California’s failure to develop a comprehensive public health approach to address drug abuse, addiction and mental illness threatens the health of millions of state residents. Tens of thousands of nonviolent offenders with addiction and mental health problems enter the criminal justice system each year, where care is typically inadequate. Young people have few options for community-based substance abuse treatment. Both problems endanger the well-being not only of people behind bars, but of the community at large.

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A new ballot measure, Proposition 5, the Nonviolent Offender Rehabilitation Act (NORA) would transform how the criminal justice system responds to drug addiction and mental illness by:

• creating and funding a system of care for youth with drug problems;
• expanding access to court-supervised, community-based addiction treatment for nonviolent offenders;
• ensuring care for dually diagnosed people in the criminal justice system;
• dramatically reforming the prison system and parole policies;
• reducing the number of people behind bars; and
• requiring individualized treatment and rehabilitation for people in prison and on parole.

Prop. 5 will appear on the Nov. 4th, 2008, ballot. NORA empowers treatment professionals, including physicians and experts in substance abuse and mental health, to play central roles in assessing treatment needs and providing appropriate services. Moreover, NORA requires independent research to highlight best practices and proven public health interventions and to ensure that they are implemented.

Relieving Prison Overcrowding & Investing in Rehabilitation to Improve Health

California’s prisons are severely overcrowded and highly unsafe, with nearly 175,000 people squeezed into facilities designed for 100,000. This has increased violence and overburdened basic services, including medical care. At the same time, overcrowding exacerbates the spread of communicable diseases, which are brought back into the community as inmates are released.

NORA will reduce the number of nonviolent offenders entering California prisons each year with effective diversion programs and by ending the parole system’s practice of cycling nonviolent offenders in and out of prisons for minor violations. These changes will mean less overcrowding, better opportunities for rehabilitation, and decreased transmission of disease.

NORA also requires the California Department of Corrections and Rehabilitation to provide appropriate treatment and other rehabilitation programs to all people nearing release from prison. Similarly, all people on parole must be given appropriate services, and the same offer of services extends to any former parolee for up to one year after discharge. The wide range of services mandated under NORA will directly improve individual and public health, while also reducing the likelihood of recidivism and re-incarceration.

Expanding Court-Supervised Treatment with Greater Involvement by Practitioners

NORA recognizes that addiction is a chronic, relapsing medical condition that responds well to individualized treatment. In the largest treatment expansion in US history, NORA allocates $460 million each year to provide a range of community-based services including drug treatment, mental health care and other support services for nonviolent drug law offenders as an alternative to incarceration. This new funding level is secured and indexed to inflation and state population.

NORA’s court-supervised treatment programs would build on several years of success with Proposition 36, California’s landmark treatment-instead-of-incarceration law approved by voters in 2000. But NORA goes much further. It links the three existing, but disparate, systems of court-supervised treatment, creating one continuum of care that starts with individualized clinical assessments by qualified assessors, followed by appropriate and targeted treatment services delivered by state-certified professionals.

NORA also makes it a priority to deliver appropriate care to dually diagnosed people—those with both a serious mental illness and a substance abuse problem. NORA creates direct links with Proposition 63, the 2004 ballot measure that created wraparound mental health services so that the two measures can work together to meet the often complex needs of dually diagnosed people.

Promoting Health Education to Empower Individuals

NORA’s comprehensive public health approach reaches beyond addiction treatment to also embrace harm reduction therapy and services inside and outside of California’s jails and prisons. Harm reduction practices give people the information and the power to protect their own health by decreasing risky behaviors. NORA requires:

• Counties and the state to increase the availability of methadone and other medication-assisted treatment services for opioid-dependent individuals in the community;
• Courts to protect people using medication-assisted treatment against forced (i.e., non-physician recommended and patient chosen) detoxification through incarceration;
• Jails to provide drug overdose awareness information to every person being released back into the community; and
• Judges to receive annual training on drug addiction and treatment, including medication-assisted treatment and the principles and practices of harm reduction.

NORA’s comprehensive criminal justice reform package, with a focus on a public health approach to substance use problems, will improve the health of individual Californians, their families and their communities and reduce the harms that our overburdened prison system continues to inflict on public health.