Have American jails become the inferior replacement for mental hospitals?

Matthew Rozsa

Salon.com

Originally posted 5 SEPT 22

Here is an excerpt:

"We've known for some time that this country's chief response to serious mental illness is incarceration, a fact that stands out because prisons are so clearly unsuited to treating mental illness," Wanda Bertram, Communications Strategist at Prison Policy Initiative, told Salon by email. "Our organization recently found that even though 43% of people in state prisons have been diagnosed with a mental disorder, only 26% have received some form of mental health treatment, and only 6% are currently receiving treatment."

Bertram added, "The readiness with which our justice system fast-tracks people with mental illnesses into prison, despite knowing that jail and prison settings won't make that person any better, speaks volumes about the system's ability to deliver justice."

Dr. Craig Haney, a psychologist who has studied the psychological effects of incarceration for decades and a psychology professor at the University of California, Santa Cruz, offered some insight into why America tends to incarcerate rather than help people with mental illnesses.

"The structural origins start with the history of two simultaneous trends that began in the early 1970s," Haney wrote to Salon. The first was the widespread closing of publicly-funded mental hospitals "in part on the promise that they would be replaced by more humane community-based treatment, a promise that was never kept" and the second was "the beginning of a decades-long 'tough-on-crime' era in which politicians competed with each other on who could criminalize the most things and impose the longest sentences. So we shrunk our mental health system and increased the size of our prison system."

Bertram also attributed the trend to imprison people who are mentally ill to ideological choices.

"I think the major problem is an ideology that says that if you have some kind of illness, including mental illness, you ought to be the primary person responsible for your own care," Bertram explained. "That's the ideology that props up our healthcare system, where sick people bear extraordinary costs and crushing debts. And it keeps us from asking why mental health services like therapy, psychiatry, and long-term care are not only expensive, but difficult to access." Pointing out that their report revealed roughly half of people in state prisons lacked any kind of health insurance prior to their arrest, Bertram concluded that "we continue to send people with mental disorders to prison, because there seems to be nowhere else for them to go."

The info is here.

America's Mental Health Crisis Hidden Behind Bars

Eric Westervelt & Liz Baker
npr.org
Originally posted 25 Feb 20

Here is an excerpt:

It's a culmination of decades of policies affecting those with a mental illness. Many of the nation's asylums and hospitals were closed over the past 60-plus years — some horrific places that needed to be shuttered, others emptied to cut costs.

The idea was that they'd be replaced with community-based mental health care and supportive services. That didn't happen. Ensuing decades saw tougher sentencing under aggressive "war on drugs and crime" policies as well as cuts to subsidized housing and mental health. It all created a perfect storm of failed policies driving more of the mentally ill into the nation's jails and prisons.

Many were left to fend for themselves. Substance abuse and homelessness sometimes followed, as did encounters with police, who often are called first to help deal with the effects of or related to mental crises.

It has put the jails in an awkward position. Today the three biggest mental health centers in America are jails: LA County, Cook County, Ill. (Chicago) and New York City's Rikers Island jail. Without the support needed, conditions have created new asylums, advocates say, that can resemble the very places they vowed to shut down.

"Local jails and prisons have become the de facto mental health institutions," says Elizabeth Hancq, director of research at the Treatment Advocacy Center, a national nonprofit that works to eliminate barriers to treatment for people with severe mental illness. "It's really a humanitarian crisis that if you suffer from a severe mental illness in this country, you almost need to commit a crime in order to get into the system."

The info is here.

Brain science should be making prisons better, not trying to prove innocence

Arielle Baskin-Sommers
theconversaton.com
Originally posted November 1, 2017

Here is an excerpt:

Unfortunately, when neuroscientific assessments are presented to the court, they can sway juries, regardless of their relevance. Using these techniques to produce expert evidence doesn’t bring the court any closer to truth or justice. And with a single brain scan costing thousands of dollars, plus expert interpretation and testimony, it’s an expensive tool out of reach for many defendants. Rather than helping untangle legal responsibility, neuroscience here causes an even deeper divide between the rich and the poor, based on pseudoscience.

While I remain skeptical about the use of neuroscience in the judicial process, there are a number of places where its findings could help corrections systems develop policies and practices based on evidence.

Solitary confinement harms more than helps

Take, for instance, the use within prisons of solitary confinement as a punishment for disciplinary infractions. In 2015, the Bureau of Justice reported that nearly 20 percent of federal and state prisoners and 18 percent of local jail inmates spent time in solitary.

Research consistently demonstrates that time spent in solitary increases the chances of persistent emotional trauma and distress. Solitary can lead to hallucinations, fantasies and paranoia; it can increase anxiety, depression and apathy as well as difficulties in thinking, concentrating, remembering, paying attention and controlling impulses. People placed in solitary are more likely to engage in self-mutilation as well as exhibit chronic rage, anger and irritability. The term “isolation syndrome” has even been coined to capture the severe and long-lasting effects of solitary.

The info is here.

Horrific deaths, brutal treatment: Mental illness in America’s jails

Gary A. Harki
The Virginian-Pilot
Originally published August 23, 2018

Here is an excerpt:

“We are arresting people who have no idea what the laws are or the rules are because they're off their medications,” said Nashville Sheriff Daron Hall, a vice president of the National Sheriffs’ Association. “You'd never arrest someone for a heart attack, but you're comfortable arresting someone who is diagnosed mentally ill. No other country in the world is doing it this way.”

In addition to causing pain and suffering for people with mental illness, the practice is costing municipalities millions.

At least 53 percent of the deaths examined have resulted in a lawsuit. Combined, the cases have cost municipalities at least $145 million. The true cost is much higher – in many cases, lawsuits are still pending and in others the settlement amount is secret. The figures also do not take into account lawyers’ fees.

The article is here.

There are a series of articles related to mental health issues in prison.

County Jail or Psychiatric Hospital? Ethical Challenges in Correctional Mental Health Care

Andrea G. Segal, Rosemary Frasso, Dominic A. Sisti
Qualitative Health Research
First published March 21, 2018

Abstract

Approximately 20% of the roughly 2.5 million individuals incarcerated in the United States have a serious mental illness (SMI). As a result of their illnesses, these individuals are often more likely to commit a crime, end up incarcerated, and languish in correctional settings without appropriate treatment. The objective of the present study was to investigate how correctional facility personnel reconcile the ethical challenges that arise when housing and treating individuals with SMI. Four focus groups and one group interview were conducted with employees (n = 24) including nurses, clinicians, correctional officers, administrators, and sergeants at a county jail in Pennsylvania. Results show that jail employees felt there are too many inmates with SMI in jail who would benefit from more comprehensive treatment elsewhere; however, given limited resources, employees felt they were doing the best they can. These findings can inform mental health management and policy in a correctional setting.

The information is here.

Trump Wants More Asylums — and Some Psychiatrists Agree

Benedict Carey
The New York Times
Originally published March 5, 2018

Here is an excerpt:

The third, and perhaps most critical, point of agreement in the asylum debate is that money is lacking in a nation that puts mental health at the bottom of the health budget. These disorders are expensive to treat in any setting, and funds for hospital care and community supports often come out of the same budget.

In his paper arguing for the return of asylums, Dr. Sisti singled out the Worcester Recovery Center and Hospital in Massachusetts.

This $300 million state hospital, opened in 2012, has an annual budget of $80 million, 320 private rooms, a range of medical treatments and nonmedical supports, like family and group therapy, and vocational training. Its progress is closely watched among mental health experts.

The average length of stay for adolescents is 28 days, and the average for continuing care (for the more serious cases) is 85 days, according to Daniela Trammell, a spokeswoman for the Massachusetts Department of Mental Health.

“Some individuals are hospitalized for nine months to a year; a smaller number is hospitalized for one to three years,” she wrote in an email.

Proponents of modern asylums insist that this kind of money is well spent, considering the alternatives for people with mental disabilities in prison or on the streets. Opponents are not convinced.

The article is here.

Suicide and self-harm in prisons hit worst ever levels

Rajeev Syal
The Guardian
Originally posted June 28, 2017

Prisons have “struggled to cope” with record rates of suicide and self-harm among inmates following cuts to funding and staff numbers, the public spending watchdog has said. The National Audit Office said it remains unclear how the authorities will meet aims for improving prisoners’ mental health or get value for money because of a lack of relevant data.

Auditors said that self-harm incidents increased by 73% between 2012 and 2016 to 40,161, while the 120 self-inflicted deaths in prison in 2016 was the highest figure on record and almost double that for 2012. Since 2010, when David Cameron became prime minister, funding of offender management has been reduced by 13%, while staff numbers have been cut by 30%, the report said.

The article is here.

Jail cells await mentally ill in Rapid City

Mike Anderson
Rapid City Journal
Originally published February 7, 2017

Mentally ill people in Rapid City who have committed no crimes will probably end up in jail because of a major policy change recently announced by Rapid City Regional Hospital.

The hospital is no longer taking in certain types of mentally ill patients and will instead contact the Pennington County Sheriff’s Office to take them into custody.

The move has prompted criticism from local law enforcement officials, who say the decision was made suddenly and without their input.

“In my view, this is the biggest step backward our community has experienced in terms of health care for mental health patients,” said Rapid City police Chief Karl Jegeris. “And though it’s legally permissible by statute to put someone in an incarceration setting, it doesn’t mean that it’s the right thing to do.”

This is the second major policy change to come out of Regional in recent days that places limits on the type of mental health care the hospital will provide.

The article is here.

Hard Time or Hospital Treatment? Mental Illness and the Criminal Justice System

Christine Montross
The New England Journal of Medicine
2016; 375:1407-1409

Here is an excerpt:

When law enforcement is involved, the trajectory of my patients’ lives veers sharply. The consequences are unpredictable and range from stability and safety to unmitigated disaster. When patients are ill or afraid enough to be potentially assaultive, the earliest decision as to whether they belong in jail or in the hospital may shape the course of the next many years of their lives.

It’s now well understood that the closing of state hospitals in the 1970s and 1980s led to the containment of mentally ill people in correctional facilities. Today our jails and state prisons contain an estimated 356,000 inmates with serious mental illness, while only about 35,000 people with serious mental illness are being treated in state hospitals — stark evidence of the decimation of the public mental health system.

When a mentally ill person comes into contact with the criminal justice system, the decision about whether that person belongs in jail or in the hospital is rarely a clinical one. Instead, it’s made by the gatekeepers of the legal system: police officers, prosecutors, and judges. The poor, members of minority groups, and people with a history of law-enforcement involvement are shuttled into the correctional system in disproportionate numbers; they are more likely to be arrested and less likely than their more privileged counterparts to be adequately treated for their psychiatric illnesses.

The article is here.

Decriminalizing Mental Illness — The Miami Model

John K. Iglehart
N Engl J Med 2016; 374:1701-1703

Here is an excerpt:

Miami-Dade’s initiative was launched in 2000, when Judge Leifman, frustrated by the fact that people with mental disorders were cycling through his court repeatedly, created the Eleventh Judicial Circuit Criminal Mental Health Project (CMHP). As Leifman explained, “When I became a judge . . . I had no idea I would become the gatekeeper to the largest psychiatric facility in the State of Florida. . . . Of the roughly 100,000 bookings into the [county] jail every year, nearly 20,000 involve people with serious mental illnesses requiring intensive psychiatric treatment while incarcerated. . . . Because community-based delivery systems are often fragmented, difficult to navigate, and slow to respond to critical needs, many individuals with the most severe and disabling forms of mental illnesses . . . fall through the cracks and land in the criminal justice or state hospital systems” that emphasize crisis resolution rather than “promoting ongoing stable recovery and community integration.”

The article is here.

Cook County Sheriff Dart: Jailing poor, mentally ill is unjust

Madhu Krishnamurthy
Daily Herald
Originally posted April 6, 2016

The numbers of mentally ill people housed in the nation's prisons and jails are staggering, Cook County Sheriff Tom Dart says, and many of them shouldn't be there.

Dart, speaking Wednesday at Elgin Community College, has led a campaign to reduce what he calls the unjust incarceration of the poor and mentally ill. He's been recognized by health advocacy organizations for trying to change the criminal justice system, which perpetuates a revolving door at jails. His presentation was part of the college's Humanities Center Speakers series.

The article is here.

Madness

By Eyal Press
The New Yorker
Originally posted May 2, 2016

Here are two excerpts:

By the nineties, prisons had become America’s dominant mental-health institutions. The situation is particularly extreme in Florida, which spends less money per capita on mental health than any state except Idaho. Meanwhile, between 1996 and 2014, the number of Florida prisoners with mental disabilities grew by a hundred and fifty-three per cent.

(cut)

After the Herald article appeared, Jerry Cummings, the warden, was placed on administrative leave, and many people questioned whether the Department of Corrections had tried to cover up a case of lethal abuse. Far less attention was paid to why an inmate had exposed it, rather than one of the prison’s mental-health or medical professionals. The duty to protect patients from harm is a core principle of medical ethics. According to the National Commission on Correctional Health Care, an offshoot of the American Medical Association which issues standards of care for prisons, any mental-health professional who is aware of abuse is obligated “to report this activity to the appropriate authorities.”

The article is here.

Outsourcing the Mentally Ill to Police

By Rich Lowry
The National Review
Originally posted January 1, 2016

Here is an excerpt:

In its analysis of 2015 police shootings, the Post found dozens of cases in which the police were called as a means of getting treatment. Shirley Marshall Harrison called the Dallas police when her schizophrenic, bipolar son was out of control. He was shot down while allegedly charging police with a screwdriver. “I didn’t call for them to take him to the morgue,” she said of the cops. “I called for medical help.”

It’s a poignant lament, but why do the families of the severely mentally ill need to rely on the police for medical assistance? When someone has a heart attack or gets cancer, we don’t call the police.

The opinion piece is here.

A shocking number of mentally ill Americans end up in prison instead of treatment

By Ana Swanson
The Washington Post
Originally published April 30, 2015

Here is an excerpt:

For various reasons, these community treatment plans proved inadequate, leaving many of the mentally ill homeless or in jail. According to the Department of Justice, about 15 percent of state prisoners and 24 percent of jail inmates report symptoms meet the criteria for a psychotic disorder.

In its survey of individual states, the Treatment Advocacy Center found that in 44 of the 50 states and the District of Columbia, the largest prison or jail held more people with serious mental illness than the largest state psychiatric hospital (see map below). The only exceptions were Kansas, New Jersey, North Dakota, South Dakota, Washington and Wyoming. "Indeed, the Polk County Jail in Iowa, the Cook County Jail in Illinois, and the Shelby County Jail in Tennessee each have more seriously mentally ill inmates than all the remaining state psychiatric hospitals in that state combined," the report says.

The entire article is here.

Thousands of Inmates in Illinois sign up for Obamacare for MH Treatment

By Rick Pearson
The Chicago Tribune
Originally posted August 4, 2014

Cook County Sheriff Tom Dart, attempting to cope with what he says is a growing mental health crisis among inmates at the county jail, said up to 9,000 people who have been incarcerated have signed up for health insurance under the Affordable Care Act in an attempt to get the care they need.

“Systemically, over the course of decades, we’ve sort of carved back all the mental health services to the point where there is this question, we’ve carved it back to next to nothing,” Dart said on “The Sunday Spin” on WGN AM-720.

The entire story is here.

California Revises Policy on Mentally Ill Inmates

By Erica Goode
The New York Times
August 2, 2014

Here is an excerpt:

The increasing number of mentally ill prisoners in prisons and jails across the country — in 2013, mentally ill prisoners made up just over 28 percent of California’s prison population — has raised questions about their treatment in corrections systems poorly equipped to deal with psychiatric symptoms. Mentally ill inmates, whose challenging behavior often leads to their placement in solitary confinement, are frequent targets for a cell extraction — the forcible removal of an inmate from a cell by a tactical team equipped with Tasers, pepper spray or other less-lethal weapons — or for other uses of force by guards.

Judge Karlton, in his April order, ruled that the use of force and lengthy solitary confinement of seriously mentally ill inmates was unconstitutional and ordered the department to revise its policies.

The entire article is here.

U.S. Prisons Becoming De Facto Home of the Mentally Ill

A new study reveals that prisons in America house ten times as many mentally ill as the state-run psychiatric wards that could actually treat them.

By Abby Haglage
The Daily Beast
Originally published April 10, 2014

Here is an excerpt:

While TAC’s study—titled The Treatment of Persons With Mental Illness in Prisons and Jails—isn’t the first of its kind, it’s notable for two reasons: it’s the first to analyze the data by state, and it’s the most recent illustration that the problem is growing more acute. One of the worst offenders is New York, where the law mandates mentally ill inmates be sent to psychiatric hospitals (which—given the lack of available beds—is mostly useless). A 2011 study estimated that of the 12,200 inmates at Riker’s Island, ⅓ of the men and ⅔ of the women are mentally ill.

The entire article is here.

The New Asylums: Jails Swell With Mentally Ill

By Gary Fields and Ericka Phillips
The Wall Street Journal
Originally published September 25, 2013

Here is an excerpt:

America's lockups are its new asylums. After scores of state mental institutions were closed beginning in the 1970s, few alternatives materialized. Many of the afflicted wound up on the streets, where, untreated, they became more vulnerable to joblessness, drug abuse and crime.

The country's three biggest jail systems -- Cook County, in Illinois; Los Angeles County; and New York City -- are on the front lines. With more than 11,000 prisoners under treatment on any given day, they represent by far the largest mental-health treatment facilities in the country. By comparison, the three largest state-run mental hospitals have a combined 4,000 beds.

Put another way, the number of mentally ill prisoners the three facilities handle daily is equal to 28% of all beds in the nation's 213 state psychiatric hospitals, according to the National Association of State Mental Health Program Directors Research Institute Inc.

The entire story is here, hiding behind a paywall.

Prisons and the Mentally Ill

Religion and Ethics Newsweekly
Originally published June 21, 2013

It doesn’t make moral, ethical, or fiscal sense, according to Cook County sheriff Tom Dart, to house people who are mentally ill in jails and prisons.

Watch Prisons and the Mentally Ill on PBS. See more from Religion & Ethics NewsWeekly.

U.S. Spurns California Move for Greater Say on Prisons

By Norimitsu Onishi
The New York Times
Originally published April 5, 2013

A federal judge on Friday rejected California’s motion to regain control of mental health care in its prisons, ruling that the quality of care failed to meet standards required by the Constitution. The move dealt a blow to Gov. Jerry Brown’s broader efforts to bring the prisons back under the state’s authority.

In a ruling handed down about 90 days after the state first argued that enough improvements had been made to mental health care after 18 years of outside control, Judge Lawrence K. Karlton of United States District Court in Sacramento wrote that there were “ongoing constitutional violations” and that court oversight “remains necessary to remedy those violations.”

In a statement, Deborah Hoffman, a spokeswoman for the California Department of Corrections and Rehabilitation, said that the judge had not given enough weight to experts and evidence showing that mental health care in the prisons was “a model for the nation.” She said that the state will appeal.

The entire story is here.