Sharam Kohan

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Sharam Kohan is a social justice advocate and founder of Kohan initiative that promotes principles of community-based behavioral health services for justice-involved individuals.

Individuals with behavioral health issues are overrepresented in jails and prisons across the United States.

Most of these individuals return to their communities, families, and social networks and subsequently require community-based behavioral and physical health care services. Research has shown that mental and substance use disorders affect people from all walks of life, with or without justice involvement, and, with the services and supports of behavioral health providers, many people recover. Community-based behavioral health providers play a key role in ensuring that every individual they serve has the treatment, support, skills, and opportunity for recovery and lives productively with dignity and respect.

Unfortunately, people who need access to quality community-based care may be arrested instead. In many communities, people with behavioral health disorders cannot access adequate community-based services and find themselves channeled into the justice system. This may happen when a person is arrested for behaviors or actions related to his or her untreated mental illness. Additionally, some law enforcement officers use discretion to arrest when they believe a person needs health care services that are provided in the jail.

Arrest and incarceration often destabilize an individual’s life, including their housing, health care, employment, and social connectedness. Researchers have found that even brief incarceration leads to adverse consequences, including loss of employment and future employment opportunities, poorer physical and behavioral health due to breaks in health care services and treatment, loss of housing and future housing opportunities, and disruptions in family life and social connections. Once in the criminal justice system, individuals with mental and substance use disorders stay in jails longer, have an increased risk for self-harm, and receive more frequent punitive responses to infractions. Due to funding and staffing limitations, many people with mental illnesses do not receive the services they need and their conditions often worsen inside jail settings. For individuals already receiving medications and treatment in the community, these services may be interrupted during incarceration, creating lapses in treatment and difficulties in resuming treatment upon release and reentry to the community. Without continuous coordinated care throughout and following incarceration, these individuals are at risk for re-incarceration, emergency department use, and hospitalization.

Clinical and case management skills of community providers are the foundation of effective treatment and services for justice-involved individuals. Additional training, knowledge, and skills may be needed, but the goals of community-based treatment—improving behavioral and physical health through treatment and services, promoting social wellbeing, and preventing or reducing the likelihood of contact with the criminal justice system—remain the same. The Principles elevate essential components to achieving the goals of community-based treatment and quality care for justice-involved individuals.

Sharam Kohan is an alumnus of Harvard University.[]