High Rate of Incarceration of the Mentally

High Rate of Incarceration of the Mentally Ill

Mental illnesses are among the most serious health concerns facing administrators and policymakers in America today. With the declining availability of both mental health community treatment programs and inpatient psychiatry beds in the few facilities available, more and more mentally ill persons are going without treatment and the essential services needed to enable them cope effectively with their conditions. Often times, police are the first responders whenever a mentally ill patient experiences a relapse and acts out due to symptoms of their mental condition; worryingly, however, rather than be taken to mental health facilities for treatment, most of these end up in jails and prisons. From the very onset, our prison and correctional systems had not been designed to respond to the needs of people with mental health problems, so when such people are housed here, they become more vulnerable to abuse, fail to receive the necessary treatment and care, and end up costing the taxpayer significantly more in medical expenses than the average prisoner. Owing to the unfavorable prison environment, their symptoms worsen, and despite this, their chances of reconnecting with essential services such as Medicaid upon release from prison are very minimal. Worsening symptoms, coupled with frustration only mean a higher risk of recidivism, and increased danger to the community. Since one of the core purposes of the criminal justice system is to ensure the successful reintegration of offenders into the community, there is need to reorganize the current arrangement in such a way that it focuses more on the aspect of treatment and less on that of punishment in the handling of mentally ill persons. Achieving that will, however, require us to first acknowledge that the closure of state psychiatric hospitals is to blame for the rising numbers of incarcerated mentally ill individuals, is directly related to the rising rate of violent crime, and imposes a heavier burden on the taxpayer, costing twice as much as assertive community treatment programs.

Before embarking on the main discussion, it would be prudent to define a number of key terms that I will be making use of in this text. These words have been defined variously by different researchers, but for purposes of this text, the definitions below will be adopted.

Mental illness: this is a condition that impairs a person's normal functioning, feelings, moods, thinking, and relational ability (Busfield, 2011). Studies have found major depression, bipolar disorder, and schizophrenia to be the most common mental illnesses and psychiatric disorders affecting prisoners in the American jail system (Treatment Advocacy Center, 2007; Torrey, et al., 2010).

Incarceration: the confinement of a person in prison or jail

Deinstitutionalization: the policy of emptying state psychiatric institutions, and then closing the same to minimize overcrowding and prevent the deterioration of care, save on federal funds, or simply 'liberate' persons who have been confined (Torrey, et al., 2010).

Statistics: The Criminalization of Mentally Ill People

Researchers have differed on the exact proportion of inmates with serious mental conditions in the U.S. prison system. These discrepancies are partly due to the fact that prison staff, the primary source of such information, may either be unwilling to reveal confidential patient information or may not be available for interviews; and researchers may be forced to rely on online sources, which are often outdated. Nonetheless, there is consensus that between 10 and 16% of prisoners (up from 6.4% in 1983) in the system today have some form of severe psychiatric disorder (Treatment Advocacy Center, 2007; Torrey, et al., 2010). This implies that a massive 218,000 individuals who are supposed to be receiving treatment in psychiatric institutions are locked up in jails and prisons with either no, or very limited access to the same (Treatment Advocacy Center, 2007).

In her study seeking to assess the prevalence of severe mental conditions in Chicago's Cook County Jail, Linda Teplin (as cited in Torrey, et al. 2010) found approximately 10% of inmates with psychiatric conditions to have major depression, bipolar disorder, or schizophrenia. In fact, the American Psychiatric Association (APA) estimates that on any given day, 2.1 to 4.3%, 13.1 to 18.6%, and 2.3 to 3.9% of prisoners in state facilities suffer from bipolar disorder, major depression, and schizophrenia respectively. Two of the most commonly-used anecdotal examples are that of the Maine Hancock County Jail, where almost 50% of inmates are on psychotropic medication, and that of the Ohio State Prison, which reported an astonishing 285% increase in inmates with mental conditions between1990 and 1996 (Torrey, et al., 2010). It is estimated that if this trend continues and if the rate of incarceration remains unchanged, 63% of male inmates and 75% of female inmates in jails, and 75% of females and 50% of males in state prisons will be requiring psychiatric services every year (Aufderheide, 2014).

The situation is no different in juvenile facilities -- according to the National Alliance on Mental Illnesses (NAMI), 74% of girls and 66% of boys in the juvenile justice system suffer from some form of psychiatric disorder (NAMI, n.d.). These staggering figures are a perfect indication that our prison system is fast transforming into a large psychiatric institution lacking the requisite treatment and response facilities. As a matter of fact, none out of the 3,139 counties has its psychiatric facility matching the number of mentally ill individuals in the county jail (Treatment Advocacy Center, 2007). The trend is worrying, but then, what (or who) exactly is to blame for it?

Deinstitutionalization

The deinstitutionalization policy was initiated in the 1950s as a way to reduce overcrowding in state mental health facilities whose quality of care had been compromised by the rising numbers of patients seeking low-cost treatment as a result of successful reform efforts in the earlier decades of the century (Torrey, et al., 2010). It merely involved shutting down or emptying state psychiatric facilities. It had the support of both civil society groups, which believed that mentally ill people had a right to enjoy their freedom, and fiscal conservatives, who interpreted it as a way of saving federal funds (Torrey, et al., 2010).

As it turns out, however, the policy has had the effect of channeling mentally ill persons into the criminal justice system, which was from the very start, not designed to handle such cases. Torrey and his colleagues (2010) point out that due to deinstitutionalization; it is 10 times more difficult for a severely ill mental patient to secure a bed in a mental institution than it was in 1955. This lack of requisite treatment causes worsening of symptoms. As the authors point out, the situation is made worse by the fact that most of these patients do not often have medical insurance to cover the cost of treatment (Torrey, et al., 2010).

Problems Associated with Incarcerating Mentally Ill Persons

Higher Rates of Recidivism: since the criminal justice system does not have the requisite treatment facilities, and the prison staff lack the relevant training to administer psychotic medication and make follow-ups, the health condition of mentally ill patients worsens over their period of confinement, making them more predisposed to engage in drug use and repeat crimes upon release, especially if they are unable to reconnect with essential services such as Medicaid (Torrey, et al., 2010). Various studies have been able to support this claim -- for instance, Torrey and his colleagues found 90% of mentally ill prisoners at the Los Angeles County Jail to be repeat offenders, popularly referred to as 'frequent flyers' in the prison setting (Torrey, et al., 21010). A more anecdote example is that of schizophrenic Linda Kraige who had been in the Roanoke County Jail in Virginia so many times for repeat offences that she often named the deputy at the jail as her best friend (Torrey, et al., 2010).

Higher Costs: studies have shown that confining mentally ill persons in jail costs twice as much as having them in community treatment programs (NAMI, n.d.; Treatment Advocacy Center, 2007). Moreover, it costs the taxpayer significantly more to maintain a mentally ill inmate vis-a-vis their non-mentally-ill counterpart. In the Broward County Jail in Florida, for instance, a regular inmate takes up $80 in daily housing costs whereas their mentally-ill colleague takes up $130 (Torrey, et al., 2010). The situation is no different in Texas, where the state incurs approximately $22,000 a year to house a regular inmate, compared to between $30,000 and 50,000 for a mentally-ill inmate (Torrey, et al., 2010). A bulk of these costs accrue from the acquisition of medication and the hiring of trained psychiatric staff as required of state prison facilities by the Eighth Amendment (Torrey, et al., 2010; Aufderheide, 2014). The situation is made worse by the fact that mentally ill inmates may stay longer than their regular counterparts because they have challenges following prison rules (Torrey, et al., 2010).

Management Difficulties: inmates with mental illnesses present challenges for prisons' management owing to their inability to adequately follow rules. A perfect example is that reported at the Mississippi Hinds County Jail in 2005, where a mentally-ill inmate tore up and ate the cover of an indestructible padded cell; the staff punished him by taking his clothes and having him put on a paper suit, but he ate that too, and even when served food in a container made of Styrofoam, he ate both the food and the container, forcing doctors to perform surgery and pump his stomach severally (Torrey, et al., 2010). This symbolizes just how much of a burden mentally-ill inmates can be.

They are more Likely to Commit Suicide and be Subjects of Abuse: Torrey and his colleagues (2010) showed that approximately half of jail suicides are committed by inmates with mental illnesses. Multiple studies have reported higher rates of suicide in solitary confinement compared to the general prison population (Torrey, et al., 2010; Treatment Advocacy Rights, 2007). Torrey and his colleagues (2010), for instance, found that inmates in solitary confinement ran a 77% likelihood of committing suicide, compared to 15% in the case of the general population. One of the reasons given for this trend is that mentally-ill inmates are more vulnerable to abuse and discrimination by other inmates, and are more likely to run higher levels of frustration that prison staff may not adequately respond to owing to their lack of training (Treatment Advocacy Rights, 2007).

Possible Solutions

The deinstitutionalization policy was initiated with good intentions; the only problem is that its developers did not put in place effective mechanisms for i) responding to the treatment needs of patients once they were discharged from hospital; and ii) tending to the needs of those patients who rely fully on low-cost treatment in state-funded facilities. The solutions proposed below are geared at addressing these drawbacks.

Expand the Use of Assisted Outpatient Treatment (AOT): there is need to ensure that mentally-ill individuals, once released from prisons, jails, or hospitals, have access to relevant treatment facilities that minimize their risk of relapse. AOTs are an effective way of achieving this. They come in the form of court orders and give some form of ultimatum to mentally-ill persons, requiring them to either take their medication as required or be stripped of their opportunity to live and interact freely with other people in the community (Torrey, et al., 2010). Multiple studies have been conducted to test the effectiveness of AOTs in reducing the rate of recidivism. One such study was conducted in North Carolina, where mentally-ill ex-convicts were subjected to AOTs for a period of one year. The researchers noted a 30% reduction in the re-arrest rate (Torrey, et al., 2010).

Expand the Mental Health Court Use: mental health courts, which give ex-offenders and offenders an ultimatum to choose between adhering to their treatment plans and being confined in jail, could also be effective in reducing violent crime and recidivism (Torrey, et al., 2010). In this case, the court assumes the role of treating authority, which was originally assigned to psychiatric outpatient clinics.

Diversion of Funds: provisions need to be put to ensure that the savings realized for every bed that is closed in state psychiatric facilities is diverted to the Department of Corrections from that of Mental Health (Torrey, et al., 2010). Moreover, states need to put in place legislation requiring the latter to cater for the treatment costs of severely-ill patients confined in the local corrections departments.