Criminal Justice Policy Coalition
Dual Diagnosis and Diversion
Whitney Taylor of the Drug Policy Forum of MA moderated the session
on Dual Diagnosis and Diversion. The panelists were Judge Kathleen
Coffey of the Boston Municipal Court, Probation Officer Maureen Chamberlain of
the Worcester Dist. Court, Sandra Fallon, LICSW, of the Worcester County and
North Middlesex Court Clinic, and David Monroe, a consumer of Dual Diagnosis
services within Massachusetts. .
The panelists agreed that instead of treating the dually diagnosed
as an undifferentiated group, recovery could be improved by distinguishing among
several different cohorts of clients: those clients whose severe addictions
create a mental illness (MI) reaction; arrestees and probationers with severe
mental illnesses who attempt self medication, though not to the point of
substance addiction (SA); and individuals who are truly mentally ill and
severely addicted.
Judge Coffey spoke to the need for understanding the science of the
diseases involved on the part of the players – judges, district attorneys,
probation officers, defense counsel and police. Too many in authority rely on
pop culture myths, including the lack of understanding of the physiologic
malfunctions within the body causing the dysfunctional symptoms. Her findings
suggest that treatment accepted voluntarily rather than through coercion is
always the most effective route to recovery, and that diversion opens the door
for voluntarily received treatment. Coffey also suggested that rather than
attempting to determine whether to treat MI or SA first, integrated services be
provided; service providers treat both conditions concurrently, rather than
attempting to deal with one without addressing the other.
Officer Chamberlain noted that by far the largest contingent of
probationers are SAs, followed by dual diagnosis clients and the severely MI,
which is often a result of or coextensive with trauma. Probation Officers (POs)
are increasingly well educated, the majority having graduate degrees. This
background enables the POs to understand the occasional relapse by SA as a part
of recovery rather than a sign of failure. This increased flexibility makes
POs better advocates for continued treatment rather than a
one-strike-and-you’re-off-to-prison approach to probationers. POs increasingly
understand that relatively minor incidents by probationers often get exacerbated
during an arrest due to the interactions between the arresting police officer
and the offender. She closed by noting the current difficulty of finding both
housing and services for the large numbers of SAs in need of support.
Both Coffey and Chamberlain believe that documentation of the
positive outcomes by diversion and treatment versus criminal dispositions is
needed to persuade the public and the legislature that funding of such programs
is in the best interests of taxpayers and the treated, and so that current trial
programs can become permanent parts of the criminal justice system.
Mr. Monroe concurred with the points made by Coffey and
Chamberlain. He spoke extensively about some of the problems within the system
which harm rather than help rehabilitation: 1.a prior assault record used to
deny treatment; 2. delays in the providing of treatment coupled with inaccurate
diagnosis; 3. PO caseloads too high for effective support; 4. the use of CORI
(see brief discussion under Post-Release Challenges) by the potential employers
to hinder rehabilitation; 5. lack of treatment services on-site (within the
housing provided for SAs and MIs on probation) as well as GED and vocational
training markedly decreases the success of well intentioned programs.