Policy Goal 2: Select, understand, and use common definitions across branches and levels of government
1. Does the state have a common definition of serious mental illness (SMI)?
RATIONALE: Adopting a shared definition that is consistently used by state and local behavioral health entities and criminal justice agencies throughout the continuum helps
- Identify a common “target population” for cross-agency efforts to reduce the prevalence of SMI in local criminal justice systems;
- Ensure that eligibility for services is consistent across state and local agencies; and
- Set a common metric for establishing a baseline prevalence rate and tracking outcomes of policy and practice changes.
Ways to do it
- Convene a state-level working group to develop shared definitions. This group may look to existing definitions, for example as set by Medicaid, a state agency, or in relevant statutes, and decide to adopt and promulgate one of these definitions to a broader audience.
- Issue model definitions for voluntary uptake that could be shared across agencies.
- Require or recommend use of common definitions in program design, data collection, and reporting for state funding and cross-system grant programs.
Things to consider
- Although there is no universal, standardized definition for SMI, states can adopt a statewide definition that draws upon established definitions from credible sources, such as the DSM-5 or SAMHSA. Most states mirror DSM-5 criteria in their definitions, but there is considerable variation across states.
- SAMHSA uses the following definition: “Serious mental illness is defined by someone over 18 having (within the past year) a diagnosable mental, behavior, or emotional disorder that causes serious functional impairment that substantially interferes with or limits one or more major life activities.” SAMHSA created this definition to establish block grant eligibility.
- Note that SAMHSA also defines Serious Emotional Disturbance (SED) when referring to similar conditions in youth and young people. SED is defined as a “diagnosable mental, behavioral, or emotional disorder experienced by people under the age of 18 in the past year, which resulted in functional impairment that substantially interferes with or limits the child’s role or functioning in family, school, or community activities.”
State Examples
2. Does the state have a common definition of substance use disorder (SUD)?
RATIONALE: Adopting a shared definition that is consistently used by state and local behavioral health entities and criminal justice agencies throughout the continuum helps
- Identify a common “target population” for cross-agency efforts to reduce prevalence and improve treatment for people with SUDs in local criminal justice systems;
- Ensure that eligibility for services is consistent across state and local agencies; and
- Establish a common metric for forming a baseline prevalence rate and tracking outcomes of policy and practice changes.
Ways to do it
- Convene a state-level working group to develop shared definitions. This group may look to existing definitions, for example as set by Medicaid, a state agency, or in relevant statutes, and decide to adopt and promulgate one of these definitions to a broader audience.
- Issue model definitions for voluntary uptake that could be shared across agencies.
- Require or recommend use of common definitions in program design, data collection, and reporting for state funding and cross-system grant programs.
Things to consider
- Although there is no universal, standardized definition for SUD, states can adopt a statewide definition that draws upon established definitions from credible sources, including the DSM-5 and SAMHSA.
- The DSM-5 definition for SUD is commonly used as a standard definition at the state level.
- SAMHSA currently uses the following definition: “Substance use disorders occur when the recurrent use of alcohol and/or drugs causes clinically significant impairment, including health problems, disability, and failure to meet major responsibilities at work, school, or home.”
- The American Society of Addiction Medicine (ASAM) provides guidance on treatment placement criteria for adolescents and adults and is required in over 30 states.
State Examples
3. Does the state have a common definition of homelessness?
RATIONALE: Having a common definition of homelessness helps the state ensure that people who may not meet one of many federal definitions receive consistent services from state and local agencies, particularly as people may cycle between public systems, such as corrections, hospitals, and homelessness systems. Some definitions of homelessness, such as HUD’s “chronically homeless” definitions, can exclude people who often cycle in and out of jails if they do not meet certain requirements, such as spending more than 90 days in jail over the course of a year.
By developing a standard definition at the state level, states can ensure that people who may cycle in and out of jails—and who may lose eligibility under federal programming—can maintain eligibility for state programs as they enter or exit the criminal justice system. A state-level definition can align a state’s response to homelessness across state agencies.
Ways to do it
- Convene a state-level working group to develop shared definitions. This group may look to existing definitions, for example as set by Medicaid, a state agency, or in relevant statutes, and decide to adopt and promulgate one of these definitions to a broader audience.
- Careful consideration is needed to balance state and federal definitions to best benefit people in contact with the criminal justice system, as when there is a mismatch, this population is often excluded or faces outsized negative consequences in terms of access to housing.
- Issue model definitions for voluntary uptake that could be shared across agencies.
- Require or recommend use of common definitions in program design, data collection, and reporting for state funding and cross-system grant programs.
Things to consider
- There is no standard definition of homelessness. States and local jurisdictions must comply with different definitions associated with programs administered by a range of federal agencies. There are at least four definitions of homelessness at the federal level that the U.S. Department of Housing and Urban Development (HUD), the Department of Education, Health and Human Services, and the Social Security Administration use to determine eligibility for specific programs.
- With competing federal definitions, counties, advocacy organizations, and community organizations sometimes provide additional definitions of “homelessness” to meet the service needs of people who frequently cycle in and out of jails who may not qualify under other existing definitions but still need services.
State Examples
4. Does the state have common definitions of recidivism (e.g., rearrest, reconviction, reincarceration, revocation)?
RATIONALE: Calculating recidivism rates helps determine whether people with behavioral health needs are successful upon release from jail. State guidance on establishing a common definition of recidivism will ensure consistency across the state and better guide decisions about implementation of programming and policies to scale up successful interventions and eliminate strategies that are not proving effective.
Ways to do it
- Convene a state-level working group to develop shared definitions. This group may look to existing definitions, for example as set by Medicaid, a state agency, or in relevant statutes, and decide to adopt and promulgate one of these definitions to a broader audience.
- Issue model definitions for voluntary uptake that could be shared across agencies.
- Require or recommend use of common definitions in program design, data collection, and reporting for state funding and cross-system grant programs.
Things to consider
- There is considerable variation across state and local agencies in recidivism definitions and the means of measuring that recidivism. Key measures include the following:
- Rearrest is the broadest measure of recidivism. Because not all rearrests result in a guilty finding or conviction, this metric may suggest that there is more criminal activity than there actually is. However, it is still an important measure of the volume of people returning to courts and county jails as well as the most comprehensive indicator of a person’s interaction with the criminal justice system.
- Reconviction provides clear evidence that new criminal activity has been committed by someone with prior involvement in the criminal justice system and is considered the most accurate indicator of recidivism and public safety outcomes.
- Reincarceration can be the result of both criminal and non-criminal behavior (e.g., incarceration for certain supervision violations) and generally refers to prison incarceration. Incarceration is the costliest criminal justice response available to states, and it also generates a significant financial burden for local jurisdictions, which are often responsible for incarcerating people who have been revoked. Due to the simplicity and availability of data needed for analysis, this is the most used measure across states.
- Revocation occurs when people who have been sentenced to probation supervision or who have been placed on probation or parole following a term of incarceration have their supervision status revoked and are incarcerated as a response to their behavior. Revocation can be the result of criminal and non-criminal behavior (e.g., arrest or conviction for a new crime or the violation of supervision conditions) and has significant cost implications for local and state governments.
- States and counties also need to consider the types of offenses (i.e., new crimes or technical violations), forms of incarceration (i.e., pretrial or sentenced), and the span of time they will be using to determine recidivism (e.g., 12 months after jail release).
- States may choose to count recidivism as any subsequent jail booking (i.e., reincarceration), as it coincides with Stepping Up’s Key Measure 1, jail bookings. Some counties also track the average length of time between release and recidivism to see if people are taking longer to recidivate, which can also be a measure of success.