September 17, 2018 | | SAMHSA's GAINS Center In April 2018, SAMHSA’s GAINS Center convened a Best Practices Implementation Academy for local behavioral health, law enforcement, and criminal justice teams focused on reducing justice involvement among people with mental and substance use disorders. One plenary of the conference focused on considering racial and ethnic disparities in local strategic planning efforts. James Bell, founder and president of the W. Haywood Burns Institute, addressed the urgent need to use a systems-wide equity lens to reduce the racial and ethnic disparities in the criminal justice system. Research shows that racial and ethnic minorities are disproportionately overrepresented in the criminal justice system. Similarly, racial and ethnic minority individuals with mental illnesses and substance use disorders are more likely to be channeled into the criminal justice system versus treatment programming, when compared to their white counterparts. To address this critical issue, Bell presented three concepts: the social determinants of law violations, the impact of structural racism on criminal justice involvement, and the need for radical imagination. Social Determinants of Law Violations. Social, economic, and environmental conditions—where individuals live, work, and play—significantly impact an individual’s health and health care, including access to mental and substance use disorder treatment services. Public health professionals refer to these conditions as the social determinants of health. Similarly, Bell suggested looking at social determinants of law violations, or the social, economic, and environmental conditions related to an individual’s involvement in the criminal justice system. For example, young people who live in communities lacking resources for positive social opportunities; productive civic engagement; adult supervision and monitoring; job training to support future gainful living; employment with a livable wage; and stable housing may be at high risk of involvement with the criminal or juvenile justice system. As communities strategically plan for reducing the number of individuals with mental illnesses and co-occurring substance use disorders in their jails, it is important to recognize that racial inequities are not a “diagnosis” and “screening” problem. Stakeholders should also take steps to address the social determinants of law violations. This should be coupled with consideration of how biases may enter into decision-making about who gets arrested, what pretrial bail is imposed, and what attributes about an individual are factored into sentencing. The Impact of Structural Racism. Bell also used health data to explore the concept of structural racism and its impact on outcomes. One example he pointed to is Kansas, where the lifespan of residents differs significantly between neighborhoods. In one neighborhood, the average lifespan is 69 years; three miles away, the average lifespan is 83 years. Upon examination, it becomes clear that these areas, though close in proximity, are also sharply different in terms of race and ethnicity, with the areas of shorter lifespans representing communities of color. Structural racism can also be seen when looking at where people have traditionally been allowed to live. Bell provided examples of this, including the Rock Ridge neighborhood outside of San Francisco. Years ago, covenants for this neighborhood prohibited individuals who were Black or Asian from buying or leasing property there. These rules were enforced by the criminal justice sector, leaving those who were not permitted to live in the area at risk for questioning by police just for being present in that neighborhood. “It is the justice sector that is used for enforcement of the structural mandates that have been deliberately discriminatory and can often comprise the social determinants of law violation,” explained Bell. Radical Imagination. Bell contended that the challenge for racial social justice is both current and evolving. It is anticipated that as the year 2040 approaches, the United States will be a majority people-of-color country. “It is time that we began reimagining how we do safety, not just for now, but for the future,” he said. He encouraged leaders to engage in radical imagination: to consider how the world might or should be changed and to begin work now to make those changes a reality. This way of thinking prepares all involved to be ready to engage in major change in a short period of time. “Leading the world in incarceration with a national recidivism rate of 60 percent means it [isn’t radical] to ask, ‘Can we do better?’ Indeed, it is good government to do better,” Bell explained. He suggested several strategies for communities: Conduct an intensive system-wide inquiry about what is working and what is not, and examine how the justice system is doing business. Develop strategic and smart ideas to negotiate politics in favor of equity and help elected officials see that it is to their advantage to promote equitable conduct. Be intentional about using the budgeting process to increase rather than decrease innovation. This can include working to break down silos and being prepared to disincentivize programs and policies that do not result in equitable conduct or outcomes. Know that training—including implicit bias training—is just a tool, not a result, in your work. Leaders cannot expect different outcomes just through training. Importantly, as communities develop their strategic plans, context matters. Tools and technologies to track and address racial and ethnic disparities in behavioral health and criminal justice settings can only be effective when the broader goal is to understand the social conditions leading to disparities. During the second part of the plenary, practical examples of this type of work were provided by Abbey Stamp, MSW, LCSW, executive director of the Multnomah County Local Public Safety Coordinating Council. She spoke about the county’s efforts to reduce racial and ethnic disparities in its criminal justice system. She explained that, similar to all jurisdictions, Multnomah County has ethnic and racial disparities, but what may be different is that the stakeholders in this county agree that structural and institutional racism exists. Stamp presented some key strategies that her county has taken to achieve improved racial equity outcomes: Study and analyze the context. Conduct a decision-point analysis to understand key points along a system where disparities exist. Practice targeted universalism. In other words, recognize that “all boats don’t rise equally” in response to justice reform due to structured inequalities in the community. Include all populations in developing reform goals, but ensure interventions target the inequities observed and measured among different racial and ethnic groups. “Stir the pot.” Ask the difficult questions that politicians may be afraid to ask. Understand that effecting change requires a balance between political will and risk tolerance. Work with the right policymakers and politicians who are willing to take a risk to implement reforms. Continuously monitor program effectiveness at key decision points. Watch the clip below to learn more about Multnomah County’s efforts to tackle this issue. View the entirety of James Bell’s and Abbey Stamp’s presentations below: This article also appears on the blog of the National Association of Counties. In collaboration with the Stepping Up initiative, the Data-Driven Justice initiative, and the Safety and Justice Challenge, the Substance Abuse and Mental Health Services Administration (SAMHSA) and SAMHSA’s GAINS Center for Behavioral Health and Justice Transformation convened a Best Practices Implementation Academy to Reduce the Number of People with Mental Illnesses and Substance Use Disorders in the Criminal Justice System (the Academy) in April 2018 in Washington, D.C. At the Academy, delegations from 24 jurisdictions involved in one or more of the three initiatives met to showcase best practice strategies and advance implementation efforts to address the issue of mental illness and substance use disorders in jails.