Domain 1: Community Environment

This report defines a community environment as the environment in which people are born, grow up, learn, work, play, and age. The community environment plays a significant role in either mitigating or exacerbating the likelihood that individuals with behavioral health needs will become involved with the criminal justice system. Inequities in resources at the community level can also translate into disparities in criminal justice system involvement for people with behavioral health needs. The focus areas for community environment are socioeconomic stability, health, and safety. The metrics outlined in this domain highlight key opportunities for policymakers to target interventions and resources at the community level to improve individual and intergenerational outcomes.

Socioeconomic Stability

Socioeconomic stability at the community level protects community members against justice system involvement and creates resources for resilience in the face of traumatic experiences. Socioeconomic stability can be measured through many metrics at the community level. The published literature and stakeholder research indicate the importance of understanding community levels of income, employment, education, and housing.⁵

Health

The health environment at the community level affects access to appropriate care, including utilization of primary care, acute care, and behavioral health care.⁶ Data about health insurance coverage, health professional staffing patterns, and life expectancy all help paint a picture of community health.

Safety

The level of safety in a community affects the likelihood of victimization and exposure to trauma, which are linked to higher rates of behavioral health needs and criminal justice system involvement.⁷ Historical trauma, particularly that experienced by Black and Native Peoples, may heighten these risks.⁸ Historical trauma can be defined as a “cumulative wounding across generations as well as during one’s life span”⁹ generated from the experience of oppression, racism, and colonization.

The community environment focus areas and sample metrics are summarized in the table below.

Domain 2: Treatment Landscape

Mental health and/or substance use treatment is critical to stopping the cycle of repeated justice system involvement for those with behavioral health needs. In providing treatment for this population, it is essential to consider three key focus areas in the continuum of care that are needed to interrupt the cycle. The treatment landscape focus areas are the availability of, access to, and effectiveness of appropriate treatment programs and recovery supports. Appropriate treatment and recovery supports are defined as high quality, culturally responsive, trauma-informed service delivery, which centralizes professional expertise in meeting the needs of individuals in the justice system. Licensing strategies of treatment programs can support providers to include these vital components in their service delivery design.¹²

Treatment Availability

Availability of appropriate behavioral health treatment and recovery supports in communities may be limited or nonexistent. Treatment program designs may not be structured for cultural inclusion and responsiveness. Practitioners may not be trained, nor committed to delivering services in culturally affirming ways. Trauma-informed care within program and service delivery designs may be restricted in scope to specialists in the field, and not organization wide. Furthermore, expertise in serving people involved in the justice system may be minimal. In other words, although a substantial number of treatment programs and recovery supports may be available in some communities, the type and quality of care may not meet the specific needs of people in the justice system who have behavioral health needs.¹³

Treatment Access

Although appropriate treatment and recovery support programs may be available in some communities to people involved in the justice system, access to these programs may be difficult. At the administrative level, a lack of enrollment in Medi-Cal or another insurance may be a barrier to connecting people to community behavioral health services upon release from jail or prison. Even for those with coverage, wait times to be admitted to the treatment programs may be lengthy. Some admission processes and procedures may be fragmented or cause excessive stress and frustration to those who may need treatment the most and whose level of functioning is compromised by untreated mental health needs and/or addiction issues. Intake and assessment processes may cause re-traumatization.

Another significant challenge faced by individuals with behavioral health needs who are involved in the justice system is the ability of professional staff to engage with them in a timely and coordinated manner during the initial “window of opportunity” when a person who needs treatment is open to considering a change for the better. If the “window of opportunity” is missed, individuals can exhaust their reserves of motivation to seek help while simultaneously coping with their life circumstances and untreated mental health needs and/or substance use. This challenge alone, or together with the other identified access issues, can create barriers to treatment for this population.¹⁴

Treatment Effectiveness

The ability to access treatment is irrelevant if the treatment provided is not effective in addressing the individual’s needs. The promotion of maximum opportunities for continual engagement throughout pre-admission, intake, assessment, entrance into placement, participation in the treatment programming, entrance into the post-treatment phase, and connection with recovery supports is central to treatment effectiveness. Without continual engagement, retention decreases or disappears, often resulting in non-completion of treatment and/or recovery support programming. For continuous and impactful engagement to occur, and retention to program completion, several components are necessary. One is the use of screening and assessment tools that are culturally affirming and address mental health and substance use. It is important that the kind of tools used, and the way they are used, do not create or exacerbate possible trauma for the client being evaluated.

Another component of treatment effectiveness is programming that encourages the treatment experience to be tailored to the individual, rather than using a “one-size-fits-all” approach that is convenient for the provider but does not really meet the client’s needs, as each client is unique. Recruiting and employing clinicians and other professionals extensively trained in trauma-informed care is another aspect of effectiveness. It is also important that clinicians and other professionals who provide treatment services have lived experience in the communities the clients most closely identify with and are skilled in serving people involved in the justice system and their families. This includes familiarity with the personal impact of justice system involvement and interventions designed to address needs associated with risk of future system involvement (i.e., “criminogenic needs”).¹⁵

An additional key component is the smooth coordination of effective care for this population between treatment staff and recovery community supports. This coordination should be started with ample time before the client completes treatment, instead of after. In too many situations, individuals are left by themselves in a vulnerable state after completing treatment, trying to use new skills in a sober lifestyle without timely and important supports and resources. They often must wait too long for the supports and resources to be available because of disjointed coordination or no coordination at all. Trying to navigate the barriers created by the lack of coordination between systems, practicing new ways of coping, and facing the consequences of a past lifestyle is sometimes too much to manage all at once and clients disengage, often returning to unhealthy ways of living.

Treatment programs that prioritize these components throughout their organization are the best suited to serve this population. Not only do they know what works best, but they know their community well, and especially what works in their geographical area.

The treatment landscape focus areas and sample metrics are summarized in the table below.

Domain 3: Crisis Response System

Much work is currently underway nationally and in California to facilitate quality responses to people experiencing behavioral health crises. While in recent years crises have been handled through 911 emergency services, policymakers and communities are increasingly adopting strategies to ensure that those who respond to behavioral health crises are well-equipped to interact on the scene and make appropriate connections to crisis care. This means focusing law enforcement on public safety crises while diversifying potential crisis responders to include trained behavioral health clinicians and community members. The quality of the system response to crises strongly influences whether individuals enter behavioral health clinic settings or the criminal justice system. The extent to which the criminal justice system is unable to effectively respond to crises can drive higher and inequitable rates of criminal justice involvement for people with behavioral health needs.16 Using a broad definition of “crisis” that includes calls to all emergency numbers (i.e., 911 and 988), three focus areas within this domain shape whether people with behavioral health needs become involved in the criminal justice system: crisis response dispatch, crisis response effectiveness, and appropriate crisis resolution.¹⁷ The sections below identify metrics within each of these focus areas. This domain, in particular, is one where data collection and reporting are emergent and quickly evolving. At this time, few jurisdictions have well-established policies and processes for the metrics listed below. Bringing together data from call for service, to response by a growing array of potential responders, through to resolution is ambitious. However, it is the only way to help understand the role of crisis response in reducing criminal justice system involvement among people with behavioral health needs.

Crisis Response Dispatch Options

The ability to dispatch a community or behavioral health professional instead of or alongside law enforcement may decrease the likelihood that a behavioral health crisis is responded to as a public safety issue. The ability to dispatch community responders, mobile crisis, co-responders, behavioral health-trained officers, or other responses is clearly dependent upon the availability of those options.¹⁸

Crisis Response Options Used

Different types of crisis situations warrant different responses. Some situations may require a law enforcement response to secure public safety, while others may best be served by a behavioral health care professional who can de-escalate a situation and get help for people by connecting them right away to crisis care. Employing an effective response to a crisis call and the resulting situation is critical for reducing criminal justice system involvement. Dispatchers play an important role by understanding the nature of a crisis and sending the least restrictive appropriate response. Training of dispatchers should include understanding culturally responsive approaches to crisis, as well as familiarity with local response options. This training should cover how to appropriately select a response based on information from the crisis call.

Effective Crisis Resolution

A common concern of stakeholders is whether crisis response truly stabilizes people or leads to another crisis call shortly after discharge. Addressing how well the crisis resolution has stopped or slowed the “revolving door” of criminal justice involvement is paramount in understanding appropriate crisis resolution for individuals and communities.

The crisis response system focus areas and sample metrics are summarized in the table below.

Conclusion

Effective responses to people with behavioral health needs who are involved in the justice system are of vital importance. These individuals are overrepresented in the criminal justice system, while accessing behavioral health treatment and enjoying housing stability at lower rates, and within this population, disparities exist for people of color and Native Peoples. The causes of the overrepresentation and disparities can be better understood through analysis of data from the domains of community environment, treatment landscape, and crisis response system.

The Public Health Meets Public Safety Policy Framework supports access to data for state policymakers and other stakeholders to promote positive outcomes of health and sustained well-being for individuals, families, and communities by relying on research and evidence-based best practices. Utilizing the framework to inform policymaking now and in the future can support the reduction of justice system involvement for people with behavioral health needs and decrease the inequitable disparities that occur for people of color and Native Peoples in California. As the current unmet needs of this population have far-ranging and multigenerational effects, so will the effective solutions.

Endnotes

1. This is the statutory charge of CCJBH; see California Code, Penal Code – PEN § 6044(e).

2. These outcomes are highlighted by the national Stepping Up initiative, which has been adopted by 37 California counties and CCJBH itself. Additional criminal justice outcomes could include people with behavioral health needs on probation and on parole, pretrial release rates, use of the Incompetent to Stand Trial process, and behavioral health diversion as a case resolution.

3. As part of this project, the team is also developing an interactive data visualization that populates some of these metrics with data available for California, which includes its own specific methodology section. The precise methodology for populating the framework’s metrics will adapt over time and in different contexts as different data sources become available.

4. Because different datasets are organized according to different geographic units, “geography” is used generally within this document. Given that many criminal justice and health services are managed at the county level in California, county-to-county comparisons are a logical initial point of analysis.

5. Steven Raphael and Rudolf Winter-Ebmer, “Identifying the Effect of Unemployment on Crime,” Journal of Law and Economics 44, no. 1 (2001): 259–283; Lance Lochner and Enrico Moretti, “The Effect of Education on Crime: Evidence from Prison Inmates, Arrests, and Self-Reports,” American Economic Review 94, no. 1 (2004): 155–189; Philip J. Cook and Songman Kang, “Birthdays, Schooling, and Crime: Regression-Discontinuity Analysis of School Performance, Delinquency, Dropout, and Crime Initiation,” American Economic Journal: Applied Economics 8, no. 1 (2016); Songman Kang, “Inequality and Crime Revisited: Effects of Local Inequality and Economic Segregation on Crime,” Journal of Population Economics 29 (2016): 593–626.

6. Jacob Vogler, “Access to Healthcare and Criminal Behavior: Evidence from the ACA Medicaid Expansions,” Journal of Policy Analysis and Management 39, no. 4 (2020): 1166–1213.

7. Lyndsay N. Boggess and John R. Hipp, “Violent Crime, Residential Instability, and Mobility: Does the Relationship Differ in Minority Neighborhoods?” Journal of Quantitative Criminology 26 (2010): 351–370; Bryanna Hahn Fox et al., “Trauma Changes Everything: Examining the Relationship between Adverse Child­hood Experiences and Serious, Violent, and Chronic Juvenile Offenders,” Child Abuse and Neglect 46 (2015): 163–173; Benjamin Meade, Benjamin Steiner, and Charles F. Klahm IV, “The Effect of Police Use of Force on Mental Health Problems of Prisoners,” Policing and Society 27, no. 2 (2017): 229–244.

8. Kimberly Westcott, “Race, Criminalization, and Historical Trauma in the United States: Making the Case for a New Justice Framework,” Traumatology 21, no. 4 (2015): 273–284; Jessica L. Garcia, “Historical Trauma and American Indian/Alaskan Native Youth Mental Health Development and Delinquency,” New Directions for Child and Adolescent Development 169 (2020): 41–58; Monica Deza, Johanna Catherine Maclean, and Keisha T. Solomon, Local Access to Mental Healthcare and Crime (Cambridge, MA: National Bureau of Economic Research, 2020).

9. Maria Yellow Horse Brave Heart, “Oyate Ptayela: Rebuilding the Lakota Nation through Addressing Historical Trauma among Lakota Parents,” Journal of Human Behavior in the Social Environment 2, no. 1-2 (1999): 109–126.

10. According to the U.S. Department of Housing and Urban Development (HUD), chronic homelessness is defined as “having experienced homelessness for at least 12 months or 4 separate occasions in the last 3 years.” See “Definition of Chronic homelessness,” HUD Exchange, accessed November 9, 2022, https://www.hudexchange.info/homelessness-assistance/coc-esg-virtual-binders/coc-esg-homeless-eligibility/definition-of-chronic-homelessness/.

11. External causes of death may include accidents, overdose deaths, suicides, and homicides. Although these are not all directly related to crime, they nevertheless have an impact on the sense of community safety.

12. Substance Abuse and Mental Health Services Administration, Principles of Community-Based Behavioral Health Services for Justice-Involved Individuals: A Research-Based Guide. HHS Publication No. (SMA) 19-5097 (Rockville, MD: Substance Abuse and Mental Health Services Administration, 2019); Barbara C. Wallace, Latoya C. Conner, Priscilla Dass-Brailsford, “Integrated Trauma Treatment in Correctional Health Care and Community-based Treatment Upon Reentry,” J Correct Health Care 17, no. 4 (2011): 329–343.

13. Crime and Justice Institute and Wayne Scott, Effective Clinical Practices in Treating Clients in the Criminal Justice System (Washington, DC: National Institute of Corrections, 2008); Substance Abuse and Mental Health Services Administration, Principles of Community-Based Behavioral Health Services.

14. Henry J. Steadman, Suzanne M. Morris, and Deborah L. Dennis, “The Diversion of Mentally Ill Persons from Jails to Community-Based Services: A Profile of Programs,” American Journal of Public Health 85, no. 12 (1995): 1630–1635; Crime and Justice Institute and Scott, Effective Clinical Practices.

15. Fred C. Osher et al., Adults with Behavioral Health Needs under Correctional Supervision: A Shared Framework for Reducing Recidivism and Promoting Recovery (New York: The Council of State Governments Justice Center, 2012).

16. Committee on Psychiatry and the Community for the Group for the Advancement of Psychiatry, Roadmap to the Ideal Crisis Response System: Essential Elements, Measurable Standards and Best Practices for Behavioral Health Crisis Response (Washington, DC: National Council for Mental Wellbeing, 2021).

17. Substance Abuse and Mental Health Services Administration, National Guidelines for Behavioral Health Crisis Care: A Best Practice Toolkit (Rockville, MD: Substance Abuse and Mental Health Services Administration, 2020).

18. To learn more about different models of crisis response, see The Council of State Governments Justice Center, Preparing 911 Dispatch Personnel for New First Responder Teams (New York: The Council of State Governments Justice Center, 2021), https://csgjusticecenter.org/wp-content/uploads/2021/12/CS­GJC_Field-Notes_Preparing-911-Dispatch-Personnel_2019-MO-BX-K001_508.pdf.

References

The following is a list of selected literature references used to develop the framework.

Community Environment

Brave Heart, Maria Yellow Horse. “Oyate Ptayela: Rebuilding the Lakota Nation through Addressing Historical Trauma among Lakota Parents.” Journal of Human Behavior in the Social Environment 2, no. 1-2 (1999): 109–126.

Boggess, Lyndsay N., and John R. Hipp. “Violent Crime, Residential Instability, and Mobility: Does the Relationship Differ in Minority Neighborhoods?” Journal of Quantitative Criminology 26 (2010): 351–370.

Cook, Philip J., and Songman Kang. “Birthdays, Schooling, and Crime: Regression-Discontinuity Analysis of School Performance, Delinquency, Dropout, and Crime Initiation.” American Economic Journal: Applied Economics 8, no. 1 (2016): 33–57.

Deza, Monica, Johanna Catherine Maclean, and Keisha T. Solomon. Local Access to Mental Healthcare and Crime. Cambridge, MA: National Bureau of Economic Research, 2020.

Hahn Fox, Bryanna, et al. “Trauma Changes Everything: Examining the Relationship between Adverse Childhood Experiences and Serious, Violent, and Chronic Juvenile Offenders.” Child Abuse and Neglect 46 (2015): 163–173.

Kang, Songman. “Inequality and Crime Revisited: Effects of Local Inequality and Economic Segregation on Crime.” Journal of Population Economics 29 (2016): 593–626.

Garcia, Jessica L. “Historical Trauma and American Indian/Alaskan Native Youth Mental Health Development and Delinquency,” New Directions for Child and Adolescent Development 169 (2020): 41–58.

Lochner, Lance, and Enrico Moretti. “The Effect of Education on Crime: Evidence from Prison Inmates, Arrests, and Self-Reports.” American Economic Review 94, no. 1 (2004): 155–189.

Meade, Benjamin, Benjamin Steiner, and Charles F. Klahm IV. “The Effect of Police Use of Force on Mental Health Problems of Prisoners.” Policing and Society 27, no. 2 (2017): 229–244.

Raphael, Steven, and Rudolf Winter-Ebmer. “Identifying the Effect of Unemployment on Crime.” Journal of Law and Economics 44, no. 1 (2001): 259–283.

Vogler, Jacob. “Access to Healthcare and Criminal Behavior: Evidence from the ACA Medicaid Expansions.” Journal of Policy Analysis and Management 39, no. 4 (2020): 1166–1213.

Westcott, Kimberly. “Race, Criminalization, and Historical Trauma in the United States: Making the Case for a New Justice Framework.” Traumatology 21, no. 4 (2015): 273–284.

Treatment Landscape

Crime and Justice Institute and Wayne Scott. Effective Clinical Practices in Treating Clients in the Criminal Justice System. Washington, DC: National Institute of Corrections, 2008.

Dierkhising, Carly B., et al. “Trauma Histories among Justice-Involved Youth: Findings from the National Child Traumatic Stress Network.” European Journal of Psychotraumatology 4 (2013).

Gilmer, Todd P., et al. “Developing Trauma Resilient Communities Through Community Capacity-building.” BMC Public Health 21 (2021): 1681. https://doi.org/10.1186/s12889-021-11723-7.

Jäggi, Lena J., et al. “The Relationship between Trauma, Arrest, and Incarceration History among Black Americans: Findings from the National Survey of American Life.” Society and Mental Health 6, no. 3 (2016): 187–206.

Osher, Fred C., et al. Adults with Behavioral Health Needs under Correctional Supervision: A Shared Framework for Reducing Recidivism and Promoting Recovery. New York: The Council of State Governments Justice Center, 2012.

Osher, Fred C., and Henry J. Steadman. “Adapting Evidence-Based Practices for Persons with Mental Illness Involved with the Criminal Justice System.” Psychiatric Services 58, no. 11 (2007): 1472–1478.

Primm, Annelle B., Fred C. Osher, and Marisela B. Gomez. “Race and Ethnicity, Mental Health Services and Cultural Competence in the Criminal Justice system: Are We Ready to Change?” Community Mental Health Journal 8, no. 5 (2005): 557–569.

The Sentencing Project. Reducing Racial Disparity in the Criminal Justice System: A Manual for Practitioners and Policymakers. Washington, DC: The Sentencing Project, 2008.

Steadman, Henry J., Suzanne M. Morris, and Deborah L. Dennis. “The Diversion of Mentally Ill Persons from Jails to Community-Based Services: A Profile of Programs.” American Journal of Public Health 85, no. 12 (1995): 1630–1635.

Substance Abuse and Mental Health Services Administration. Improving Cultural Competence. Treatment Improvement Protocol (TIP) Series No. 59. HHS Publication No. (SMA) 14-4849. Rockville, MD: Substance Abuse and Mental Health Services Administration, 2014.

Substance Abuse and Mental Health Services Administration. Principles of Community-Based Behavioral Health Services for Justice-Involved Individuals: A Research-Based Guide. HHS Publication No. (SMA) 19- 5097. Rockville, MD: Substance Abuse and Mental Health Services Administration, 2019.

Taxman, Faye S., Sarah Wurzburg, and Kati Habert. Process Measures at the Interface between the Justice System and Behavioral Health: Advancing Practice and Outcomes. New York: The Council of State Governments Justice Center, 2016.

Wallace, Barbara C., Latoya C. Conner, and Priscilla Dass-Brailsford. “Integrated Trauma Treatment in Correctional Health Care and Community-Based Treatment Upon Reentry.” Journal of Correctional Health Care 17, no. 4 (2011): 329–343.

Wolff, Nancy L., and Jing Shi. “Trauma and Incarcerated Persons.” In Handbook of Correctional Mental
Health, edited by Charles L. Scott, 277–320. Washington, DC: American Psychiatric Publishing, Inc., 2010.

Crisis Response

Balfour, Margaret E., et al. “Cops, Clinicians, or Both? Collaborative Approaches to Responding to Behavioral Health Emergencies.” Psychiatric Services (2021). https://doi.org/10.1176/appi.ps.202000721.

Committee on Psychiatry and the Community for the Group for the Advancement of Psychiatry. Roadmap to the Ideal Crisis Response System: Essential Elements, Measurable Standards and Best Practices for Behavioral Health Crisis Response. Washington, DC: National Council for Mental Wellbeing, 2021.

Gillooly, Jessica W. “How 911 Callers and Call-Takers Impact Police Encounters with the Public: The Case of the Henry Louis Gates Jr. Arrest.” Criminology and Public Policy 19, no. 3 (2020): 787–803.

Lum, Cynthia, et al. “Constrained Gatekeepers of the Criminal Justice Footprint: A Systematic Social Observation Study of 9-1-1 Call Takers and Dispatchers.” Justice Quarterly 37, no. 7 (2020): 1176–1198.

Neusteter, Rebecca, et al. The 911 Call Processing System: A Review of the Literature as it Relates to Policing. Brooklyn, NY: Vera Institute of Justice, 2019. https://www.vera.org/publications/911-call-processing-system-review-of-policing-literature.

Snowden, Lonnie R., Julia F. Hastings, and Jennifer Alvidrez. “Overrepresentation of Black Americans in Psychiatric Inpatient Care.” Psychiatric Services 60, no. 6 (2009): 779–785.

Substance Abuse and Mental Health Services Administration, National Guidelines for Behavioral Health Crisis Care: A Best Practice Toolkit. Rockville, MD: Substance Abuse and Mental Health Services Administration, 2020.

Wittmann, Linus, et al. “Police Officers’ Ability in Recognizing Relevant Mental Health Conditions.” Frontiers in Psychology 12 (2021).

About the CSG Justice Center

The Council of State Governments (CSG) Justice Center is a national nonprofit, nonpartisan organization that combines the power of a membership association, representing state officials in all three branches of government, with policy and research expertise to develop strategies that increase public safety and strengthen communities. For more information about the CSG Justice Center, visit www.csgjusticecenter.org.

About the Council on Criminal Justice and Behavioral Health (CCJBH)

Established by California Penal Code Section 6044(a), the Council on Criminal Justice and Behavioral Health (CCJBH) is a 12-member council chaired by the Secretary of the California Department of Corrections and Rehabilitation (CDCR) and is comprised of the Department of State Hospitals (DSH), the Department of Health Care Services (DHCS), and appointed expert representatives from the criminal justice and behavioral health fields such as probation, court officers, and mental health care professionals. CCJBH serves as a resource to assist and advise the administration and legislature on best practices to reduce the incarceration of youth and adults with mental illness and substance use disorders (SUDs) with a focus on prevention, diversion, and reentry strategies.