As a psychiatric social worker in a busy urban clinic, I work with patients often just discharged from long prison stays. I have seen firsthand how incarceration only exacerbates mental health problems. Many of the individuals I see suffer from what is called a co-occurring disorder. That is, they suffer from both psychiatric and addictive illness.

I also experience this struggle at a very personal level. I am the mother of an adult son who suffers from addictive illness and who has been incarcerated multiple times mostly for minor violations (not showing up for a probation hearing). My son suffers from a co-occurring disorder and, like many people in jail and prison, has never harmed anyone. Both his mental challenges and his addiction compromise his ability to problem-solve, plan for the future and to have a high tolerance for frustration.

Incarceration has only exacerbated his mental problems. He’s received no vocational training, no comprehensive psychiatric treatment (including medication management and psychotherapy) and no help with the huge challenges of re-entering a world with no housing, no food, no financial support and no employment. We have fought the fight so long that we’re exhausted emotionally, physically and financially. But his co-occurring disorder remains.

As a society, we have tried and failed to arrest our way out of these social and health issues. That approach is inadequate, unjust and expensive. And what do we have to show for it? About one in four individuals in state prison suffers from mental illness. Nearly four out of five who could benefit from substance abuse treatment do not receive it.

It’s time for a better approach.

Last year, California voters overwhelmingly approved Prop. 47, which reclassified six low-level drug and petty theft offenses as misdemeanors in order to cut incarceration costs and invest those savings in mental health and drug treatment services, keeping kids in school and services for crime survivors. Prop 47 was designed to stop the punitive approach to non-violent offences and to promote safer communities by getting at the root causes of crime.

Prop. 47 creates the opportunity to shift toward a more compassionate, effective and cost-effective approach to mental illness and drug addiction. Now we need our leaders to demonstrate their commitment to carrying out that voter mandate by expanding proven crime-prevention strategies – not the same old approach of simply arresting people and doing nothing else.

San Diego is an innovative place. We can do this. We already have programs we could expand right now with state funds our county receives every year specifically for crime prevention (including mental health and drug treatment). Take, for example, San Diego’s Serial Inebriate Program, which works with repeat misdemeanor offenders struggling with alcohol and methamphetamine. There’s also the city’s Homeless Outreach Team, which connects 700 homeless people a year with services – and could do more with increased funding. The city attorney took the initiative to create a Community Court for people facing misdemeanor charges but that program isn’t currently able to link people with drug treatment.

We should also learn from others. In Seattle, for example, the Law Enforcement Assisted Diversion program directs people to social services rather than booking them into jail. The program is associated with a nearly 60 percent drop in recidivism.

Prop. 47 was a historic milestone for California, but we can’t stop until our own new vision for safety is an integral part of every neighborhood. State and local leaders need to respect the will of the voters and get behind implementation reforms rather than fight against them at the cost of community health and safety.

Caroline Ridout Stewart is a licensed clinical social worker and seasoned psychotherapist with over 25 years of experience in co-occurring disorders (persons with both psychiatric and addictive illness). She is also president of the board of A New PATH (Parents for Addiction Treatment and Healing). Stewart’s commentary has been edited for style and clarity. See anything in there we should fact check? Tell us what to check out here.


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