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High-priority needs identified by the workshop on managing the seriously mentally ill in corrections

• Society needs to prioritize mental illness and dedicate sustainable treatment resources accordingly. The justice system should advocate for better access to treatment in the community.
• Individuals with SMI need comprehensive, coordinated supportive services (e.g., housing, employment) as well as interventions targeting criminogenic needs (e.g., substance use disorders, antisocial thinking) pre- and post-justice involvement.
• Greater emphasis is needed on prevention, early detection, and intervention, particularly for children.
• Law enforcement agencies need training for better response to incidents involving individuals with SMI and for alternatives to jail.
• The courts need guidance on effective diversion strategies.
• For those who must be incarcerated, institutions should be resourced so that they can effectively treat and manage the population (e.g., meet both mental health and criminogenic needs); effective alternatives to administrative segregation are required.
• Coordinated discharge planning is needed to ensure continuity of care between agencies and providers. Inmates should leave with "warm hand-offs," referrals, an ample supply of medication, and uninterrupted benefits.
• Barriers to collaboration and information-sharing among entities with a "need to know" must be removed.
• The divide between the criminal justice system and the mental health system (e.g., treatment focus, approaches, duplication of efforts) needs to be bridged to provide better care to individuals with SMI.
• Cost-benefit analyses are required to support the redistribution of funding to the most effective intervention points (e.g., pre-justice involvement, diversion, and reentry).

A disproportionate number of individuals with serious mental illness (SMI) become involved in the criminal justice system and ultimately fall under some form of correctional control. Although some jurisdictions are making great strides with respect to how the criminal justice system deals with individuals with SMI, significant challenges and opportunities for improved outcomes remain. In light of the ongoing challenges the corrections sector faces in managing individuals with SMI, RAND researchers convened an expert workshop to better understand the challenges and identify the high-priority needs associated with how these individuals become justice-involved and how to achieve better outcomes before and after these individuals come under correctional control.

The majority of needs identified in this report are not new. Indeed, several issues closely mirror previous recommendations made by national advocacy groups and correctional health care organizations. This would seem to imply that the practitioners who work with this population essentially understand what is required to improve outcomes. Like many other issues, the gap appears to be a matter of prioritization and insufficient resources. That said, the needs identified in this report represent a strong and diverse agenda that can serve as a foundation for transformational change, given the social and political will to pursue this direction.

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