Remarks of Laurie Robinson, Assistant Attorney General
Office of Justice Programs
American Correctional Association
2010 Winter Conference
January 23, 2010
Thank you, Jim. It's really great to be here - and to be back with my many good friends at the ACA. It's good to see Betty Gondles. Betty is a long-time friend, as well as a leader in correctional health care over many, many years.
As Jim mentioned, I served as Assistant Attorney General for the Office of Justice Programs for seven years under President Clinton and Janet Reno, and I had - happily - many opportunities to meet with and speak to the ACA during that time. It was always affirming, because many of the issues you care about - in particular, promoting evidence-based approaches to dealing with offenders - are ones I care strongly about, as well.
I did not expect to return to OJP. I was leading a very nice life at the University of Pennsylvania - part of the Criminology Department there - involved in very fulfilling work to integrate research more fully into practice. But Eric Holder talked me into returning to OJP - as many of you know, he was the Deputy Attorney General under Janet Reno - and he can be an awfully persuasive guy.
The AG pointed out that there was important work to be done at the Department of Justice - including rebuilding relationships with our front-line partners - corrections leaders chief among them. So I'm very glad to be back and to be working with all of you.
I'm particularly pleased to be addressing this group - the Healthcare Professional Interest Section - because the issues of healthcare and mental health in our nation's corrections system bear so strongly on public safety and recidivism. These issues are important, not just for reasons of humaneness and decency, but also, of course, because the vast majority of inmates return to the community. If those inmates are carrying disease or infection, they will bring it back to their loved ones, neighbors, and others. So correctional health care really is equivalent to community health care - and we can never forget that. I think it's important that I make it clear to this audience: That this Administration and this Department of Justice are committed to improving the health care delivery system in our nation's prisons.
I know that, just as health care in the general population is a very complex issue, so is correctional health care. And in some cases, the issues with offender care are, of course, even more complex. Many elements, many constituencies are involved in addressing the issues - which range from implementing vaccination programs to cost-effective methods of prescription drug delivery. And I just want to applaud all of you for making an all-out effort to address these questions. I also want to tell you how impressed I am by your peer-review journal, Correctional Health Today. This is a great resource. And I really appreciate the way it frames the need for stronger links between treatment and security. This is so critical.
Let me also say that the journal not only reflects the priority that ACA places on the issue of offender health care, but it also underscores the support of ACA - and the broader correctional community - for science-based approaches - a theme that the Obama Administration and the Department of Justice firmly support and applaud.
I also want to emphasize that we understand that inmates are not a homogenous group. We're aware there are many special needs groups, like women offenders - who have suffered so much emotional damage - aging and older offenders, and juveniles. We recognize that they bring with them special health care needs, as well, and I'm pleased to see you're addressing these at your session.
Some of the issues you're tackling here are outside of OJP's domain - not to mention outside of my area of expertise - but many fall squarely within it. There are three critical areas that we in the Department of Justice are involved in and that I'd like to talk about - substance abuse treatment, treatment of mentally ill offenders, and sexual violence in prisons.
Let me start with substance abuse. I'm sure I don't have to tell this audience about the prevalence of drugs in the criminal justice system. I'll just underscore what you already know. Data from our Bureau of Justice Statistics tell us that more than half of all state inmates were abusing or dependent on drugs in the year before their admission to prison. By way of comparison, the last published National Survey on Drug Abuse and Health from the Substance Abuse and Mental Health Services Administration found that nine percent of the general population was classified with substance dependence or abuse in the past year.
There's no question that substance abuse and crime are strongly connected, and we're working to address this link on both the front and back ends. On the front end, we're supporting alternatives to incarceration - in particular, drug courts. As you know, drug courts use the monitoring power of the judicial system to provide treatment to drug-involved offenders. Both President Obama and the Attorney General are strong supporters of this approach, and studies have found it to be very effective, not only in reducing recidivism, but in saving taxpayer dollars.
My friend, Gil Kerlikowske - who, as you know, is the current drug czar - is a staunch advocate of drug courts. He knows from experience as a police chief that drug courts work and need to be expanded. And with states facing huge budget shortfalls and trying to figure out ways to contain corrections costs, this is a smart approach.
There are other models, too, that recognize the importance of treatment, but that it's also a scarce resource. I'm sure many of you are familiar with the HOPE program in Hawaii. HOPE is focused on probationers, and it relies on swift, certain, and proportionate sanctions for probation violators. If someone violates a term of his probation - say, by failing a drug test - he goes to jail within 48 hours. The first time, the sentence is short - a weekend or maybe a week - but it lengthens for each successive sentence. It also uses a triage approach. Sanctions alone work in keeping some offenders off drugs, and HOPE accounts for that. But offenders who can't stay off drugs and who keep coming back will get referred to intensive treatment. Our National Institute of Justice-funded evaluation of HOPE shows that it has been very effective in reducing positive drug tests. There also have been far fewer probation revocations and fewer arrests for new crimes.
I mention drug courts and HOPE because I think it's important that we keep these models in front of us. They can - and should - be part of the solution to some of the problems we're facing in institutional corrections.
Of more direct relevance to you is our Residential Substance Abuse Treatment - or RSAT - program, which I know you're undoubtedly familiar with. RSAT provides intensive drug treatment in prison, and it has been effective in treating the substance abuse disorders of offenders and preparing offenders for reentry. Follow-up studies on RSAT programs have shown that graduates have lower relapse and lower recidivism rates.
I'm pleased that this year, we were able to triple our funding of RSAT from last year, to $30 million. And our RSAT for State Prisoners Program solicitation is now out, with a deadline for applications of February 11th. The solicitation and more details are on OJP's Web site.
From the RSAT evaluations, we've found that programs are most effective when they're used both inside the walls and outside in the community. Community matters. We also know they're most effective when they address other, non-substance abuse issues - like mental health disorders. I know that offenders with mental illness are a major concern of yours, and we recognize the challenges you're facing in this area.
We know that people with mental illness are over-represented in jails and prisons. A recent report from the Council of State Governments and Policy Research Associates suggests that almost 17 percent of jail inmates have a serious mental illness. That's three to six times higher than the general population, and it means that as many as two million bookings of people with serious mental illness may occur every year. We've been hearing for more than a decade that prisons and jails have, practically speaking, become a core element in the mental health system.
As in the case of substance abuse, we're working to address this on the front end, by training law enforcement to work more closely with mental health providers during encounters with the mentally ill - and also through mental health courts, which apply the same problem-solving principles as drug courts. We fund some of these through our Justice and Mental Health Collaboration Program in our Bureau of Justice Assistance, and we'll have $12 million for mental health courts this fiscal year.
But we know the fact remains that until these approaches are taken to scale, people with mental illness will continue to come into the correctional system in large numbers. And we need to be prepared to deal with them. Part of this is adopting the philosophy that reentry back into the community begins the moment an offender enters the system. This, I think, applies doubly for those with mental illness.
Life behind bars can, of course, take a disproportionate psychological and emotional toll on a person with mental illness. And there are other concerns, too. For example, we know that benefit programs may be suspended or terminated - and this can be very difficult, especially for mentally ill individuals who are often poor and rely on these programs for medication and treatment. When they come out of the system, they have to reapply for those benefits, and that can take weeks or months. In some cases, they aren't reinstated at all.
For this reason, we know that partnerships are so important. Corrections officials can link mentally ill inmates with appropriate treatment services while in jail or prison, and they can begin looking ahead the moment the offender arrives to start planning for what will happen once they're released. This means reaching out to treatment services, to housing agencies, even to Social Security offices.
There are so many other issues related to mental illness in the justice system. There's the high rate of women offenders suffering from serious mental illness - more than twice the percentage of male offenders, according to the Council of State Governments study I mentioned earlier.
There's also the issue of juvenile offenders with mental illness. The National Center for Mental Health and Juvenile Justice found that 70 percent of youth in the juvenile justice system suffer from mental health disorders. That's staggering. And there are unique challenges to this group that demand increased attention to partnerships - with schools and foster care, for example. Many of our Justice and Mental Health grants over the last three years have gone to support efforts to address juveniles with mental illness.
Finally, there's the cost. We all know state budgets are shrinking, and the amount that states are spending on mental health treatment is going down. Add to that the fact that some studies show that offenders with serious mental illnesses are incarcerated longer than other inmates, and that the daily cost of their incarceration can be significantly higher than the general inmate population. And of course, there are the costs associated with repeated responses to individuals whose mental illnesses continue to go untreated.
Speaking of state budgets, BJA is working with the Council of State Governments on an initiative called Justice Reinvestment. Some of you, I know, are already involved in leading this effort in your own state. Basically, Justice Reinvestment is designed to help states use a data-analysis approach to figure out how to lower corrections costs and reinvest those savings without sacrificing public safety. While state spending on mental health treatment has gone down, spending on corrections has gone up faster than just about any other budget item. But that's no longer sustainable.
This effort has gotten a great deal of bipartisan support from Members of Congress, and on Wednesday, I'll be speaking at a National Summit on Justice Reinvestment. We'll be talking about approaches that are working in some of the states - for example, in Texas, which redirected millions of dollars from additional prison space to substance abuse, mental health, and intermediate sanctions programs - to great success.
This is one of those smart-on-crime approaches that we've heard the Attorney General talk so much about, and it goes hand-in-hand with an overall emphasis by Eric Holder on promoting evidence-based approaches. This is a top priority of mine, as you probably know, at OJP.
We have an agency-wide effort that's well under way that I launched last spring called the Evidence Integration Initiative, or E2I. What we're doing is assessing the state of our understanding about what works in reducing and preventing crime, and figuring out ways to use that information to help states and communities fight crime more effectively. As a major part of that initiative, we'll be creating a Crime Solutions Resource Center to share distilled information about promising practices and a diagnostic center - or "help desk" - to provide jurisdictions with training, technical assistance, and other assistance as they try to apply these approaches.
I assume - and hope - that this initiative can help meet needs in the field. ACA has been a leader in integrating data- and evidence-based approaches in corrections - in many ways, you're the model - and I look forward to sharing more about this effort with you as we move ahead.
I now want to turn to a subject on all of our minds - the Prison Rape Elimination Act (PREA). The subject of sexual assault in correctional facilities has gotten a lot of attention lately. The recent report from the Bureau of Justice Statistics found that 12 percent of adjudicated youth in state-operated and large local and private juvenile facilities have been sexually victimized. We'd all agree that sexual assault - whether it involves juveniles or adults - is a very serious problem that we need to aggressively address.
But I know you also have some practical concerns about some of the recommendations in the PREA Commission Report. The Attorney General addressed this yesterday in his remarks to the National Sheriffs' Association, and I just want to underscore what he said. He understands the challenges that corrections officials are facing, and he wants to work with you to figure out how we can address this problem, together.
He is personally overseeing the Department's review of the PREA Commission's recommendations, and he is seeking input from all interested stakeholders. We're holding listening sessions as part of the Department's PREA Working Group. And there will be opportunities for formal written comment on the proposed regulations. I also invite you to share your feedback with us informally. My counsel, Marlene Beckman, is here. Seek her out and get her e-mail address and send your comments to her. We'll make sure the Department Working Group sees them.
I also want to let you know that I recently made three appointments to the PREA Review Panel. As you know, the purpose of this panel is to take a look at facilities with a low and high incidence of sexual assault. Information from those hearings is used to aid BJS in identifying common characteristics of victims, perpetrators, and facilities.
I've appointed Reggie Wilkinson, who, of course, is very familiar to all of you as a long-time director of Ohio's corrections system and past President of ACA. I've also appointed Sharon English, a victim advocate and former Deputy Director for the California Youth Authority. I've also re-appointed Gwen Chun, who is also a past President of ACA and now heads the Juvenile Justice Institute at North Carolina Central University. I felt it important to mention this here because I want you to be assured that all three members of the panel have a background in corrections, and they understand what you're struggling with.
PREA is a good example of the many difficult challenges the corrections community is now facing. But it's also an example of how the Department wants to work with you to meet those challenges.
The health and mental health of the inmates in your charge is an issue that merits our closest collaboration, both because it's the humane thing to do, and because it has such a strong impact on community safety generally. I commend you for all that you are doing to strengthen systems of healthcare delivery in our nation's prisons. I'm confident that, by continuing to work together, we can find ways to ensure comprehensive care for offenders and better public safety outcomes for all of America.
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