Deputy Surgeon General
U.S. Department of Health and Human Services
Larry Meachum, Director
Corrections Program Office
Office of Justice Programs
U.S. Department of Justice
H.Westley Clark, Director
Center for Substance Abuse Treatment
U.S. Department of Health and Human Services
Summary of Proceedings
Opening remarks for the second day of the National Assembly focused on implementing a multidisciplinary systems approach in the criminal justice system, which increasingly finds itself dealing with individuals and families having multiple and complex problems and needs. The resources, knowledge, and skills required to meet these needs go beyond those available through traditional criminal justice programs. Integration of services provided by multiple service systems, particularly public health (including mental health) and criminal justice, is imperative.
Systems integration requires leadership from the highest levels of government with the private sector encouraging, perhaps even requiring, collaborative working relationships among the systems. This leadership commitment depends on the recognition that the well-being, health, and safety of individuals, families, and communities are inextricably related.
Dr. Kenneth Moritsugu, Deputy Surgeon General, urged criminal justice professionals to work together to ensure a community-based continuum of care for individuals involved in the criminal justice system. This continuum, according to Moritsugu, includes appropriate prevention and education efforts, screening and early detection of substance abuse and physical/mental illness, interventions and treatment opportunities, and necessary follow-up and aftercare services.
Dr. H. Westley Clark, Director of HHS's Center for Substance Abuse Treatment (CSAT), also argued for systems integration, and suggested that individualized case management is the best approach to ensure success in the long run. No easy solutions can be applied to all people or circumstances: Juveniles and women have needs that differ from those of adult men, for example. New programs and approaches tailored to the individual must be developed. Creative, community-driven solutions, such as drug and other specialty courts, can help meet these needs.
CSAT is exploring a program that would restore substance-abusing felony offenders, who recover from their addiction and pay their debts to society, to full citizenship rights, including voting and employment. This would mean sealing criminal records (unless new crimes were committed) because the stigma of a felony conviction is a permanent serious impediment to meaningful employment.
A covenant would be created in which former offenders would comply with individual treatment and accountability plans. In return, the justice system would minimize and avoid excessive, lengthy, or permanent legal penalties for nonviolent crimes of illegal drug use or for nonviolent crimes committed while a person was a substance abuser.
When substance-abusing criminals are rehabilitated and permitted to redeem themselves, everyone in society benefits, Clark said. If such a rehabilitation and redemption system could be created, millions of persons who were convicted for nonviolent criminal activities related to drug abuse could be returned to society as drug-free, productive citizens.
Although both speakers emphasized the importance of prevention, education, and early intervention at the community level, they also noted there always will be individuals who will need to be incarcerated. A collaborative, systems integration approach also will be most effective in prison settings, where extended incarceration provides opportunities for mandatory treatment of substance abuse and a case management system that offers a wide range of services to help offenders successfully reenter communities.
Agreeing that the time is right for collaboration and systems integration between criminal justice and public health, Larry Meachum of the Office of Justice Programs' Corrections Program Office talked about the difficulty of implementing some of the ideas presented. In the criminal justice system, for example, many professionals are being asked to change their basic philosophical model. In the 1960s and 1970s, corrections systems tended to reflect an older "medical model" perspective, which viewed a "sick society" as responsible for producing criminalsi.e., unhealthy environments produced unhealthy individuals. A more recent philosophy in criminal justice represents a radical shift from the medical model to one based on behavioral theories. From this perspective, individuals are seen as responsible for their actions. The behavioral model may well conflict with the medical model that still tends to pervade public health's approaches.
Furthermore, said Meachum, some lingering distrust exists between the two systems, stemming from the large-scale deinstitutionalization of the mentally ill in the 1960s and 1970s coupled with a failure to establish community networks of mental health facilities to replace closed hospitals. The result, in the view of many, was that the criminal justice system became the "dumping ground" for mentally ill persons.
However, regardless of past events or lingering perceptions, Meachum was optimistic that now is the time to move forward with new relationships based on cooperation and collaboration. "The very fact that we are all here for this Assembly means that the problems are solvable and that we can work together to do something positive," he said.
Both criminal justice and public health professionals believe that the government has the dual responsibilities of maintaining social order and reducing and preventing human suffering by helping to ensure quality of life, Meachum noted. These common values and beliefs can drive the work that needs to be done.
Last Updated: March 4, 2002