People with both a mental illness and a substance use disorder are arrested at higher rates than their peers with only a mental illness or addiction, according to a new report from The Pew Charitable Trusts published this week.
The report found that while about 2% of the U.S. population has a co-occurring disorder (both a mental illness and substance use), people with both diagnoses made up a disproportionate 15% of arrests.
“One of the main takeaways is clearly that we need to recognize that most of the people with mental illness who are arrested also have a substance use disorder. Yet this is not the way that this is often talked about,” said Tracy Velázquez, the lead researcher on the report.
Treatment programs and the broader behavioral health system — both in the Seattle area and nationwide — need to do a better job of understanding and addressing the intersections between mental illness and substance use if they’re going to help people effectively, people who work in the field told The Seattle Times.
“My experience here in Seattle is that beds are not available for this population to be getting both the mental health support and the substance use support at the same time,” said Richard Deluga, clinical supervisor on the community outreach and assessment team at Downtown Emergency Service Center that serves homeless residents in the Seattle region. “It’s usually one or the other”
Pew analyzed data from the National Survey on Drug Use and Health from 2017 to 2019. It’s a self-reported survey, but it’s the only national data source available for patterns about behavioral and mental health and treatment. It also asks respondents if they were arrested in the past year.
Among the findings, Pew also found that women with co-occurring disorders were arrested 19 times more often than women with neither diagnosis. Black adults were also 1.5 times more likely to be arrested with a co-occurring disorder than their white counterparts.
Almost half of the people arrested had a drug-related charge but no other offenses. Only 10% of the arrests were for a serious, violent offense.
When it comes to treatment, the report also found that few people received coordinated care to tackle their co-occurring disorders — despite the research showing that this form of treatment produces better outcomes for people. Forty-five percent of survey respondents say they received help for just their mental illness, 3% received help for their substance use, and only 10% received it for both.
None of that is surprising to Deluga at DESC.
“This is what I see on a day in and day out basis,” he said.
“Unfortunately, the way the system is set up is that [people with co-occurring disorders] go to jail. And then they are released back into the streets without the resources,” Deluga said.
Deluga points to the cycle familiar to many mental health providers: People destabilize, sometimes cope with drugs, often exacerbating their mental health, and law enforcement gets involved — either because of drug charges or because concerned community members reach out to police.
If there’s any chargeable offenses, police arrest individuals who await their cases in jail, often without treatment. For lower-level offenses, charges are often dismissed and people cycle back through.
“Law enforcement feels — and I’m definitely not trying to put any words in anybody’s mouth — but law enforcement feels pressure to address some of the common problems that the community is dealing with,” Deluga explained.
Christopher Archiopoli, the director of Peer Seattle, which provides peer counseling in the LGBTQ+ community and serves people with mental illnesses, addiction and HIV/AIDs, echoed that he sees police cracking down on people in the midst of crisis.
He said the greatest challenges for some of his organization’s members include stigma for both their illness and drug use, as well as how long it can take to find the appropriate treatment.
“If somebody has made this decision that they want to improve their life and make changes, they need that support immediately. They don’t need it in two months,” he said.
“In two months, they could have changed their mind, in two months they could have died of a fentanyl overdose.”
In 2017, King County announced the first detox facility in the region to also fully integrate mental health treatment. Located in Seattle’s Beacon Hill neighborhood, the facility touted 33 detox beds and 40 intensive inpatient treatment beds.
It remains one of the few facilities in the Seattle area to clearly serve people with co-occurring disorders and prioritize homeless residents specifically. While other private facilities exist that target dual diagnoses, they often do not accept Apple Health, Washington’s Medicaid plan.
Leo Flor, the director of the King County Department of Community and Human Services, said the mental and behavioral health field acknowledges this and has been integrating over time to tackle these twin issues.
“I think it’s uncontroversial,” he said. “It’s absolutely where we need to go.”
While King County voters will soon be deciding on whether to implement a tax levy to build five new crisis centers in the region, those services are years away from being built, if at all — and they’re functionally a different part of the mental health system, focusing on crisis management not longer-term, dual treatment.
Still, Velázquez, the author of the report, stresses the benefits of building services for people with co-occurring disorders: “Addressing the needs of this population could both reduce the use of the criminal justice system and improve outcomes for these individuals and their communities,” she said.
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