When drug addiction & mental health meet the criminal justice system: Interview with Chief Judge David Nuffer

David Nuffer is Chief Judge of the US District Court for the District of Utah. In this interview, he discusses the interlocking problems of drugs, mental health and the criminal justice system. He stresses that his answers are his views and not official statements.

Jathan Janove: Describe the problems regarding the interface between the criminal justice system and drug addiction and mental health problems in our country.

Judge Nuffer: The drug addiction problem is poorly understood, and the criminal justice hammer is not always suited to solve it. If the user is not wealthy, addiction has to be funded by dealing, so drug distribution, bank fraud and theft prosecutions — and even possession of a firearm — are “cover” offenses for addiction. We have too often punished the offense more than treated the addiction. Similarly, mental illness often results in criminal behavior, such as drug use in an attempt to self-medicate, or anti-social behavior such as theft, threats or even assault. With the loss of mental health treatment programs in institutions and communities, the courts and jails are used as “solutions.” Addiction and mental illness often co-occur, with one leading to the other. If not treated, addiction and mental illness will result in more criminal offenses. People who are mentally ill or addicted often have no social support network because they have a dysfunctional family, or the family has tired of their behaviors.

Courts are now integrating social support, treatment and rehabilitation programs to diminish the cycle of repeating offenses. The mentally ill and addicted can receive supervised treatment, intensive re-education and compliance guidance as they learn to function in the community. Jobs, housing, medical treatment, social and vocational education, and emotional support help change participants’ lives. This is an example of the need for traditional institutions to morph to solve new challenges.

Jathan Janove: What is the cost/benefit analysis of incarcerating people with drug and/or mental health problems vs. putting them in programs that create a chance at recovery/rehabilitation?

Judge Nuffer: This is a big point of debate. We are just learning about drug courts and behavioral health courts — but the science is emerging, though not complete, and many, but not all, principles are known by the many courts in existence. The dollar cost in 2016 of keeping people in custody in the federal system was $31,976 per year, compared with a cost of $26,083 in a community correctional center where high intensity treatment is coupled with work release for those who show responsibility. But supervision by a probation officer only costs $4,097 per year. The cost of an intensive treatment court where individuals meet weekly with a professional team, including a judge, therapist and probation officer, along with attorneys, is surely somewhere between $4,000 and $26,000 per year, very likely in the range of $10,000 per year. But the trick is — not everyone succeeds in these programs. Participants often fail to stay sober — and suffer short term sanctions, like a few days in jail. Sometimes, other crimes are committed. But almost every participant, even those who “fail” to graduate, learn something and are better by participation. In all cases, therapeutic court participation reduces the risk of harm to the community by the participant. And in many cases, a family — a mother, father, brother, sister, child, spouse — get their family member back. We cannot count that in dollars.

Jathan Janove: If you were “Tsar for the Day,” what changes would you implement?

Judge Nuffer: I would like to reduce the political motivation to accuse the addicted and mentally ill, increasing society’s compassion for those who are disabled by these conditions. Then, I would like to see resources devoted to rehabilitation and care for these populations. Of course, there are many who cannot break the cycle and need incarceration, but there are many who need support, resources and to be believed in. We can save lives, create useful citizens, and restore dignity and capacity.