Consumers and Representatives of the Mental Health 

and Criminal Justice Systems in Dialogue

U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES

Substance Abuse and Mental Health Services Administration

Center for Mental Health Services

www.samhsa.gov

Building Bridges

Consumers and Representatives of the Mental Health 

and Criminal Justice Systems in Dialogue

Building Bridges

U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES

Substance Abuse and Mental Health Services Administration

Center for Mental Health Services

www.samhsa.gov
Acknowledgments

A variety of people contributed to the development of this publication: their 

names appear in the Participant List. The publication was prepared for the 

Substance Abuse and Mental Health Services Administration (SAMHSA), U.S. 

Department of Health and Human Services (DHHS), under contract number 

280-01-8054. Paolo del Vecchio and Carole Schauer served as government 

project officers. Irene Saunders Goldstein served as author of the monograph.

Disclaimer

The views, opinions, and content of this publication are those of the dialogue 

participants and do not necessarily reflect the views, opinions, or policies of the 

Center for Mental Health Services (CMHS), SAMHSA, or DHHS.

Public Domain Notice 

All material in this document is in the public domain and may be reproduced 

without permission from SAMHSA. Citation of the source is appreciated 

(see below). This publication may not be reproduced or distributed for 

a fee, however, without specific written authorization of the Office of 

Communications, SAMHSA, DHHS. Please send a copy of the publication or 

Web site in which this document is cited to the Office of Consumer Affairs, 

Center for Mental Health Services/SAMHSA, 1 Choke Cherry Road, Rockville, 

MD 20857.

Electronic Access and Copies of Publication

This publication can be accessed electronically on the Internet at www.samhsa.

gov. For additional free copies of this publication, call SAMHSA’s National 

Mental Health Information Center at 1-800-789-2647 or 1-866-889-2647 (TDD).

Recommended Citation

Center for Mental Health Services. Building Bridges: Consumers and 

Representatives of the Mental Health and Criminal Justice Systems in Dialogue. 

DHHS Pub. No. (SMA) 05-4067. Rockville, MD: Center for Mental Health 

Services, Substance Abuse and Mental Health Services Administration, 2005.

Originating Office

Center for Mental Health Services, Substance Abuse and Mental Health Services 

Administration, 1 Choke Cherry Road, Rockville, MD 20857

DHHS Publication No. (SMA) 05-4067

Printed 2005

ii
iii

Contents

Introduction .................................................................................... 1

Issues of Mental Health Consumers in the 

Criminal Justice System .................................................................. 3

Dialogue Themes and Findings ..................................................... 7

In Their Own Words ................................................................ 7

Issues of Personhood .............................................................. 9

Person-Level Factors That Promote Recovery ................... 9

Person-Level Factors That Hinder Recovery .................... 10

Issues Related to Systems ...................................................... 11

System-Level Factors That Promote Recovery ................. 11

System-Level Factors That Hinder Recovery .................... 14

Recommendations for Action: Highlights ................................... 17

Appendix A. Recommendations ................................................... 19

Appendix B. References and Resources ....................................... 31

Appendix C. Participant List ........................................................ 35
Consumers and Representatives of the Mental Health and

Criminal Justice Sytems in Dialogue
1

Introduction

In 2003, the President’s New Freedom Commission on Mental 

Health issued its final report, Achieving the Promise: Transforming 

Mental Health Care in America. The report calls for transforming 

the way that services are provided for people who experience 

mental health problems throughout the country. As the lead 

Federal agency, the Center for Mental Health Services (CMHS) of 

the Substance Abuse and Mental Health Services Administration 

(SAMHSA) has designated this transformation as a central focus of 

its work. 

Both personal and systems transformation depend on 

relationships and connections between people. CMHS sponsors 

dialogues in which consumers and other stakeholders in mental 

health provision share their personal and professional experiences 

with the ultimate goal of forging recommendations that foster 

recovery models for consumers of mental health services.

On July 26-27, 2004, CMHS sponsored a dialogue among invited 

consumers of mental health services who have had contact 

with the criminal justice system and representatives of various 

sectors of the criminal justice and mental health systems, 

including service providers, advocates, and policymakers. In an 

effort to develop improved mutual understanding, respect, and 

partnerships, the two dozen participants:

 Identified issues involving mental health consumers in contact 

with the criminal justice system, including diversion from 

incarceration, prevention prior to consumer entry into jails and 

prisons, and community reentry efforts;

 Identified factors at both the person level and the system level 

that promote or hinder recovery from mental illnesses; and 

 Developed recommendations regarding systems transformation 

that can foster recovery and community integration.

The participants’ findings and recommendations are summarized 

in this publication.
Consumers and Representatives of the Mental Health and

Criminal Justice Sytems in Dialogue
3

Issues of Mental Health 

Consumers in the Criminal 

Justice System

The Governor of Virginia expressed dismay that he was 

“forced to authorize the confinement of [persons with 

mental illnesses] in the Williamsburg jail, against both 

his conscience and the law” because of lack of 

appropriate services. This occurred in 1773. (DHHS, 1995)

More than two centuries have elapsed since Virginia’s colonial 

governor made his poignant observation, but even today U.S. jails 

are a “catchall” for persons who are homeless and have mental 

illness and substance use problems. 

When the group of mental health consumers who have had 

experience in the criminal justice system and mental health and 

criminal justice professionals, advocates, and policymakers met 

for dialogue in July 2004, they began by reviewing the facts 

about mental illness and substance abuse in the criminal justice 

system. Citing state-of-the-science research findings in its 2004 

background paper (New Freedom Commission on Mental Health, 

2004), the Subcommittee on Criminal Justice of the President’s 

New Freedom Commission on Mental Health summarized the 

scope of the current national problem related to persons with 

mental health problems who are involved with the criminal justice 

system: 

 Approximately 2 million persons are incarcerated in State and 

Federal prisons and local jails, and more than 4 million people 

are under probation or parole supervision in communities. 

 About 7 percent of all incarcerated people currently have 

serious mental illnesses, a rate three to four times that of the 

U.S. population as a whole. 

 The proportion of incarcerated persons with any type of mental 

illness is significantly higher than 7 percent. 

The Subcommittee noted that persons with serious mental 

illnesses who are involved with the criminal justice system–

 typically are poor and uninsured, are disproportionately 

members of minority groups, and often are homeless and have 

co-occurring substance use disorders;
4

Consumers and Representatives of the Mental Health and

Criminal Justice Sytems in Dialogue

 frequently enter homeless shelters, hospitals, and jails; and

 sometimes, but not typically, receive mental health or 

substance use services.

Most important, the majority of these persons with serious mental 

illnesses have commited misdemeanors and do not belong in the 

criminal justice system (New Freedom Commission on Mental 

Health, 2004). 

Henry J. Steadman, Ph.D., director of the National GAINS Center, 

asserts that far more people with mental illnesses reside in U.S. 

jails and prisons (200,000) than in State mental hospitals (61,700). 

An estimated 3,000 inmates with mental illnesses are incarcerated 

at New York City’s Rikers Island correctional facility at any given 

time, 800 in hospital beds and the rest in the general population, 

thus making Rikers the State’s “largest psychiatric facility, vying 

with the Los Angeles County jail for the status of largest inpatient 

psychiatric facility in the country” (Kamenetz, 2004).

 When they are put in jail, people with mental illnesses 

 frequently do not receive appropriate mental health 

 services. Many lose their eligibility for income supports and 

 health insurance benefits that they need after they are 

 discharged to reenter and reintegrate into the community. 

 (New Freedom Commission on Mental Health, 2003).

A critical corollary is that insufficient treatment and other supports 

are available in the community for persons with mental illnesses, 

including those who have had contact with the criminal justice 

system. 

The New Freedom Commission on Mental health reported the 

following: The U.S. Supreme Court’s 1999 Olmstead decision 

affirmed the right of persons with disabilities (including mental 

illnesses) to receive services in the most integrated setting 

possible. But five years after that historic decision, Bazelon Center 

for Mental Health Law’s legal director Ira Burnim noted:

 While many Americans with disabilities have made progress 

 since the Olmstead ruling, people with mental illnesses have 

 been largely left behind in efforts to implement the 

 decision. . . .

 Budget pressures have closed psychiatric hospitals across 

 the country, but few appropriate community services have 

 been adequately funded to help people with mental 

 illnesses live successfully in the community. . . . Thousands 

 wind up in jail or prison because chronically underfunded 
5

 community mental health systems fail to provide meaningful 

 support. (Bazelon Center, 2004)

The dialogue participants shared the understanding that recovery 

from mental illnesses is now considered a possibility—even an 

expectation. Persons with mental health diagnoses can expect to 

achieve satisfying, hopeful, purposeful, and contributing lives—

despite any limitations their illnesses may cause. The efforts of a 

large cadre of consumer advocates and peer supporters across the 

country have been critically important in fostering hope and the 

means and methods for consumers to set and achieve their goals 

for a meaningful life in the community.

Before developing their recommendations, the dialogue 

participants discussed the need for decriminalization of mental 

illnesses, improved availability and quality of mental health care 

within correctional facilities, pretrial diversion programs, transition 

services into the community, anti-stigma and anti-discrimination 

campaigns, recognition of the role of trauma in mental illnesses 

and retraumatization within the criminal justice system, and 

recognition of the value of peer support programs. Peers in this 

context are individuals with mental and behavioral problems who 

have experienced involvement in the criminal justice system and 

who provide supportive services.
Consumers and Representatives of the Mental Health and

Criminal Justice Sytems in Dialogue
7

Dialogue Themes and Findings

Judges release persons with mental illnesses, but housing providers 

are the most difficult barrier. Our program has resources for 

evidence-based practices, but we have to advocate to get people 

into housing in order to do the evidence-based practices.

 —Service provider

In Their Own Words

To start the dialogue, participants shared relevant personal 

experiences related to the recovery of persons with mental health 

problems who have had contact with criminal justice systems.

Some participants described how the symptoms of their mental 

illnesses have led to trouble with police and then to jail, despite 

their having engaged in no criminal behavior: 

People are incarcerated simply because they are sick. When a 

family calls 911 because a person has not taken his or her meds, 

police officers arrive first and try to talk to the person. But a 

paranoid person, for example, does not want to talk when he sees 

the badge, the gun, the stick. He slams the door to his room and 

then is cited for resisting arrest. So a person who the family wanted 

to go to the hospital is going to jail instead.

—Consumer advocate/former consumer/former addict
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Consumers and Representatives of the Mental Health and

Criminal Justice Sytems in Dialogue

Many spoke about how their experiences have led to meaningful 

work as peer support workers and providers of consumeroperated services:

After 15 years in prison, and having earned five undergraduate 

and graduate degrees, I own and operate two ex-offender agencies 

that offer services to clients. We help them get housing, educational 

opportunities, and employment, and assist them in moving from 

poverty to self-sufficiency within one year.

—Consumer-operated service provider/former offender/trauma 

survivor

Peers can help policymakers decide who should get mental health 

services. The quality of services should be adjudicated rather than 

a person judged as noncompliant. To preserve people’s rights, 

judges should hear mental health consumers as well as providers.

—Service provider

Other participants discussed their work as consumer advocates:

As a member of a statewide justice coalition, I speak before the 

State legislature on reinstituting voters’ rights for offenders and for 

in-school suspension instead of out-of-school suspension, which 

leads progressively to delinquency and adult criminal behavior.

—Service provider/trauma survivor/former offender/former 

addict

The therapeutic intervention of empowerment gives consumers a 

place. They are the experts. They have street knowledge. We need to 

collaborate and to educate.

—Service provider/former addict/consumer

Some participants described experiences with trauma and then 

retraumatization within the criminal justice system:

We provide services to women who are incarcerated for nonviolent 

crimes. I see the cycle of violence and trauma, and hope to derail it 

for myself and my family. . . . I watch women in our program for 

the first time experience what it is like to be a parent, to hold their 

babies and feel worthy of having that child in their arms—and 

to begin to feel that they deserve something and that they are 

worthwhile human beings.

—Trauma survivor/service provider/consumer advocate
9

Issues of Personhood

Participants identified a series of person-level factors that promote 

and that hinder recovery. These factors are listed below.

Person-Level Factors That Promote Recovery

Participants agreed that overarching person-level factors

include drawing on individuals’ resilience, fostering hope for 

recovery, and providing adequate services. They noted additional 

recovery-promoting factors that fall in the general categories 

of personal circumstances, mental health services, community 

reintegration, and advocacy.

 Factors related to personal circumstances include–

 secure economic status, including decent, permanent, safe 

housing (In surveys and at regional and national meetings, 

consumers of mental health services across the Nation for years 

have universally identified the need for housing and jobs as 

top priorities in their recovery process.); 

 “a life in the community”—activities and interests beyond just 

work and treatment, including recreation and socialization, 

educational opportunities, supports for spirituality, and the 

opportunity for association with a faith community (DHHS, 

2004); 

 self-esteem and empowerment as components of recovery; and

 positive personal relationships established between consumers 

and local law enforcement. 

Factors related to mental health services include– 

 culturally competent services that reflect consumers’ 

preferences and needs (for example, race, ethnicity, gender, 

language, neighborhood characteristics, mental health and 

criminal justice background); 

 holistic approach to wellness and recovery; 

 trust in service providers;

 peer-provided services; 

 focus on family as part of the recovery team; and 

 recognition and assessment of, and comprehensive services 

for, trauma, addictions and other co-occurring disorders, and 

mental health recovery.
10

Consumers and Representatives of the Mental Health and

Criminal Justice Sytems in Dialogue

Consumers can be valuable members of provider staff. Providers

see us at our worst. It’s important for providers and others who 

aren’t consumers to see us at our best.

—Consumer-operated service provider/consumer

 Factors related to community reintegration include–

 forgiveness and second chances in the community; 

 individualized discharge planning prior to community 

reintegration; 

 multidisciplinary transition teams that link persons to 

community-based services;

 supported housing irrespective of diagnosis or treatment status; 

and 

 training, education, and assisted employment opportunities that 

lead to competitive employment.

I was raised in the mental health and judicial systems. My “family” 

has been doctors, family workers, case workers, and my peers. . . 

I saw a sign on a wall: “Are you mentally ill? Looking for a job? 

Arrested before? We want you.” I joined the staff of a nonprofit 

company whose 360 of 480 employees are in recovery.

—Supervisory peer support specialist/consumer advocate

Advocacy promotes empowerment of consumer advocates. 

Telling one’s recovery story helps facilitate others’ recovery.

For close to 14 years I have been active in the consumer movement, 

and my passion is to help encourage, support, develop, and 

mobilize communities to include ex-offenders in the movement.

—Consumer advocate/family member

Person-Level Factors That Hinder Recovery

Dialogue participants also identified a number of factors that 

hinder recovery. They considered the broad area of stigma 

and discrimination, racism, NIMBYism (Not In My BackYard), 

and lack of cultural competence in service provision to be 

overarching negative factors. Other factors fall into the general 

categories of personal circumstances, mental health services, and 

contact with the criminal justice system. 

Factors related to personal circumstances include–

 lack of means to earn a living; 

 lack of means to live in decent, safe, and permanent housing; 

and

 lack of opportunities for education or training.
11

Factors related to mental health services include– 

 lack of access to, or inadequate quality or duration of, mental 

health services and 

 inappropriate assessment or treatment, particularly related to 

trauma.

Factors related to contact with the criminal justice system

include–

 arrest by police due to symptoms of mental illness, and

 ineligibility for services (for example, housing and education) 

due to one’s criminal record.

There is a difference between serious mental illness and 

criminality, and persons with serious mental illness are not exempt 

from criminal behavior. I’ve never broken the law, although I have 

been mistreated by police and placed in jail. Now I make sure that 

I know police officers and that they know that I am not violent. . . 

The real issue is stigma.

—Consumer advocate

Issues Related to Systems

Participants identified a number of system-level factors that they 

know to promote or hinder recovery. System refers to a broad 

range of jurisdictions—Federal, State, and local departments of 

corrections and mental health, as well as specific institutions and 

facilities, and communities in general.

System-Level Factors That Promote Recovery

Dialogue participants identified a series of recovery-promoting 

factors related to service provision to consumers, mental health 

practices in criminal justice systems, and community reintegration 

services, in addition to several other factors that promote 

recovery.

Factors that promote recovery in service provision to 

consumers include a spectrum of services for consumers, such 

as prevention, diversion from incarceration, treatment, and 

community reintegration. Specific factors include– 

 routine screening and services related to persons’ trauma 

histories; 

 recognition of the role of faith and/or spirituality in recovery;

 collaborative, comprehensive pretrial services to avert 

incarceration and/or facilitate reintegration; 
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Consumers and Representatives of the Mental Health and

Criminal Justice Sytems in Dialogue

 preentry social services for women with children;

 jails that serve as places of last resort to obtain services (for 

example, shelter, treatment, a bath) in the absence of access to 

housing and/or mental health services; 

 peer support specialist services that are Medicaid billable;

 education of and collaboration with the business community to 

promote peer support; 

 peer support specialists trained and integrated into criminal 

justice systems; and

 consumer-run, community-based organizations engaged to 

support transition into communities. 

Many people enter the criminal justice system and are not 

diagnosed for trauma, post-traumatic stress disorder, and 

depression. My life changed when I learned about trauma, and it 

clicked about what goes on for most women and how they need to 

be treated to recover.

—Service provider

Mental health practices in criminal justice systems 

promote recovery when they– 

 reflect recognition of the cost effectiveness, compared with 

incarceration, of the prevention and treatment of mental 

illnesses and promotion of mental health;

 focus on the needs and contributions of families of persons 

who are incarcerated (including provision of children’s 

services); and 

 provide trauma-related services, including early contact with 

family members when trauma survivors enter treatment and 

culturally specific group treatment for trauma (for example, 

groups that focus on domestic violence, other trauma, 

fathering, and couples support).

What can we do in our system, in our jail, that will create 

the likelihood for recovery? A transition team is needed whose 

members know what community support groups are available. 

Recovery can be measured in reduction in incarceration days 

and homeless days and in days employed. We need to define 

employment—does it include volunteerism, school attendance? The 

idea is to measure, to enable us to document the components of 

recovery, and to decide how to pay for them.

—Consumer advocate/former offender/family member
13

Community reintegration services that promote recovery 

include–

 services that provide customized services;

 comprehensive, co-located services (“one-stop” facilities); 

 services available during convenient hours (for example, noon 

to 8 p.m.); 

 supported housing that does not discriminate against mental 

health consumers or persons with experience in the criminal 

justice system; and 

 a living wage, businesses owned and operated by former 

offenders and consumers, and employment commensurate with 

individual abilities and/or limitations.

In a 13-year partnership with wardens, we make policy to break 

system barriers that deny community services to persons from 

the criminal justice system. We address housing barriers by 

providing rental assistance. The State matches Federal funding 

with services, and people can get dignified permanent housing. . 

. . My position allows me access to systemic changes and access to 

people for whom I have a passion. . . . We have trained thousands 

of correctional officers. Wardens are our biggest allies. 

—Policymaker/advocate/family member

Additional system-level factors that promote recovery

include– 

 advocacy in the criminal justice system for persons with mental 

 health issues; 

 community-based advocacy and action; 

 those in the criminal justice field embracing the possibility of 

 recovery; and 

 people of color assuming more leadership roles in the 

 consumer movement.

System-Level Factors That Hinder Recovery

Overarching systemic factors that hinder recovery are a 

chronic lack of mutual understanding between criminal justice 

and mental health professionals and policymakers of the priorities 

and constraints of each field; and, in communities, stigma, 

discrimination, NIMBYism, and lack of cultural competence. In 

addition, participants identified a long list of system-related factors 

that impede recovery, including issues related to inadequate 
14

Consumers and Representatives of the Mental Health and

Criminal Justice Sytems in Dialogue

mental health and other community services, criminal justice 

issues, and a number of other concerns.

Factors related to mental health services that hinder 

recovery include–

 fragmentation of the mental health system;

 limited access to services in rural (and other) areas;

 a “revolving door” process in mental hospitals, with discharge 

unrelated to readiness to live in the community;

 treatment and other services by mental health and/or substance 

use providers denied for persons with co-occurring disorders; 

and 

 a lack of personal outcome measures.

On my reservation, 48 percent of incarcerated persons have 

mental illnesses. 

—Corrections officer

Factors related to criminal justice issues that hinder 

recovery include– 

 facilities’ insufficient resources to provide proper mental health 

assessment and services; 

 overrepresentation of minorities in jails and prisons;

 the absence of linguistic and other aspects of cultural 

competence in prisons and jails; 

 conflicting priorities between public safety and public health, 

favoring security over health concerns; 

 dependence by former offenders on government agencies for 

services;

 “pleading out” of the criminal justice system by consumers; 

 seclusion and restraint and other traumatizing (and 

retraumatizing) practices; 

 intergenerational effects of incarceration of persons with mental 

and behavioral disorders, whereby children and other family 

members become secondary victims.

Monolingual staff in prisons ask people to sign documents they do 

not understand, and when the people don’t comply, it’s termed 

refusal and resistance—and there are consequences. 

—Consumer advocate/former consumer/former addict
15

Inadequate community services that hinder recovery

include– 

 lack of transition teams in communities; 

 little collaboration between traditional service providers and 

peer-run programs in communities; 

 lack of services in rural and other geographical areas; 

 denial of services (for example, housing and employment) due 

to mental health and/or substance use status; and

 lack of services for pregnant women in criminal justice systems. 

Barriers include no job to support themselves, a felony or drug 

conviction that rules out eligibility for financial assistance, lack of 

family supports to earn a living, and lack of direct services.

—Service provider/former consumer/former addict
Consumers and Representatives of the Mental Health and

Criminal Justice Sytems in Dialogue
17

Recommendations for Action: 

Highlights

People with mental illness involved in the criminal justice system 

have similar needs to other individuals with mental illness. Serving 

this population is simply the right thing to do (Massaro, 2004).

Dialogue participants proposed a series of recommendations for 

action. Highlights are listed below; see Appendix A for the entire 

set of recommendations. 

Policy

 Address fragmentation in mental health service systems (for 

example, by creating one-stop service centers that engage in 

outreach and follow-up).

 Circumvent criminal history as a barrier to employment and 

assist rehabilitation by appropriate expunging and sealing 

records and by providing certificates of rehabilitation.

 Engage AmeriCorps to provide transition services.

Program Development

 Address language barriers (for example, confusion and/or 

stigma regarding “consumer,” “ex-offender”).

Dialogue Participants’ Vision

Dialogue participants prefaced their recommendations for 

action in the future with a consensus statement of their 

vision:

We envision a consumer-driven prevention and

 recovery support system for individuals and

 families in the criminal justice system who are

 affected by trauma and mental illness, and for

 individuals at risk of involvement in the system. 

The support system the participants envision would 

span a continuum that includes prevention, diversion 

from incarceration, treatment, education, and community 

reintegration services. Peer support would be available 

within a mental health recovery unit at correctional 

facilities, and a transition team would ease community 

reintegration.
18

Consumers and Representatives of the Mental Health and

Criminal Justice Sytems in Dialogue

 Establish local forensic intervention consortia composed of 

mental health service providers, law enforcement personnel, 

and judges (and create broader, multistakeholder partnerships) 

in order to establish trust, transform adversarial criminal justice 

systems, and promote more humane alternatives.

 Develop individualized safety plans to avoid seclusion and 

restraint.

 Infuse consumer/peer support services into criminal justice 

systems.

Training and Education

 Educate professionals and the public on the role trauma plays 

in mental health problems and criminal justice involvement.

 Focus on compassion to enable families to help the person 

who is incarcerated.
19

Appendix A. 

Recommendations

The table below presents dialogue participants’ recommendations 

for action by policymakers, service providers, consumers, and 

researchers to improve the situation for mental health consumers 

involved in criminal justice systems. The participants’ priority 

issues are arranged by category: policy, program development, 

training and education needs, research, and rights protection. 

Within each category, recommendations are grouped by subject 

matter: mental health services, criminal justice issues, housing and 

employment, peer support, community reintegration, families of 

persons who are incarcerated, and discrimination and stigma. 

(Not all topics appear within all tables.) 

Policy

 Mental health 

services

1. Address fragmentation in mental health 

service systems (for example, by creating 

one-stop service centers that engage in 

outreach and follow-up).

2. Improve/establish mental health services 

in rural and other underserved areas.

3. Focus on individuals’ behavioral and 

attitudinal outcomes.

4. Remove bureaucratic and other barriers 

to treating co-occurring disorders jointly.

5. Update vocational rehabilitation 

programs to accommodate persons with 

mental illnesses (for example, provide 

training prior to job placement).

6. Provide funding for trauma-related 

services.

Criminal justice 

issues

1. Address the needs of persons in criminal 

justice systems with co-occurring 

substance use and mental illnesses. 

2. Use pretrial services for diversion from 

the criminal justice system.

3. Reduce the use of seclusion and restraint 

for problems related to mental illnesses. 
20

Consumers and Representatives of the Mental Health and

Criminal Justice Sytems in Dialogue

4. Engage the U.S. Department of Labor to 

establish and enhance services at onestop centers to ease the transition from 

incarceration into communities.

Housing and 

employment 

1. Circumvent criminal history as a barrier 

to employment and assist rehabilitation 

by expunging and sealing records and by 

providing certificates of rehabilitation.

2. Work to remove restrictions on housing 

and educational opportunities.

3. Take a holistic approach to housing and 

employment.

4. Ensure that housing is provided 

independently of treatment.

5. Permit families to live together in HUD 

(and other supported) housing.

6. Increase funding and scope of the 

Social Security Administration’s PASS 

program for education and vocational 

development, without loss of benefits.

7. Increase funding for employment training 

and internships.

8. Develop outcome measures to improve 

accountability of programs.

9. Promote business development, 

microenterprise, and niche markets for 

consumers.

 Peer support 1. Ease regulations to permit peers to 

provide services in correctional facilities.

2. Provide funding for peer support services 

in the criminal justice system.

3. Permit Medicaid reimbursement for peer 

support services.

4. Promote consideration by judges of 

testimony by mental health consumers as 

well as providers.

5. Increase accountability of governmentfunded programs by hiring consumer 

staff.
21

 Community 

reintegration

1. Engage AmeriCorps to provide transition 

services.

2. Establish standards for prosecutors, 

judges, and attorneys regarding 

expectations surrounding mental 

illnesses.

3. Establish and implement outcome 

measures for community reintegration 

services.

4. Define expectations and develop 

standards for criminal justice personnel 

regarding discharge planning and 

community reintegration of persons with 

mental illnesses.

5. Make set-aside funding available for 

transition services.

6. Create one-stop transition centers.

Families of 

incarcerated 

persons 

1. Reform the Aid to Families with 

Dependent Children Program.

2. Set family reunification as a priority.

3. Focus on prevention of mental disorders 

for children of persons who are/have 

been incarcerated.

Discrimination 

and stigma

1. Work to eliminate discrimination in 

employment related to criminal history.

2. Increase funding for programs for former 

offenders.

Program Development

Overarching 

principle

1. Address language barriers (for example, 

confusion and/or stigma regarding 

“consumer,” “ex-offender”).

Mental health 

services

1. Facilitate collaboration between mental 

health consumer-friendly and traditional 

criminal justice programs.

2. Incorporate consumers in meaningful 

program planning and services provision.
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Consumers and Representatives of the Mental Health and

Criminal Justice Sytems in Dialogue

3. Monitor mental health and other 

services for quality and accessibility by 

consumers.

4. Facilitate the connection to services when 

individuals move to new jurisdictions.

Criminal justice 

issues

1. Establish local forensic intervention 

consortia composed of mental health 

service providers, law enforcement 

personnel, and judges (and create 

broader, multistakeholder partnerships) 

in order to establish trust, transform 

adversarial criminal justice systems, and 

promote more humane alternatives.

2. Develop individualized safety plans to 

avoid seclusion and restraint. 

3. Facilitate collaboration between mental 

health consumer-friendly and traditional 

criminal justice programs.

4. Create links among the criminal justice 

system, traditional service providers, and 

peer-run programs in communities. 

5. Encourage jail diversion programs to 

recruit consumers as staff, volunteers, 

and policy board members.

6. Establish mental health recovery units 

in prisons that include peer support, 

educational opportunities, and antistigma activities.

Housing and 

employment

1. Convene dialogue(s) with Federal 

policymakers and legislators to discuss 

how to ease restrictions on education 

and housing.

2. Take a holistic approach to housing and 

employment.

3. Enlist directors of corrections 

departments, sheriffs, wardens, and 

others to plan and advocate together 

with the mental health community for 

housing solutions.
23

4. Develop alternative pathways to 

employment, in addition to vocational 

rehabilitation, including development 

and support of consumer-run businesses, 

microenterprise, and niche markets for 

consumers.

5. Offer support services intensive 

employment training and supported 

employment, with subsequent transition 

to competitive employment.

6. Provide the services of job coaches, 

retraining educators, business mentors, 

and consumer-run employment agencies.

7. Provide support services to facilitate 

employment (for example, transportation, 

child care).

8. Address trauma issues to facilitate clients’ 

readiness for work.

9. Develop peer supports for a continuum 

of jail diversion and/or reintegration 

services that rely on self-determination 

and choice. 

Peer support 1. Infuse consumer/peer support services 

into criminal justice systems.

2. Professionalize the peer specialist role 

and standardize guidelines for peer 

support.

3. Establish training and certification 

programs for peer specialists nationwide.

4. Promote recovery-oriented, selfdetermined, individualized service plans.

5. Broaden the peer support community to 

include consumers with criminal justice 

experience. 

6. Provide services aimed to sustain 

individuals’ desire to change, despite 

family cultures that do not support 

breaking the cycle.

7. Hire consumers as staff in jail diversion 

programs.
24

Consumers and Representatives of the Mental Health and

Criminal Justice Sytems in Dialogue

Community 

reintegration

1. Engage transition teams that include 

consumers in discharge planning.

2. Mobilize communities to facilitate 

reintegration.

3. Constitute transition teams whose 

members understand multiple community 

systems.

4. Focus on meaningful activities in the 

community, not just public safety or 

mental health treatment.

5. Establish and disseminate guidelines for 

family services.

6. Create jobs to avoid the burden of 

poverty.

7. Provide wraparound services in the 

community that include mental health 

and drug rehabilitation services.

8. Provide opportunities to learn to 

manage/balance one’s life responsibilities 

in addition to employment.

Discrimination 

and stigma

1. Mount a national campaign against 

discrimination and stigma( for example, 

in collaboration with the National 

Institute on Judicial Training and other 

relevant organizations).

2. Recognize that discrimination and stigma 

impact service availability and quality.

Training and Education

Overarching 

principle

1. Establish or enhance collaboration 

among technical assistance centers, 

governmental associations, and 

professional associations in the criminal 

justice and mental health fields.

2. Reach out to and educate allied groups 

at their meetings (for example, National 

Governors Association, corrections 

unions).
25

Mental health 

services

1. Educate professionals and the public 

on the role trauma plays in mental 

health problems and criminal justice 

involvement.

2. Promote recognition of the difference 

between severe mental illness and 

criminality.

 Criminal justice 

issues

1. Describe the population (of mental 

health consumers with involvement in 

the criminal justice system) succinctly 

to lawmakers in order to secure State 

resources.

2. Train first responders in crisis 

intervention methods using updated 

curriculum.

3. Establish technical assistance centers to 

guide professionals and consumers on 

issues at the intersection of the mental 

health and criminal justice fields. 

4. Provide technical assistance to women’s 

programs on evidence-based practices. 

5. Educate personnel in the criminal justice 

system on recovery.

6. Train transition teams to address access 

to housing, substance use and mental 

health treatment, and employment.

7. Coordinate meetings on the criminal 

justice system and mental health with 

criminal justice professional groups (for 

example, judges, corrections directors, 

sheriffs).

8. Train criminal justice personnel on 

inappropriate use of “quiet rooms” and 

“special housing units.”

9. Train corrections and mental health staff 

on alternatives to seclusion and restraint.

10. Create a national organization of 

persons with mental health problems 

and experience with the criminal justice 

system in order to educate advocates and 

serve as a clearinghouse for information 

and practice models.
26

Consumers and Representatives of the Mental Health and

Criminal Justice Sytems in Dialogue

11. Build trust between justice officials and 

consumers.

Housing and 

employment

1. Educate employers about Federal hiring 

incentives (for example, fidelity bonding, 

tax credits, certificates of rehabilitation).

2. Educate the business, faith, and general 

community about Equal Employment 

Opportunity regulations.

3. Educate legislators on the need to 

eliminate restrictions on educational 

support (for example, Pell grants and 

student loans) for former offenders.

4. Educate employers about recovery, using 

peers as educators.

5. Train a cadre of workforce-readiness 

instructors to recognize and to help to 

resolve individuals’ issues (including, 

for example, pre-job readiness concerns 

such as managing family needs, time, 

and priorities). 

Peer support 1. Develop and implement mechanism(s) 

by which peers educate criminal justice 

personnel on recovery.

2. Cross-train providers on the value of peer 

supporters and their life experiences, 

the importance of peer supporters in 

program planning, and ways to engage 

peer supporters in the work.

3. Update professional education to include 

modules on peer support and forensic 

mental health issues.

4. Educate consumers on the importance 

of establishing personal relationships 

with local law enforcement to avoid 

discrimination, stigma, and criminal 

justice involvement.

5. Create a national mentoring program for 

peer supporters.

Families of 

incarcerated 

persons 

1. Focus on compassion to enable families 

to help the person who is incarcerated.
27

2. Address family issues of adults and 

children within the criminal justice 

system.

3. Keep families of persons who are 

incarcerated informed and provide 

supports for them.

4. Recognize the need for services that 

sustain individuals’ desire to change, 

despite family cultures that do not 

support breaking the cycle.

5. Educate mental health and criminal 

justice professionals about attachment 

and bonding, and about women with 

trauma issues.

Community 

reintegration

1. Create and disseminate State/community 

guides for transition opportunities and 

resources.

Discrimination 

and stigma

1. Establish educational teams (mobile 

or other) in communities to counter 

discrimination and stigma.

2. Disseminate anti-stigma materials to State 

corrections officials and unions.

3. Educate personnel in State mental health 

systems on consumer inclusion.

4. Mandate anti-discrimination/anti-stigma 

education for professional mental health 

provider associations and for unions.

5. Develop courses that award continuing 

education units (CEUs) on issues relating 

to mental health and the criminal justice 

system.

6. Use people-first language (for example, 

people with mental illnesses, people who 

have committed crimes).

7. Address the NIMBY (Not In My 

BackYard) problem related to housing 

and job creation.

8. Establish a consumer-run technical 

assistance center (investigate Department 

of Justice programs).
28

Consumers and Representatives of the Mental Health and

Criminal Justice Sytems in Dialogue

9. Replicate dialogues at the State and local 

levels.

10. Develop standard presentations to 

educate community stakeholders.

11. Disseminate dialogue monographs to 

mental health providers, corrections 

officers, judges, police, tribal 

governments, legislators, and other 

stakeholders. 

Research

Mental health 

services

1. Identify and create evidence-based 

practices and promising practices.

2. Identify and implement linguistically and 

culturally competent, gender-specific 

service models of practice.

3. Develop measures for recovery that will 

lead to reimbursement for mental health 

services.

4. Determine evidence-based practices 

regarding mental health courts.

Housing and 

employment

1. Develop an understanding of the 

underlying issues and needs of clients in 

workforce programs, and devise ways to 

help clients work through them.

Peer support 1. Engage in research that investigates (and 

supports) the credibility of peer support 

programs.

Rights Protection

Criminal justice 

issues

1. Address institutionalized racism, 

including overrepresentation of 

minorities in the criminal justice system.

2. Support SAMHSA’s goal of working 

with States, consumers of mental health 

services, advocates, service providers, 

and provider organizations to eliminate 

the use of seclusion and restraint.
29

3. Recognize racial issues; people of color 

disproportionately experience seclusion 

and restraint.

 Housing and 

employment

1. Educate the business, faith, and general 

community about Equal Employment 

Opportunity regulations.
Consumers and Representatives of the Mental Health and

Criminal Justice Sytems in Dialogue
31

Appendix B. 

References and Resources

References

Bazelon Center for Mental Health Law. (2004, June 21). 

Legal advocate cites ongoing segregation on eve of Olmstead 

anniversary: Five years after key decision, Bazelon Center blasts 

slow movement of people with mental illnesses into the community, 

lack of services. Retrieved May 4, 2005, from 

www.bazelon.org/newsroom/6-21-04olmstead.htm.

Council of State Governments. (2002). Criminal Justice/Mental 

Health Consensus Project. New York: Author. Retrieved May 4, 

2005, from www.consensusproject.org

Kamenetz, A. (2004, January 14-20). A mentally ill inmate slips 

through the cracks—into the path of a subway train: The suicide 

of Mr. A. Village Voice. Retrieved December 21, 2004, from 

www.villagevoice.com/issues/0402/kamenetz.php

Massaro, J. (2004). Working with people with mental illness 

involved in the criminal justice system: What mental health 

service providers need to know (2nd ed.). Delmar, NY: Technical 

Assistance and Policy Analysis Center for Jail Diversion. 

New Freedom Commission on Mental Health. (2003). Achieving 

the promise: Transforming mental health care in America. 

Final report. DHHS Pub. No. SMA-03-3832. Rockville, MD: U.S. 

Department of Health and Human Services. Available at 

www.mentalhealthcommission.gov

New Freedom Commission on Mental Health. (2004). 

Subcommittee on Criminal Justice: Background paper. DHHS Pub. 

No. SMA-04-3880. Rockville, MD: U.S. Department of Health and 

Human Services. Available at 

www.mentalhealthcommission.gov
32

Consumers and Representatives of the Mental Health and

Criminal Justice Sytems in Dialogue

Technical Assistance and Policy Analysis (TAPA) Center for Jail 

Diversion. (2004). Towards a blueprint to respond to the President’s 

New Freedom Commission on Mental Health recommendations 

on adult criminal justice diversion. Notes from an expert panel in 

Annapolis, MD, October 28-29, 2003. Delmar, NY: Author.

U.S. Department of Health and Human Services. (1995). Double 

jeopardy: Persons with mental illnesses in the criminal justice 

system. Report to Congress. Rockville, MD: Center for Mental 

Health Services, Substance Abuse and Mental Health Services 

Administration.

U.S. Department of Health and Human Services. (2004). Building 

bridges: Mental health consumers and members of faith-based 

and community organizations in dialogue. Rockville, MD: Center 

for Mental Health Services, Substance Abuse and Mental Health 

Services Administration. Available at 

www.mentalhealth.samhsa.gov

Resources

Center for Mental Health Services

Substance Abuse and Mental Health Services Administration

U.S. Department of Health and Human Services

—the Federal agency that leads the national system that delivers 

mental health services to provide the treatment and support services 

needed by adults with mental disorders and children with serious 

emotional problems

1 Choke Cherry Road

Rockville, MD 20857

E-News Alert: www.mentalhealth.samhsa.gov/consumersurvivor

(join the listserv at the bottom of the screen)

Funding opportunities: www.samhsa.gov

Resource Center to Address Discrimination and Stigma: 

www.adscenter.org

Elimination of Barriers Initiative: 

www.allmentalhealth.samhsa.gov; 

www.nuestrasaludmental.samhsa.gov (Spanish)

Bazelon Center for Mental Health Law

—a national legal advocate for people with mental disabilities

1101 15th Street, NW, Suite 1212

Washington, DC 20005

www.bazelon.org
33

Criminal Justice/Mental Health Consensus Project

—a project to define the measures that State legislators, law 

enforcement officials, prosecutors, defense attorneys, judges, 

corrections administrators, community corrections officials, victim 

advocates, mental health advocates, consumers, State mental health 

directors, and community-based providers agree will improve the 

response to people with mental illness who are in contact (or at high 

risk of involvement) with the criminal justice system

Council of State Governments

40 Broad Street, #2050

New York, NY 10004

www.consensusproject.org

National Disability Rights Network

—the voluntary national membership association of Protection and 

Advocacy Systems and Client Assistance Programs, which constitute 

the nationwide network of congressionally mandated, legally based 

disability rights agencies

900 Second Street, NE, Suite 211

Washington, DC 20002

www.napas.org

National GAINS Center for People with Co-Occurring Disorders in 

the Justice System

—a national center for the collection and dissemination of 

information about effective mental health and substance abuse 

services for people with co-occurring disorders who come in contact 

with the criminal justice system

345 Delaware Avenue

Delmar, NY 12054

800-311-4246

www.gainscenter.samhsa.gov/flash/default.html

Office of Justice Programs, U.S. Department of Justice

—an agency that provides Federal leadership in developing the 

Nation’s capacity to prevent and control crime, improve the 

criminal and juvenile justice systems, increase knowledge about 

crime and related issues, and assist crime victims 

810 Seventh Street, NW

Washington, DC 20531

202-307-5933

www.ojp.usdoj.gov
34

Consumers and Representatives of the Mental Health and

Criminal Justice Sytems in Dialogue

Technical Assistance and Policy Analysis (TAPA) Center for Jail 

Diversion

—an organization that addresses the technical assistance and 

policy analysis needs of communities in developing programs to 

divert people with mental illness from jail into community-based 

treatment and supports (a branch of the National GAINS Center)

345 Delaware Avenue

Delmar, NY 12054

866-518-TAPA

518-439-7612 (fax)

www.gainscenter.samhsa.gov/flash/default.html
35

Appendix C. 

Participant List

 Planning Committee

 Joan Gillece 

 State of Maryland

 Mental Hygiene Administration

 Jessup, Maryland

 Tom Lane 

 New Horizons of the Treasure Coast

 Ft. Pierce, Florida

 Jacki McKinney 

 National People of Color, Consumer/Survivor Network

 Philadelphia, Pennsylvania

Henry Steadman

 Policy Research Associates, Inc.

 Delmar, New York

Dialogue Participants

Peter Boyles

 Bernalillo County 

 Albuquerque, New Mexico

Jeanne Cohen

 Legacy Health Systems

 Portland, Oregon

Rhonda Elsey-Jones 

 Trauma Network

 Baltimore, Maryland

Ramiro Guevara

 NAMI

 Arlington, Virginia

Melvin Hawkins

 Legacy Health Systems

 Portland, Oregon
36

Consumers and Representatives of the Mental Health and

Criminal Justice Sytems in Dialogue

 Stephen House

 Asheville, North Carolina

Justin Leon

 META Services, Inc.

 Phoenix, Arizona

Ann-Marie Louison

 Center for Alternative Sentencing and Employment Services

 New York, New York

Dorothy Madden

 Jewish Family and Children’s Services

 Glenside, Pennsylvania

Shirley Madden

 Jewish Family and Children’s Services

 Glenside, Pennsylvania

LaVerne Miller

 Howie the Harp Peer Advocacy Center

 New York, New York

Susan Mockus

 Tamar’s Children

 Cockeysville, Maryland

Anna Paxson

 Tohono O’odham Police Department

 Sells, Arizona

Stephanie Penn

 Offender Aid and Restoration Post-Release Services

 Kalamazoo, Michigan

Raymond Ortiz

 Urban Justice Center

 New York, New York

Daniel Souweine

 Council of State Governments

 New York, New York
37

Federal Representatives: SAMHSA/Center for Mental 

Health Services

Paolo del Vecchio

SAMHSA/CMHS

 Rockville, Maryland

Chris Marshall

 SAMHSA/CMHS

 Rockville, Maryland

Carole Schauer

 SAMHSA/CMHS

 Rockville, Maryland

Carlton Speight

 SAMHSA/CMHS

 Rockville, Maryland 

Facilitator

Ronald O. Forbes, M.D.

 Central State Hospital

 Petersburg, Virginia

Writer

Irene Saunders Goldstein

 Arlington, Virginia




SMA 05-4067

2005