When we talk about America’s policy of mass incarceration, it’s impossible to ignore the decline of mental health facilities.
Locking up the mentally ill
In jails, serious mental illness now affects about one in six men and one in three women, rates four to six times higher than the general population. There are currently 10 times more mentally ill people in jails and prisons than in state mental health institutions. The majority were incarcerated for non-serious crimes.
The issue compounds upon itself as prisons and jails are increasingly overwhelmed by mental health issues in facilities.
Where the problem came from
The issue of mental health in prisons stems back to the 1960s. Until 1965, psychiatric facilities had been growing in the United States. When Medicaid was passed in 1965, the program excluded coverage for those in mental health institutions, which incentivized states to move people out and into hospitals or nursing homes.
In 1967, California passed the Lanterman-Petris-Short Act, which made involuntary hospitalization of mentally ill people much more difficult. A year after the act was passed, the number of mentally ill people in the criminal justice system doubled.
In 1980, President Jimmy Carter moved in the other direction by signing the Mental Health Systems Act, which aimed to revamp mental health programs and improve services for those with mental illness.
President Ronald Reagan reversed this effort in 1981 by repealing Carter’s legislation and establishing block grants for the states, ending the federal government’s involvement in providing mental health services and decreasing federal mental health spending by 30 percent.
In 2004, studies emerged showing the vast number of people with mental health issues locked in prisons. At that time, there were about 100,000 psychiatric beds in hospitals and over 300,000 mentally ill inmates. Even despite this data showing a three-to-one ratio of mentally ill people in the wrong place, the problem was about to get a lot worse.
In 2009, during the aftermath of the Great Recession, the government required states to cut $4.35 billion in public mental health spending over the next three years. Since then, states have been forced to close down hospitals and psychiatric facilities and cut medical health services.
With nowhere to go for treatment, the mentally ill population has flooded prisons and jails, overwhelming a criminal justice system that is not equipped to address the issue.
Why is this a problem?
Around 60 percent of adults with mental illness have not been treated in the past year. Leaving the mentally ill population untreated has led to tragic consequences.
Nearly 38,000 Americans commit suicide each year, and about 90 percent of these are related to mental illness. Those with mental health issues who do not commit suicide still die an average of 23 years sooner than other Americans, due to being victimized by violence or being too sick to take care of themselves.
But a huge consequence of this lack of treatment is that without proper counseling and medication, those with mental health issues exhibit behavior that results in encounters with law enforcement – often leaving them incarcerated in an environment in which their illnesses cannot be properly addressed.
Solitary confinement has been traditionally relied on in prisons and jails as a technique for controlling inmates, but isolation can be extremely harmful to those with a mental illness, as it can exasperate psychological problems.
In addition to prisons not being the best environment for the mentally ill, they also pose risks to other inmates. Studies have shown that those affected by mental illness are more likely to break rules and cause violent incidents with other prisoners.
How treating the mentally ill could save money
Beyond the harmful consequences of incarcerating the mentally ill, leaving them rotting in prison costs so much more than implementing mental health programs would in the long term. In Texas, community-based treatment costs $12 per day as opposed to $137 for a jail bed and $986 for a hospital bed.
There are alternative programs that can be implemented to prevent and treat mental illness, which also decreases the chance of rearrests in the future.
For prevention, there are options to explore in law enforcement. Specialized policing responses (SPRs), which include crisis intervention teams (CITs) and police-mental health co-responder teams, are trained to connect mentally ill with treatment options instead of arresting them. For SPRs, police teams are trained to identify mental illness, de-escalate situations, decrease stigmatization and link those with mental issues to treatment.
By reducing reliance on police, jails and emergency rooms to handle mental health crises, SPRs can save quite a bit of money. One study showed that after CIT was implemented in Albuquerque, the use of high-cost SWAT teams to respond to mental health crises decreased by 58 percent.
Beyond prevention, utilizing jail-diversion programs, including treatment and therapy, for those with mental health issues, has been shown to significantly decrease costs. An assessment of jail-diversion programs in New York City showed an average of $7,038 lower jail costs per person.
Specialized courts, including mental health, drug courts (over 70 percent of people in jails with serious mental illness also have a reoccurring substance-use disorder) and veterans’ courts (veterans returning from combat are at higher risk for mental health and substance-use problems) have been proven to be more effective options than incarceration and therefore huge financial savers.
An analysis of specialized courts found that, in the one and one-half years of follow-up after entering the program, participants were less likely to be arrested and spent fewer days incarcerated compared to those with similar profiles who were incarcerated with no specialized court treatment.
If someone with mental health issues does end up incarcerated, there are still more programs that can be implemented after an inmate is released to help transition them back into society.
Programs to help with housing have shown to be of significant help. New York City’s use of housing assistance programs for those traveling between jail and shelters yielded a 91 percent housing retention rate, 53 percent reduction in jail days and 92 percent reduction in shelter days. This resulted in average savings of $2,953 per person, per year.
Prisons and jails are no places to treat mental illness. While we are addressing the issue of mass incarceration, we need to recognize that mental health plays a role in our vast prison populations.
In order to combat the issue, we need to reverse the budget cuts that led to the dismantling of our mental health services. We need to put community mental health programs back in place for preventative care as well as increase the number of psychiatric beds in hospitals to help provide specialized treatment following incidents.
Providing adequate treatment will save huge costs in the long term. But more importantly, it is vital to those struggling with mental illness in prisons that we get them the help they actually need.
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