Vera’s Substance Use and Mental Health Program (SUMH) conducts applied research to help public officials and community organizations develop empirically driven responses to the substance use and mental health needs of people involved in justice systems. SUMH staff collect and analyze quantitative and qualitative data to examine the interaction between public health and justice systems and evaluate existing programs to understand the experiences of those affected by psychiatric disorders or substance use and policies that prolong their involvement in the justice system.
The program’s work includes:
Examining the public health implications of mass incarceration
The millions of people cycling through our nation’s courts, jails, and prisons every year experience far higher rates of chronic health problems, substance use, and mental illness than the general population. Mass incarceration impacts individual and community level health outcomes and has played a role as a driver of larger scale health inequalities. SUMH programs raise awareness of this link to devise and share solutions that improve health outcomes and increase the use of alternatives to incarceration.
Measuring the impact of drug policy
States are increasingly reconsidering ways to respond to nonviolent drug offenses, and policymakers have a pressing need for empirical evidence that can help inform their decisions. SUMH conducts research on the impact of drug policy, such as the use of treatment-based alternatives to incarceration in lieu of lengthy prison sentences.
Improving services for people with behavioral health needs
Many people leaving jail Many people in the criminal justice system face a range of problems, from accessing mental health treatment to securing a place to live. Evidence shows that access to appropriate services can improve individual health outcomes and reduce the likelihood of future arrests. SUMH is working with correctional facilities, public defenders, city government agencies, and innovative public-private partnerships to design more accessible and effective legal representation, health, and reentry services.
Using information-sharing between public health and justice systems to improve service provision
Many people in contact with the criminal justice system have mental health and substance use problems. Yet health and justice systems rarely share information with each other to improve awareness of clients’ needs or to enhance the services they provide. In order to address these gaps, SUMH hosts an online knowledge bank to foster information sharing between justice and health agencies and conducts projects that integrate data from mental health, substance use, and criminal justice agencies in order to help jurisdictions better identify and serve people with behavioral health problems.
Leveraging health care reform to improve outcomes for people in the justice system
SUMH is informing agencies and jurisdictions how to utilize Health Information Technology and implementation of the Affordable Care Act as intersectoral solutions. By creating models for increasing Medicaid enrollment for people involved in the justice system, SUMH works with jurisdictions around the country at various stages of ACA adoption to take advantage of potential new opportunities created by national health reform to improve community health.
Why this Work Matters
There are three times as many people with serious mental illness in jails and prisons than in hospitals, and about two-thirds of people in prison report regular drug use. However, justice systems around the country are ill equipped to provide behavioral health services, and individuals often fail to get the help they need. This has serious implications for people involved in the justice system, their families, and the communities in which they live. SUMH research helps jurisdictions design policies that increase access to treatment, reduce reliance on the criminal justice system as a response to these problems, and improve public safety.
For more information, contact Research Director and Vice President Jim Parsons.
The Substance Use and Mental Health Program (SUMH) studied the impact of 2009 reforms to New York State's Rockefeller Drug Laws that eliminated mandatory minimum sentences for people convicted of a range of felony drug charges and expanded eligibility for diversion to treatment. Researchers compared cases pre and post reform to assess changes in the use of jail and prison, rates of diversion to treatment, racial disparities in sentencing, recidivism, and cost.
Preventing suicide and other forms of serious self-harm is a major challenge facing correctional systems across the country. Suicides account for about one-third of all deaths occurring in U.S. jails each year—more than any other cause. Correctional systems often respond to suicidal behaviors with reactive measures that may address individual behavior but fail to consider the full range of systemic factors at play. However, instances of suicide and self-harm in jails are “sentinel events”, indicating a breakdown in the systems responsible for ensuring inmates’ safety.
Bridging the Justice-Health Divide, an expansion of the DC Forensic Health Project, uses data from several Washington, DC agencies to provide government and community-based organizations with the information they need to gauge rates of mental health problems among the people arrested and improve the effectiveness and reach of mental health services.
In 2012, the City of New York launched the nation’s first social impact bond—an innovative form of pay-for-success contracting that leverages private funding to finance public services—to fund the Adolescent Behavioral Learning Experience (ABLE) program, a large-scale initiative serving 16- to 18- year old youth detained in New York City’s Rikers Island jail.
For people with complex health conditions in need of timely access to medical services, the time between arrest, arraignment, and admission to jail is particularly dangerous and represents a missed opportunity to connect this population with much needed services and support. The Vera Institute of Justice is working with the New York City Department of Health and Mental Hygiene (DOHMH) to ensure that people who are arrested in the city have timely access to the health care that they need.
Vera’s Substance Use and Mental Health Program launched the Justice and Health Connect (JH Connect) initiative in 2011 with support from the Bureau of Justice Assistance. JH Connect aims to increase agencies’ capacities to share data across behavioral health and justice systems in confidential, legal, and ethical ways to better serve people with behavioral health needs who come into contact with justice systems.
Our work in New York City spans across Vera’s centers and programs. What these projects have in common is close collaboration with our partners, data and evidence-driven approaches, and recommendations that seek to improve the systems that New Yorkers rely on for public safety, justice, and human services. Although these projects take place in the unique context of New York City, they all bear important implications and lessons for jurisdictions across the country.
Vera’s Substance Use and Mental Health Program launched a project to study the role of indigent defense, commonly known as public defense, for defendants with mental health disorders (MHD) in January 2013. With support from the National Institute of Justice, this work aims to 1) enhance understanding of the challenges faced by indigent defenders and their clients with MHD; 2) improve outcomes for defendants with MHD; and 3) inform the development of guidelines and training materials for defense attorneys that address common challenges to providing indigent defense for people with MHD.