Behavioral Health Key to Louisiana’s Problems in Corrections says Director

Dr. Raman Singh, Director, Medical and Behavioral Health, Louisiana Department of Public Safety & Corrections, told psychologists last month that the leverage for dramatic changes in the state’s incarceration rate was to institute behavioral health reforms in the Louisiana criminal justice system. The legislature passed laws in its 2017 session to begin the reforms that Governor Edwards said was a top priority, and some of the key changes Singh explained were needed to overhaul the problems Louisiana has in its corrections and justice system.

Singh, a medical doctor and cardiologist by training, spoke to a packed session at the Convention of the Louisiana Psychological Association (LPA) held June 2 and 3 in New Orleans.

“Louisiana’s incarceration rate contributes to over-representation of the mentally ill in the criminal justice system,” Singh told the audience, noting that the United States has the highest per capita incarceration rate in the world and that Louisiana has the highest per capita incarceration rate in the US. Dr. Susan Tucker, clinical psychologist and the Assistant Warden at the Bossier Parish Medium Security Facility, and in-coming President-Elect of LPA, introduced Dr. Singh and explained the significance of comprehensive psychological programs in the corrections and justice system. Tucker developed the Steve Hoyle Intensive Substance Abuse Program which has earned national recognition for excellence. In 2016 the Louisiana Legislature commended Tucker and her team in a House Concurrent Resolution pointing to multi-million dollar cost savings to the state because of shorter incarceration times of those offenders who participated in the psychological programs designed by Tucker. Dr. Singh is responsible for the functional supervision of medical and behavioral health staffs who coordinate on-site care for 19,000 offenders assigned to state prisons, for all off-site health care needs for 38,000 DOC offenders and 16,000 local offenders housed in all state prisons and 104 local jails or detention centers. Singh explained to the audience of psychologists and professors that the reasons for over-incarceration in Louisiana is well-established. Based on a 2016 Louisiana Legislative Auditor’s review Singh said the top reasons were mandatory sentences and habitual offender laws, high rates of local incarceration without treatment programs, and “not addressing issues driving criminal behavior such as substance and mental illness.” Singh said that the 599 criminal statute and 164 mandatory minimum sentences contribute to over-incarceration in Louisiana, which are sentences without benefit of probation, parole or suspension. He said that 55 percent of mandatory minimum sentences are for non-violent crimes and that these minimums “shift sentencing discretion from judges to prosecutors.” Another serious factor is the high rates of local incarceration in Louisiana where there is no treatment. Jails and prisons have a disproportionately high number of persons with mental health issues and people with a serious mental illness (SMI), Dr. Singh explained. He noted that of the mentally ill in society, greater than 40 percent have been arrested and the majority of these are brought in for minor offenses. Those with mental illness spend two to five times longer in jail. Singh told the attendees that there was a complex interplay of multiple societal factors stemming from problems in education, stressed family structures, socio-economic challenges and lack of job opportunities. He pointed out that the unemployment rate in the mentally ill adults in Louisiana is 88.3 percent.

And while 16 percent of the DOC prison population has been diagnosed with a SMI, 82 percent are diagnosed with a substance use disorder. “Incarceration of mentally ill exacerbates symptoms of mental illness. Rarely does incarceration of the mentally ill lead to an improvement in their mental status,” said Singh. His vision is to reduce the criminalization of those with mental illness and to resolve the crisis with a comprehensive solutions that provide treatment to those who need it. He promotes the Medicaid expansion and mental health parity. He said that 43 percent of the entire eligible Medicaid Expansion population in Louisiana has a mental health condition, and that offenders with mental illness or substance use disorder can be treated effectively. He wants more outpatient mental health care, more Rapid Stabilization Centers, and emerging models that prevent arrest and incarceration of adults with mental illness, called the Forensic Assertive Community Treatment Programs. To help create alternatives to incarcerating those with mental illness, Dr. Singh said that Forensic Diversion Facilities are needed to help alternative sentencing for offenders with mental health issues and who have committed a minor crime. Expansion of the Mental Health Courts are essential, especially because a majority of offenders are incarcerated for “crimes of survival” such as theft of food or breaking in to find a place to sleep. He wants to strengthen family and communities and help judges divert nonviolent offenders away from jails with better mental health legislation. Dr. Singh serves on the Louisiana Governor’s Drug Policy Board, Louisiana Task Force on Telehealth Access, Louisiana Re Entry Council, Louisiana Medicaid Quality Committee, Louisiana Commission on Preventing Opioid Abuse as well as chairs the Louisiana Commission on HIV/AIDS and Hepatitis C. He has also been appointed by Governor Edwards to be his liaison to the White House Data Driven Justice Initiative project.

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