Criminalization of mental illness in Miami, Florida

Social Change Portfolio Criminalization of Mental Health in Miami, Florida Outline

Prevention, Consultation, and Advocacy Introduction Scope and Consequences Social-ecological Model Theories of Prevention Diversity and Ethical Considerations Advocacy INTRODUCTION
Crime and mental health are closely connected issues that impact both public safety and quality of life. Up to twenty percent of inmates are mentally ill, their criminal behaviors a symptom of untreated mental illness (Eide, 2018). Lack of access to mental health services is one facet of the problem. Another is the criminalization of the mentally ill or the diversion of mentally ill persons to the criminal justice system. In many cases, ethnicity, gender, and age are compounding variables that increase the propensity for persons to be diverted towards jail rather than towards effective mental health services. Yet in other cases, even Harvard graduates have fallen through the cracks in the system that are contributing factors to the proliferation of both violent and nonviolent crimes in Miami, Florida (Rivero & Green, 2019).
Recent initiatives to address the problem have demonstrated the promise of applying the social-ecological framework to focus more on prevention, taking into account biophysical, psychological, social, and spiritual risk and protective factors (American Mental Wellness Association, 2019; Eide, 2018; Reupert, 2017).

This project focuses first on the scope and consequences of the issue of criminality and mental health. The scope of the problem will be analyzed using current data and statistics on the local trends, and show how those local trends compare with national averages. Then, the analysis will address the many consequences of criminalization of mental health, including long-range factors such as the impact on educational attainment in affected communities, on income disparities, and on social justice outcomes. The goal statement of this project is aligned with the conscientious efforts on the part of local lawmakers, policymakers, and healthcare advocates dedicated to reducing barriers to mental health care.
References American Mental Wellness Association (2019). Risk and protective factors. Retrieved from https://www.americanmentalwellness.org/prevention/risk-and-protective-factors/ Eide, S. (2018). Keeping the mentally ill out of jail. City Journal. Autumn 2018. Retrieved from https://www.city-journal.org/miami-dade-criminal-mental-health-project Rivero, D. & Green, N. (2019). How Miami-Dade’s mental health program steers people to treatment, not jail. WJCT. 13 March, 2019. Retrieved from https://news.wjct.org/post/how-miami-dades-mental-health-program-steers-people-treatment-not-jail Reupert, A. (2017). A socio-ecological framework for mental health and well-being, Advances in Mental Health, 15:2, 105-107, DOI: 10.1080/18387357.2017.1342902

PART 1: SCOPE AND CONSEQUENCES The scope of the matter is huge. According to the Eleventh Judicial Circuit of Florida (2019), Miami-Dade County is “home to the largest percentage of people with serious mental illnesses...of any urban community in the United States,” at 9.1% of the population (p. 1). Thus, even if criminalization were not a major cause for concern, the prevalence rates of mental illnesses in Miami are. Serious mental illnesses include schizophrenia, bipolar disorder, major depression, yet only 13% of those suffering from these mental illnesses ever receive care (Eleventh Judicial Circuit of Florida, 2019). Because of inadequate prevention and care, the majority end up behind bars. Yet as Eide (2018) points out, “incarceration tends to worsen serious mental illness,” (p. 1). The problem of criminalization therefore needs to be addressed as a primary social change issue.
The consequences of the criminalization of mental illness are severe, given Miami-Dade County has twice the national rates of both violent and non-violent crimes (“Overview of Miami-Dade County,” 2019). Many of these crimes can be prevented through effective interventions and preventative strategies. A large proportion of violent and non-violent crimes can be traced to “a severe lack of access to quality and affordable mental healthcare,” (Rivero & Green, 2019, p. 1).
Not only does the problem affect public safety and quality of life for all residents, but also reduces the effectiveness of the criminal justice system. For example, 17% of the total inmate population has serious mental illnesses, costing taxpayers more than $50 million per year (Eleventh Judicial Circuit of Florida, 2019). The criminal justice system is not designed to be a mental health care facility, and using it as such increases wastefulness in public spending. Furthermore, ineffective responses to mental health problems leaves lingering scars on the lives of individuals, their families, and entire communities due to problems related to violence, poverty, and isolation.

References Eide, S. (2018). Keeping the mentally ill out of jail. City Journal. Autumn 2018. Retrieved from https://www.city-journal.org/miami-dade-criminal-mental-health-project Eleventh Judicial Circuit of Florida (2019). Criminal mental health project. Retrieved from https://www.jud11.flcourts.org/Criminal-Mental-Health-Project “Overview of Miami-Dade County,” (2019). US News and World Report. Retrieved from https://www.usnews.com/news/healthiest-communities/florida/miami-dade-county#public-safety Rivero, D. & Green, N. (2019). How Miami-Dade’s mental health program steers people to treatment, not jail. WJCT. 13 March, 2019. Retrieved from https://news.wjct.org/post/how-miami-dades-mental-health-program-steers-people-treatment-not-jail

PART 2: SOCIAL-ECOLOGICAL MODEL The social-ecological model provides a holistic framework for responding to the criminalization of mental health in Miami, Florida. Comprised of a systematic analysis of biophysical, psychological, social, and spiritual risk and protective factors, the social-ecological model can effectively reduce mental health disparities and lead to comprehensive solutions for both prevention and intervention (American Mental Wellness Association, 2019). Research on severe mental health issues like suicide require a “multi-level approach” that takes into account numerous and diverse risk and protective factors (Cramer & Kapusta, 2017, p. 1). In fact the social-ecological model can be used for developing the most appropriate methods of assessment, treatment, and prevention according to the needs of specific population subsets (Cramer & Kapusta, 2017). The social-ecological model is therefore effective at addressing the needs of the diverse populations in Miami, Florida.
Both risk and protective factors will vary depending on demographics, socioeconnomic conditions, political climate, and individual differences. Risk factors can compound a propensity to develop a severe mental illness or can trigger mental illness. Biophysical risk factors include family history of mental illness, chronic physical illness, drug or alcohol use, and poor nutrition. Psychological risk factors include stressful life events, lack of effective coping strategies, lack of self-efficacy, and low educational attainment. Social risk factors include exposure to violence, abuse, and neglect, lack of social or cultural capital including linguistic barriers, poor social support networks, mental health stigma, poverty, discrimination, and low awareness or lack of access to mental health services. Some members of the Miami community might also experience spiritual risk factors related to existential beliefs about the meaning or purpose of one’s life or one’s perception of sin and death (American Mental Wellness Association, 2019). The most effective social change strategies take multiple factors into account.
The social norms related to mental health will also have a strong impact on whether a person will perceive stigma or lack of support. Likewise, social norms will affect the individual’s outlook on life, promoting either an optimistic or pessimistic worldview. As Swearer & Hymel (2015) point out in a social-ecological model related to bullying prevention, peer group influences, family influences, community factors, and cultural influences can also have strong bearings on either risks or protective factors.
Protective factors provide the individual or family with coping strategies and other means to build resilience. Biophysical protective factors include overall sound physical health and healthy lifestyle. Psychological protective factors include a positive outlook, high self-esteem or self-efficacy, emotional intelligence, trust in the mental healthcare system, and willingness to accept help. Protective social factors include access to financial and social resources, engagement with family and community, access to mental health services, and participation in mental health services such as counseling or support groups. The goal of any social change initiative should be to decrease risk factors and increase protective factors for all target populations.

References American Mental Wellness Association (2019). Risk and protective factors. Retrieved from https://www.americanmentalwellness.org/prevention/risk-and-protective-factors/ Cramer, R.J. & Kapusta, N.D. (2017). A social-ecological framework of theory, assessment, and prevention of suicide. Frontiers in Psychology 2017(8): doi: 10.3389/fpsyg.2017.01756 Swearer, S. M., & Hymel, S. (2015). Understanding the psychology of bullying: Moving toward a social-ecological diathesis–stress model. American Psychologist, 70(4), 344-353

PART 3: THEORIES OF PREVENTION Theories of prevention typically start with education. Education can transform values and norms, improving attitudes towards mental health in general and increasing the extent and strength of social support networks throughout the community (Laureate International Universities, 2018). Furthermore, educational institutions provide formal support systems such as free peer support groups, free or affordable counseling services, and referral services to students and other members of the community. By focusing on risk and protective factors, the social-ecological model is congruent with theories of prevention. In addition to the biopsychosocial theory of mental health, other applicable theories of prevention include developmental theory, social cognitive theory, health belief theory/model, the stages of change theory, and the theory of planned behavior (Min, Lee & Lee, 2013). Applied to the problem of criminalization of mental health issues in Miami, the social-ecological model for prevention provides the most comprehensive insight into how to anticipate the needs of diverse sub-populations, offer culturally-appropriate and age-appropriate outreach and advocacy services, and also uproot some of the underlying issues that trigger stress among individuals, families, and communities. Prevention also includes a thorough assessment of the existing political and policy concerns that impact mental health services. While Miami is leading the nation in progressive interventions that divert the mentally ill from the criminal justice system, there is still more that can be done to reduce rates of preventable violent and nonviolent crime through effective public policy.

References Laureate International Universities (2018). Educating Uganda’s Future Community Leaders. Retrieved from http://laureatehereforgood.net/HFG-in-action/educating-ugandas-future-community-leaders/ Min, J., Lee, C. & Lee, C. (2013). Mental health promotion and illness prevention. Psychiatry Investigation 10(4): 307-316.