Introduction
Issues associated with people suffering from mental illness poses significant challenge for policy making. This can be described by the factors that contribute to the challenge that the criminal justice system is facing in relation to incrimination of the mentally ill. Local and state criminal justice system does not have a reliable policy in dealing with cases that involves the mentally challenged. For example, Virginia’s criminal justice system lacks the resources and expertise in dealing with encountered mentally ill. In addition, the mental healthcare system does not have the resources and guiding policies in addressing similar issues (Virginia Department of Criminal Justice Services, 2008). The interrelation between policies for social change, criminal justice and the state of mental healthcare will be explored in the following sections of this study including the discussion on the relevance of how the policy and criminal justice system will foster and initiate change and social improvement. In addition, a public policy will be proposed to address the concerning issues of criminal justice and the challenge they face in encountering mentally ill considering the shortfalls in the mental healthcare system. The scarcity of community and state mental health system, facilities and policies results to criminal justice system becoming the last resort for obtaining mental health treatment, which assumes that early identification of mental health paired with adequate insurance policies is a potential mitigating approach.
Literature Review
Before providing the description or path that policy would take from conception to implementation, it is important to determine whether or not healthcare in general, which encompasses the mental health sector is constitutional or not. The US constitution does not explicitly address the people rights to healthcare (Swendiman, 2012) including cost, accessibility, coverage and quality and accountability. Swendiman (2012) points out that the underlying policies are not in consideration of healthcare status and care as a legal, moral or constitutional right. The World Health Organization specifically denotes the definition of health as the absence of physical and mental infirmities or disease. However, even the international organization did not provide a strong constitutional basis for adequate healthcare system that will address the problem related to the right of the people particularly for mental healthcare that greatly affects the outcome of criminal justice system decisions. Therefore, the lack of focus on policies was due to the inadequacies found in the constitution itself for not having a definite provision that mandates healthcare for the people.
Goldman and Grob (2006) conducted a study regarding the relationship of mental illness in mental health policy stipulating the importance of associating policy change to mental illness. Recent policies have focused on the broad spectrum of mental disorders within the nomenclature of diagnosis that hopes to integrate mental illness to mainstream health and social policies (Goldman and Grob, 2006). According to the study, there are about 5.4% of American adults with mental disorder that interferes with at least one area of social functioning (Goldman and Grob, 2006). This interference reflects as either a disturbance to the community or crime related in which the criminal justice system is left to deal with. Such problem occurs because of the lack of adequate healthcare support for mentally incapacitated. The study encompasses a conclusion that addressing the weakness of the policies concerning mental healthcare will significantly enable social change, which in return would also improve situation of the criminal justice system in dealing with mentally ill offenders (Capers, 2011).
On the other hand, the American Bar Association view the problem as an avenue for criminal justice system improvement (2008) in which sentencing disparities can be eliminated by supporting alternatives to incarceration. The growing consensus on US criminal justice policy evolves beyond the over-reliance on incarceration as the primary means for state punishment. However, significant number of sentenced offender’s claims to be suffering from mental illness, which was only established during the trial (American Bar Association, 2008). There is an existing dilemma encompassing the problem of non-detection of mental incapacitation before the commitment of the crime. If policies only exist to address the social problem of mental illness at the onset of its manifestation, the problem would have not escalated to crime level wherein the criminal justice sector is the one that will put the person to the appropriate institution.
Given the problem of identifying mental illness and establishing mental health insurance policies, the criminal justice system would be les burdened in dealing with cases related to crimes committed by the mentally ill. This is because early detection will prevent mental patients from harming themselves or others, which will result to decrease in occurrences of crimes involving he mentally ill. Early detection on the other hand, improves the social statute of the rest of the population, as implemented policies will enable actions to rectify the problems of mental illness in the social level. In this regard, policies will be proposed to address mental health detection and establishing mental health insurance to foster social change and stability. In addition, the criminal justice system will no longer be the primary agent that will institutionalize the mentally ill. Proposing such policies will entail proper conceptualization and implementation approach. The World Health Organization (2003) clearly stipulates that people with mental disorder have equal rights to receive quality treatment delivered by means or responsive care service. However, state policies and the constitution are not clear about the mental healthcare.
Policy Concept
The concept of mental healthcare can be integrated to the current primary healthcare, which is described as the system of essential care provided to individuals and families in the community. The essential is initially the basic health care requirement of the greater population based on their needs. It is rather decentralized and requires the active participation of the community and individuals benefiting from healthcare services. Providing mental healthcare on the other hand involves diagnosis and treatment wherein strategies are in place for prevention and application of behavioral and psychological science skills. However, healthcare services are delivered through a specifically designed health plan. Not all health plans have mental care integrated into it except for treatment of minor psychological problems such as anxiety and depression. In general, primary care plans do not have provisions that provides services to such needs, thus making it accessible would require additional cost on the part of the plan holder.
This is one of the prevailing problems that policies failed to address, if mental related care is optional in a basic care plan, early detection would be much difficult to attain. The first step in the integration process is to achieve collaboration between mental care providers, public and private mental institutions and healthcare plan companies. Once the collaboration between the aforementioned groups was achieved, public consultation will follow enquiring about the mental related problems that the community is experiencing with other people or with themselves. The next process is to determine the extent of impact that mental problem have on each individual’s social, family, work and community. Determining the impact of occurrences of mental health cases in certain areas is detrimental to determining the level of care that the people require, average time needed for treatment and cost of treatment. Once all necessary statistics were acquired, the next process is for legislative endorsement.
Rationale for Healthcare Integration
Integrating mental healthcare to primary healthcare through legislation constitutes several advantages.
- Reduced Stigma – Primary healthcare is not associated to specific health conditions, therefore creating policies the integrates mental healthcare to primary healthcare will reduce the stigma of seeking for mental care provider making it more accessible to families and seeking for standalone services would be less difficult.
- Improved Access – integrating multiple care service in primacy healthcare through a legislated policy enables access to services with co-morbid conditions. Mental health is likely to occur on pre-existing health conditions such as tuberculosis, diabetes, and cancer, HIV/AIDS among others. Substantial comorbidity is linked to mental conditions starting from anxiety to depression leading to more badly mental state. Treatment of comorbidity conditions should also incorporate treatment of mental illness that emerged in the presence of the pre-existing health condition. In addition, treating comorbidity conditions together with mental diagnosis will improve early detection and prevention of mental disorders.
- Improved chronicity and improved social integration – Early detection of mental health problems during treatment of a pre-existing health problem encompasses improvement of social integration. Policies regarding social improvement stipulate suitable living conditions that will foster healthy social environment. However, the existence of mentally ill within the social circle constitutes fear of mentally ill, discrimination and disruption of normal daily life. Having the mental problem detection at the onset of the symptoms will reduce chronicity and therefore allowing the person diagnosed with mental problem to integrate himself to the social public.
Implementation
It was mentioned earlier that the best way to deliver mental healthcare to enable detection is to integrate mental healthcare insurance to existing primary healthcare. After policies are enacted and implemented, the current primary healthcare providers will be subjected to include provisions to allow accommodation of mental related health issues to the basic healthcare packages (Boardman and Parsonage, 2007). The cost of implementing the policy can be taken shared by the healthcare plan holders and the rest of the cost is to be subsidized by the government. Since the criminal justice system is also taking part in the initiative for seeking alternatives to incarceration, the justice department could also share budgetary portions to keep the mental healthcare within the basic structure of primary healthcare. Integration would be more flexible than having a standalone healthcare system for mental illness.
Conclusion
The concept of policies towards the integration of mental healthcare in primary care is a step towards social change in which the people will have more options to take the matters in their own hands when it comes to dealing with the mentally ill. Leaving people to suffer mental illness due to the lack of sufficient healthcare system to provide their need for remedy causes several social problems including crimes committed by mentally challenged individuals. The criminal justice system acting as an instrument to put a person in an institution is an added responsibility, which could actually be mitigated through pro-active detection and prevention. Having policies that will make mental healthcare more accessible, early detection of mental illness would then be resolved by having a mental healthcare integrated to the current care system.
References
American Bar Association (2008). Criminal justice system improvements. American Bar Association. Retrieved from http://www.americanbar.org/content/dam/abaa/migrated/poladv/transition/2008dec_crimjustice.authcheckdam.pdf
Boardman, J., & Parsonage, M. (2007). Delivering the Government’s Mental Health Policies Services, staffing and costs. The Sainsbury Centre for Mental Health. Retrieved from http://www.centreformentalhealth.org.uk/pdfs/scmh_delivering_govt_mental_health_policy.pdf
Capers, M. (2011). Shared Decision-Making in Mental Health Care. U.S. Department of Health and Human Services. Retrieved from http://store.samhsa.gov/shin/content/SMA09-4371/SMA09-4371.pdf
Goldman, H. H., & Grob, G. N. (2006). Defining ‘Mental Illness’ In Mental Health Policy. Health Affairs, 25(3), 737-749. doi:10.1377/hlthaff.25.3.737
Swendiman , K. S. (2012). Health Care: Constitutional Rights and Legislative Powers. Congressional Research Service, 7(5700). Retrieved from http://www.fas.org/sgp/crs/misc/R40846.pdf
Virginia Department of Criminal Justice System (2008). Setting a Course for the Future of the Criminal Justice System in Virginia. Environmental Scan. Retrieved from http://www.dcjs.virginia.gov/research/documents/08environmentalscan.pdf
World Health Organization (2003). Mental health legislation & human rights. Mental Health Policy and Service Guidance Package. Retrieved from http://www.who.int/mental_health/resources/en/Legislation.pdf
