Wednesday, February 21, 2007

Our Limiting Resources: Treating the Mentally Ill in Jails

Recently, MSNBC had a special on Los Angeles County Jails in which they gave detailed tours of correctional facilities such as Men's Central and Twin Towers. Through the video and several interviews with inmates and officers working in these facilities, we are able to see the conditions on the inside and the stressors that must be dealt with everyday. Today, approximately 283,800 inmates are identified as having a mental illness. This represents 16% of the inmate populations of state and local jails. Jails have effectively become America’s new mental institutions; they house a larger volume of mentally ill people than all other programs combined. However, these inmates rarely receive the treatment that they need and have a right to. The criminal justice system is overpopulated and under equipped to deal with those with psychotic disorders requiring mental health care services.

The shift in residency of the mentally ill from hospitals to the criminal justice system is the result of deinstitutionalization, which occurred in the early 1990’s. This grave process began in the 1970’s to eliminate the negatively infamous mental institutions. These “warehouses” of the past where known for their sparse living conditions, brutal treatment of patients, and harsh medical procedures and treatments such as electroshock therapy. Concern for the civil rights of mentally ill persons, a desire to cut costs, and a hope that new medications could replace supervised care spurred the movement to close the institutions.

The overflow of the mentally ill has overloaded the prison system. The American Correctional Association recommends that jails should operate at 90% of capacity. All jails were at 85% capacity in 1985, and were already up to 111% capacity by 1987. The overcrowded conditions disrupt the efficiency and function of the prison system. Room for booking and close observation areas upon admission is scarce. Even if a mentally ill inmate is correctly recognized as in need of further observation or treatment, on-sight mental health professionals are very limited and there may not be anyone on duty due to time of day or location of the facility. Admittance screening is rushed and many mentally ill inmates who should receive treatment instead slip through the cracks of the system. On the other end of the spectrum, this inefficient process may allow for malingering inmates to sneak their way into the psychiatric system for some secondary gain. Some individuals do this to avoid a more harsh sentencing while others may want the benefits of being prescribed medications that they can use to either continue their substance abuse or for some monetary gain while incarcerated. This takes away from the already limited means provided to treat the mentally ill in our legal systems. The original social goal providing these individuals with more humane mental health care is lost.

Our society has attached a heinous stigma to mental illness, which makes it difficult for individuals to ask for or receive help. The perception that mentally ill people are violent is a common one. In reality, studies have shown that they commit violent acts no more often than a random sample of their peers, if they do not abuse alcohol or drugs. The small percentage of mentally ill people who do represent a significant risk to themselves or others should not be ignored though. These people do belong in a correctional facility. However, many are arrested on minor charges and for non-violent crimes. In fact, 29% of jails in one survey reported holding mentally ill persons against whom no charges were ever pressed. They are jailed because more appropriate community based programs do not have the funding or space to deal with them.

A large number of prison inmates today suffer from psychotic disorders that are severe enough to warrant mental health care. Numerous court cases have established that mentally ill inmates have the constitutional right to these services. However, more often than not, inmates are denied these needed services. Most prison administrators report that they do not have the resources or ability to respond to the needs of mentally ill offenders. They describe their programs as “grossly understaffed” and “in urgent need” of help from mental health organizations to develop appropriate programs. In effect, today’s prisons and jails are shouldering the responsibility for the mentally ill which used to reside with community based hospitals and institutions.

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