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Getting Out of Jail

Terry McLeod

Not for profit Community Mental Health Centers (CMHCs) must become entrepreneurs in order to make it through the bumps in the financial road most have experienced lately.

jail cellAdopting a CMHC entrepreneurial mind set is to provide the public with more, better and different services…more help available is good for everybody. As an exercise, let's turn an entrepreneurial effort into a new, profitable, ongoing business - even if it's non-profit. It's a fun exercise, and every management team I've been involved in does this.

I ran across a couple problems today that need attention, and finding a problem to address is important to our project.

  • Annual suicides (33,000) almost double the number of annual homicides (18,000)
  • People with mental illness are three times more likely to be in the criminal justice system than hospitals

Thomas Insel, Director of the National Institute of Mental Health advises these are little known facts requiring attention.

Prevention comes to mind for suicide, and that's been done and is being done. It's a requirement for agencies to ask about suicidal thoughts, plans, etc; most agencies have an assessment either in the Electronic Medical Record or on paper that's completed as required. Anybody who's even thinking about suicide immediately catches a mental health practitioner's attention.

What can be done about the sorry state of America's population with mental illness in jail? Perhaps prevention is again the answer.

My mind jumps: "OK, how can we treat these folks efficiently and effectively, showing outcomes that give us a true picture of whether we are really providing value to the public and helping an individual recover?" That's well and good, but a bit premature. I don't even have a consumer for this new, profitable, ongoing business.

Marketing is the first step leading to our inevitable success. CMHCs who will survive are improving marketing now, but non-consumers are slipping through the cracks, living in their illness, and winding up in jail. How do we reach these folks when they seem to see is crime as a solution to all their problems?

A number of programs are in play today to reach mentally ill prisoners. Common sense tells me that since a high percentage of people needing treatment are in jail today, and most prisoners have been in jail before with a high likelihood of coming back to jail, the problem may be a distancing from treatment after folks are released and rejoin us.

Crime is exciting. Life can be a drag. Problems come up, and treatment tools go out the window, and Poof! Crime is the answer!

Here are ways to reach the person at that point that a provider should be able to get paid for:

  • Peer interventions: NY Medicaid, for one, pays for peer services…build an army of peer advocates. AA says that there's no treatment like one alcoholic talking to another. Perhaps this approach will be effective with disorders other than addictions.
  • Outreach: Assign professional staff or peer advocates to go to jail, talk with people who will be released soon and set up an appointment the day of release.
  • Hold hands. Release is the critical point, so be there. Meet the family; invest a few minutes confirming your prospect will come to the appointment.
  • Where do prisoners go after they rejoin us? Find out. Talk with them face-to-face, it's better than the phone. Discover that spark of willingness. Your ratio of success may only be one in a hundred, but don't worry about that. Most jails are overcrowded, so you'll have plenty of prospects for this new business we just built.