Dr. Morgan T. Sammons, the National Register's Executive Officer, attended a presentation on decarceration, given by Dr. Ron Manderscheid, the Executive Director of the National Association of County Behavioral Health and Development Disability Directors (NACBHDD). In response to this presentation, Dr. Sammons provided the following comments.

"In his highly illuminating presentation, Dr. Manderscheid draws particular attention to the high rate of incarceration among persons with mental illness.  As he correctly noted, if our intervention strategies are aimed at providing treatment alone, we will do little to address the drivers of many aspects of chronic mental illness, substance abuse, and recidivism.  We must adopt more comprehensive, community based interventional strategies, to be sure.  But at the same time, if we do not address the roots of these problems by providing appropriate housing, transitional living, and family and community support we will have done little to lighten the burden of chronic mental illness on individuals, families, care systems, and communities."

Dr. Manderscheid's presentation highlighted a significant amount of background information on this subject. For approximately 750,000 persons in county and city jails, around 25% have a mental illness, 50% have a substance use disorder, and there is "major co-morbity between the two groups." One example Dr. Manderscheid cites in terms of an effort to adopt more comprehensive, community based interventional strategies is the NACBHDD Decarceration Initiative. This initiative explores "how support may be offered to reduce the high percentage of those individuals with mental illness and addiction within the jail system" with the goal being to "increase the capacity of county behavioral healthcare systems to intercept people before they fall into the jails and to provide continuous care."

Behavioral health services need to be readily available to all individuals in a community. Dr. Manderscheid's presentation recommends that focus be made on community crisis response systems, care coordination and case management, building key partnerships, and making sure there is necessary information technology available to facilitate these efforts. Accomplishing these goals requires funding, especially for three items: extended Medicaid payments, development and extension of behavioral health crisis response systems, and coordinating care between county behavioral health and county jails.

Another example of efforts to reduce the number of people with mental illnesses in jail is the Stepping Up Initiative. StepUpTogether.org has a video that illustrates the Stepping Up Initiative.