment with a mental health professional may be measured in months, while
in small rural communities the responsible agency may be based in a town many
miles across the county. In either case, it cannot be said that mental health
services are available when or where they are most needed.
To be effective, services must meet the immediate needs of
those who seek them. They must be comprehensive, meaning they must be prepared
to address the full range of issues presented by an individual with mental
illness. They must also be flexible enough to be tailored to each person who
enters the system. In highlighting the
need for improved access to mental health services, advocates, providers, and
others in the mental health field frequently use these two phrases. On first
glance, these terms may appear to be contradictory, but the two concepts can be
entirely complementary. A "no wrong door" policy addresses
the critical need to engage people in care while a "single point of
entry" is a mechanism for integrating services in response to an
individual's complex needs. (See sidebars below for more on the concepts)
No wrong door refers to a service system that welcomes people in need wherever they try to gain access. Persons with mental illness
often have a broad array of associated health, social service, and support
needs. Not knowing the mission of an
agency or the relationship between agencies, they may present different
providers with any one of a number of concerns. "No wrong door" policies commit all service agencies to
respond to the individual's stated and assessed needs through either direct
service or linkage to appropriate programs, as opposed to sending the person
from one agency to another until he is able to establish a connection with the
system. Many people with mental illness lack the capacity to navigate the
complicated array of services or they may feel rejected in their efforts to
obtain help. Discouraged, they simply drop out of the system and join the ranks
of untreated, homeless people with mental illness who come into frequent
contact with the criminal justice system. A no wrong door policy accepts that
the first step toward successful mental health care is engaging the individual.
A
single point of
entry is a mechanism for ensuring an individual gets the appropriate range
of services. The "single point of
entry" system accepts the burden of integrating services rather then
placing that burden on the individual.
It places responsibility with a designated agency to oversee each client's
movements through the different services and programs available in a given
community. The care that person needs can then be coordinated, even when more
than one agency is involved in providing it.
An individual with multiple needs who seeks care in a community with a
"no wrong door" policy may be referred to a "single point of
entry."
