Letter

In Reply: To clarify, our article reported on state mental health agency (SMHA) directors' priorities, not our own. However, ongoing activities of SMHA directors throughout the country demonstrate that people with mental illness who become involved in the justice system are not a forgotten population.

Data from the National Association of State Mental Health Program Directors (NASMHPD) Research Institute indicate that in fiscal year 2005, seven of 44 SMHAs provided mental health services to adults in prison through a formal arrangement with the state department of corrections; in 38 states, the state department of corrections provides these services. In addition, over one-third of the $8 billion currently expended by SMHAs in state psychiatric hospitals is for forensic and sex offender services, and these expenditures are expected to increase. Twenty-five of 43 states use mental health courts to divert persons with mental illness from the criminal justice system. Thirty-four of 40 SMHAs have reported specific initiatives to reduce fragmentation between the SMHA and the state's corrections department, including coordinating client eligibility and combining and coordinating funding streams and service delivery systems.

SMHAs differ across the country in the role that they play regarding persons with mental illness in the correctional (and judicial) system. The activities of the SMHA are defined by state statutes and regulations and by dictates from the governor's office. Our experience with SMHA directors suggests that they are concerned with the corrections population from several perspectives. They are concerned that there is little opportunity for presentencing screening to identify persons who have a severe mental illness and about the transfer of inmates from prisons and jails to state hospitals and other SMHA facilities because these inmates have received no therapeutic benefit from services provided in the correctional system. They also have concerns about their restricted ability to provide services immediately after prison release because of processing delays in determining Medicaid eligibility.

SMHAs' additional investment is also reflected in their participation in the Council of State Government's Criminal Justice and Mental Health Consensus Project and in the council's current development of a "blueprint" to coordinate state mental health, substance abuse, and corrections agencies. Also, NASMHPD has an ongoing task force on mental health and corrections. Finally, a number of states applied for the U.S. Department of Justice's fiscal year 2007 Justice and Mental Health Collaboration Program.

Although in Dr. Roskes' experience persons with mental illness in corrections may be victims of an "out of sight, out of mind" SMHA policy, attributing this outcome to a conscious effort by SMHA directors to abdicate responsibility does not comport with our interactions with these directors. When asked about priorities for a given fiscal year, directors tend to report the coming year's priorities, most of which are new and emerging initiatives, which may partially explain why issues with this population were not specifically highlighted as a priority.

Our thanks to Dr. Roskes for his interest in and concern for accountability within the public mental health system.

Dr. Mazade is executive director of the NASMHPD Research Institute, Inc., and Dr. Glover is executive director of NASMHPD.