People with mental illness are increasingly ending up being imprisoned, rather than in the mental health care system where many of them belong. With the down economy, states and counties — who are primarily responsible for the health of the indigent — cut social services first. And with most public psychiatric hospitals long-since closed, people who have a mental disorder end up being warehoused not in hospitals, but in prisons.
Yes, we succeeded in closing down the state mental hospitals. But we moved the population not to outpatient facilities, but to our prisons.
Now, finally, people are realizing the short-sightedness of locking people with mental illness up, as the spiraling prison costs of doing so become a burden to cash-strapped local governments.
In Philadelphia, a new mental health court has just started, meant to divert people away from prison and into mental health treatment. By doing so, the hope is that they can reduce the incidence of mental illness within prisons, and provide better care for people with a mental disorder in the process.
The new court is part of an approach called “sequential interception,” which includes programs designed to intervene so that people with mental illness don’t get caught up in the criminal justice system – or even killed by it. [...]
The court and the CIT are responses to a complex problem that began decades ago when the closing of state hospitals released mentally ill people into the community without adequate support or services.
Decades later, the high numbers of mentally ill people occupying prisons – some reports put the number at 30 percent of the inmate population – suggests that in too many cases, prisons have replaced state hospitals.
Imagine that — up to 30 percent of prisoners could have a treatable mental disorder. And guess what kind of mental health care most prison systems offer? Limited, if any (federal prisons tend to do a better job in this area than state-run prisons, but none come close to offering the kinds of services one would typically find in their local community).
Human Rights Watch has called out the U.S. prison system for its warehousing of the mentally ill and giving them inadequate care:
In 1998, the Bureau of Justice Statistics reported there were an estimated 283,000 prison and jail inmates who suffered from mental health problems. That number is now estimated to be 1.25 million. The rate of reported mental health disorders in the state prison population is five times greater (56.2 percent) than in the general adult population (11 percent).
Women prisoners have an even higher rate of mental health problems than men: almost three quarters (73 percent) of all women in state prison have mental health problems, compared to 55 percent of men.
“While the number of mentally ill inmates surges, prisons remain dangerous and damaging places for them,” said Jamie Fellner, director of Human Rights Watch’s U.S. Program and co-author of a 2003 report, “Ill-Equipped: U.S. Prisons and Offenders with Mental Illness.” “Prisons are woefully ill-equipped for their current role as the nation’s primary mental health facilities.”
Prison systems are horrifying places to be in the first place. They are even more so for someone who is suffering from schizophrenia or bipolar disorder and doesn’t have access to standard treatments for them. The previous Human Rights Watch report noted:
Inmates with mental illness are often punished for their symptoms. Being disruptive, refusing to obey orders, and engaging in acts of self-mutilation and attempted suicide can all result in punitive action. As a result, the report noted, prisoners with mental illness often have extensive disciplinary histories.
Frequently, the prisoners end up in isolation units. “In the most extreme cases, conditions are truly horrific,” the report stated, adding:
Mentally ill prisoners locked in segregation with no treatment at all; confined in filthy and beastly hot cells; left for days covered in feces they have smeared over their bodies; taunted, abused, or ignored by prison staff; given so little water during summer heat waves that they drink from their toilet bowls. … Suicidal prisoners are left naked and unattended for days on end in barren, cold observation cells. Poorly trained correctional officers have accidentally asphyxiated mentally ill prisoners whom they were trying to restrain.
These are conditions one would expect in a third-world country. Not in the U.S. And not for people who are often most in need of compassion and care.
What research is there to show such mental health courts help? On Friday, a study was released that showed a 20 to 25 percent improvement in offender outcomes under the mental health court system in Minnesota.
Those who did not go through the specialized court got arrested again in less than three weeks.
Sociologist Henry Steadman, who heads the New York-based policy research group, said it’s important to view those numbers in context.
“Taking a hard-core, challenging population that has failed repeatedly in all three systems: criminal justice, substance abuse and mental health,” Steadman said, “and has cycled and is a particularly challenging group, and have come up with an intervention that is a 20 to 25 percent improvement on almost all the measures. My evaluation is that’s pretty damn good in today’s world.”
Indeed. While mental health courts don’t result in immediate cost savings, after about a year and a half, the savings start to add up. And of course, those 20 to 25 percent of people who go through such programs are leading far better lives than if they were stuck behind bars in prison.
But in the end, it’s not really about costs, is it? It’s about treating humans with basic dignity and respect, and taking care of those who need treatment and care. A society is judged in part by how they take care of their most vulnerable and sick citizens. Today, our society just got a little bit better.
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Last reviewed: By John M. Grohol, Psy.D. on 18 Jul 2009
Published on PsychCentral.com. All rights reserved.
Grohol, J. (2009). Imprisoning People with Mental Illness. Psych Central. Retrieved on November 27, 2014, from http://psychcentral.com/blog/archives/2009/07/18/imprisoning-people-with-mental-illness/