People with mental illness and/or substance use disorders (individuals with “behavioral health” conditions) have largely fallen into our country’s prisons and jails as a result of:
(1) a de-institutionalization movement that closed a system of inhumane mental asylums without funding community-based mental health alternatives;
(2) the failure of traditional health insurance to treat behavioral health as equal to physical health when it comes to access to and payment for treatment; and
(3) the war on drugs, which swept people with addictions into a system not designed to treat their disease, but rather to punish their ‘immorality.’
In a time when the United States incarcerates more people per capita than any other country on earth (with 22% of the world’s prisoners but only 4.4% of the world population) and jails have been deemed “America’s largest mental hospitals,” this problem is gaining recognition for the extreme expense and poor outcomes generated by a system designed for punishment rather than treatment and rehabilitation. However, the criminal justice system alone is siloed into a dizzying array of actors (city-run police departments; county-run jails; countywide elected district attorneys; state and federal judges; state and federal prisons), each with a piece of the responsibility but easily able to pass responsibility on to others. The healthcare system, a complicated and massive system itself, struggles to adequately serve people with the toughest behavioral health needs. No one actor can fully solve the problem alone.
Given that government is responsible for the current system and will need to adapt its practices in order to solve the problem, Catia is focused on building tools internal to government agencies that will help to connect fractured systems into networks of actors with a common strategic vision of systematically shifting people from jail to treatment. To this end, Catia is currently working for the Middlesex County Sheriff’s Office in Massachusetts on “Smart Justice Initiatives” – the idea that the county jail can act as a hub for county-wide, data-driven strategies to divert people before arrest; better serve them while they are in jail; and make better health and housing plans for them as they re-enter the community from jail, reducing their likelihood of recidivism by improving their health and social outcomes. She hopes to create a localized strategic management process that she can grow and replicate across the country.
Catia recieved her MPP from the Harvard Kennedy School in 2018. Catia became passionate about criminal justice reform and behavioral health while helping Bernalillo County, New Mexico (Albuquerque) create a cohesive continuum of behavioral health services that would in part prevent the criminalization of individuals with mental illness and/or substance use disorder. In New Mexico, she witnessed the lack of options available to people who struggle with behavioral health conditions, and the perverse problem of diminishing healthcare options as severity of disease increases. She saw first-hand how this creates a downward spiral into the criminal justice system as mental disease begets loss of social supports begets further mental deterioration begets police involvement.
Catia’s dream is to create a criminal justice with a collective conscience – a coherent, system-wide strategic management practice that sets a goal (reduce the number of people with behavioral health conditions who are incarcerated) and then works, across all actors from police officers to correctional staff to judges, to divert people to healthcare options at every step. This will require mainstreaming the idea that a criminal justice system’s core mission is to reduce the need for incarceration. This is a nuanced way of saying that the system’s mission is to increase public safety or to reduce crime, because crime is subjective and public safety is enhanced, not diminished, by treating the underlying conditions that lead to arrest. She is published in the Kennedy School Review policy journal and is featured in a podcast discussing strategic management of the criminal justice system.