The mentally ill is over-represented in the criminal justice system when compared with the larger United States population. People with mental illness are incarcerated approximately 8 times more frequently than they are admitted to state mental hospitals, and are incarcerated for significantly longer time than other inmates (Ascher-Svanum, Nyhuis, Faries, Ball, & Kinon, 2010). This has been linked to an increased danger to themselves, other inmates and persons employed in the prison system. Effectively identifying and properly treating these individuals is crucial in creating a safer and more effective prison system.
Currently there are approximately three times as many mentally ill in the prison system than in our mental health facilities (Fellner, 2007). As a presidential advisory commission in recent years reported, the mental health system is “in disarray. ” It is fragmented, chronically underfunded, and rife with barriers to access, particularly in minority communities. As a result, too many people who need publically financed mental health services cannot obtain them until they are in an acute psychotic state and are found to be a danger to themselves or others (Fellner, 2007).
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This lack of availability and support is evident in significantly higher rates of mentally ill imprisonment in minority communities. Prison can be a dangerous place, especially for the mentally ill. Many mentally ill inmates are victimized by other inmates; we have increased rates of violence, mental breakdowns, and suicide in prison and jails (Harvard Mental Health Letter, 2000). In addition, many of these inmates receive inappropriate kinds or amounts of psychotropic medication that further impairs their ability to function.
The failure of mental health systems has led to what some have called the “criminalizing of the mentally ill” (Fellner, 2007). The mentally ill in our prisons have a diverse background, although overwhelming majorities of the mentally ill in prison were homeless prior to being incarcerated. Each night in the United States there are approximately 600,000 people homeless, tracking the homeless over a five year period that is approximately 2-3 percent of the population, or 8 million people, are homeless for at least one night.
Of this about 80 percent of them will find housing within a few weeks, but about 10 percent will be homeless for a year or more. “About a quarter to a third of the homeless have a serious mental illness???usually schizophrenia, bipolar disorder, or severe depression???and the population is growing” (Harvard Mental Health Letter, 2005). Many attempts have been made to address the homeless issue; the main support for the homeless is Social Security and emergency shelters, which are underfunded and the staff has no specialized training. “The shelters are often filthy, dangerous, and crime-ridden.
Many of the mentally ill avoid shelters because they fear violence and theft or cannot tolerate the noise, crowds, and confusion” (Harvard Mental Health Letter, 2005). The mentally ill who have been previously imprisoned are at especially high risk of homelessness. They find it difficult to adjust and to navigate the complex process of regaining the entitlements they had prior, and many have an even further damaged mental capacity. Unfortunately, often the underlying problem of having a mental disorder is overshadowed by the actual offence, such as drug use or violent crime, which is common among the criminally mentally ill.
Many in the community and political leaders have the attitude that arresting specifically the homeless population when possible achieves both cleaning up the streets from undesirables and shows the “effectiveness” of the police in that community. This misses the target of finding a solution to the actual core problem with a vast majority of the homeless in the community. Many of the mentally ill prisoners do not have to capacity to comply with prison rules as other inmates.
This leads to a very high disproportionate amount of mentally ill being disciplined for misconduct within the prison, as well as increased lengths of time for the punishment due to continual violation of the rules. In Washington State, “offenders with serious mental illness constitute 18. 7 percent of the prison population but account for 41 percent of the infractions” (Fellner, 2007). There are many examples of misconduct being a symptom of the mental illness but go overlooked. “Prisoners have been punished for self-mutilation because that behavior ntailed the “destruction of state property”???to wit, the prisoner’s body. ” Prisoners who tear up bed-sheets to make a rope for hanging themselves have been punished for misusing state property. Others who scream and kick cell doors while hearing voices have been charged with destruction of state property and creating a disturbance. Some who have smeared feces in their cells have been punished for “being untidy” (Fellner, 2007). Although such obvious indications of possible mental illness are evident the feeling by many is shared by the Director of the Ohio Department of Rehabilitation and Correction, Dr.
Reginald Wilkinson, when he stated, “what we cannot do is ignore the disciplinary aspect of misconduct. Otherwise, this would lead to faking of mental illness by other inmates” (Fellner, 2007). One corrections expert stated, “The idea of ceding security authority to mental health personnel is pretty repugnant to most prison administration” (2007). This mentality plagues the current corrections system and makes an effective solution difficult. Most prison systems do not offer the possibility of tailored sanctions to accommodate mental illness.
The same sanctions are used for everyone and are based on the severity and history of the inmate. “If punishment is supposed to help deter future misconduct, that goal is clearly misplaced when individuals have no meaningful control over their conduct” (Fellner, 2007). This becomes a great hindrance for the mentally ill inmates when they stand before a parole board; they have a much higher rate of being denied because of this recorded behavior. The harshest punishment in prison for misconduct is a form or solitary confinement called segregation.
This requires inmates to be held alone in their cells for 23-24 hours a day, with 3-5 hours a week for out-of-cell “recreation” and shower time. This recreation often consists of solitary exercise in another empty room. Their access to entertainment such as a radio and television is not available, as well as their options for reading are extremely limited. This has a dramatic effect on many of the “strongest” inmates. To the mentally ill it can be extremely detrimental and further worsen their condition. Mentally ill people in supermax onditions “is equivalent of putting an asthmatic in a place with little air to breathe” (Fellner, 2007). The percentage of mentally ill in solitary confinement is shockingly high, and the length of time spent there is statistically much higher as well. Unlike the mentally ill in a community health center, inmates imprisoned are not held based on their mental ability to be a part of society. Mental health facilites strive to “stablize” the individual and assiting them in reintegration into society. Prisoners on the other hand are only held based on their sentence that is keeping them locked up.
Once that time limit has been completed, mentally ill or not, they are released back into society. Of course to many inmates this is a very difficult time and the ability to adjust is greatly hindered by the mental illness. Many instances show that paranoia and rapid anger response is very common among this recently released inmates. This is strongly showed by the high recidivism rate among the mentally ill. The cost associated with merely reacting to the criminal portion of the mentally ill instead of being proactive is surprising.
Studies have shown that because of savings elsewhere in the system, providing housing for the mentally ill does not increase costs. “One study found that homeless persons placed in supportive housing spent 57% fewer days in psychiatric hospitals, made 58% fewer visits to emergency rooms, and had a 50% lower rate of imprisonment” (Harvard Mental Health Letter, 2005). A University of Pennsylvania study found that people with mental illness placed in permanent supportive housing cost the public $16,000 less per year for emergency room services, jails, and psychiatric hospitalization (2005).
Also often overlooked are the effects and costs associated with the victims of crimes committed by the mentally ill. By preventing the scenario from happening that often is a predecessor of a crime there is an untold amount of pain and savings by not ending up with victims of the crimes as well. One unique problem for the mentally ill is that although discrimination against the disabled is generally illegal, discrimination against users of illicit drugs and alcohol abusers is not. Landlords can refuse to rent to them, housing programs can exclude them, and group homes can reject them.
But demanding that they are abstinent with these substances is often asking too much of the mentally ill homeless (Harvard Mental Health Letter, 2005). Solutions to dealing with the mentally ill have been attempted for many years, some of the more promising stem from what is referred to as the Federal Era in mental health. President John F. Kennedy in 1963 wanted to take mental health in a new direction. It had been vastly controlled by individual states. Large “prisons” were essentially created to house and unfortunately mistreat a large number of mentally ill.
Kennedy wanted to improve on this abysmal attempt at helping the mentally ill. President Kennedy spoke of this need, “This situation has been tolerated far too long. It has troubled our national conscience ??? but only as a problem unpleasant to mention, easy to postpone, and despairing a solution (Bloom, 2010). ” Kennedy’s concern was introduced before congress one month prior to his death. This was signed by President Johnson to create the community mental health center movement. It seemed that finally the mentally ill would be able to receive treatment, instead of mistreatment.
This caused the large State institutions to be shutdown and large numbers of mentally ill were to receive their help from this new and improved system. Unfortunately though, due to various reasons such as lack of funding and miscommunication from the Federal to State level this program was conceptually a success but failed to come to fruition in reality. In 1979 President Jimmy Carter wanted to refocus the effort on helping the mentally ill. He recognized the failed attempt and wanted to again support Federal assistance to the mentally ill.
What had happened since the 1963 attempt by President Kennedy is that there was an “accelerated discharge of the state hospital patients into local communities” (Bloom, 2010). This was the time that the terms “deinstitutionalization”, “the homeless mentally ill,” and “the chronic mental patient in the community” first appeared (2010). This concern was also first recognized that “the mentally ill were becoming a significant population with the nation’s jails and prisons” (Bloom, 2010). Currently the State run hospitals that remain predominately serve the courts; civil commitments make up 24% of the patients and the criminal courts another 63%.
This reactive approach to handling the mentally ill has obvious faults. In the 1960’s, nearly 600,000 beds were available across the United States for individuals with mental illness. Today only around 40,000 beds exist (Deferrari, 2010). Of course since the 1960’s the population has grown as well, this leaves a very large number of mentally ill being uncared for. Another proactive approach that is being utilized to try and help the mentally ill avoid prison is called “The Memphis Model”; this model uses a crisis intervention team that responds to the initial scene when the police are involved.
This began after the shooting death of a severely mentally ill man in Memphis, TN in 1988. The idea is to have a highly trained crisis team available immediately to give the choice for officers to take the individual to jail or drop them off at a mental healthcare center. Part of the idea is that taking a mentally ill person to jail is a matter of convenience for the officer rather than to deal with the situation, especially without any significant training to do so. This gives the officers the same convenient choice with better results (Carey, 2009).
This is critical to have available in cities such as Newport, VA. A survey conducted in 2007 revealed that 37 percent of the inmate population there had a severe mental illness. In Newport they took the concept a step further and have a trained professional try and intervene and help those mentally ill that are currently in prison as well. Also they attempt to make a proactive approach and work with the community when possible to both educate and identify at risk mentally ill individuals. This model is being used in various cities to try and make a positive impact, and has shown some good success.
Studies have shown that the larger the prison or jail is, the more proactive they become in getting community and state involvement in treating the mentally ill. Prisons and jails have, practically speaking, become a core element in the mental health system (Robinson, 2010). Seeing firsthand the dramatic increase of the mentally ill in prison forces many institutions to look for alternative programs to assist. One of the core problems with finding a viable long term method to treat and help the mentally ill avoid prison, is that as a society the understanding of mental illness is very low.
Politicians generally don’t become elected by promising to raise taxes to help care for the mentally ill. It is a dilemma at times to morally do the right thing and to also be able to be elected or re-elected as a politician. Education is vital in creating a sustainable mental health service. Overall communities have a feeling that the mentally ill homeless can be ignored because although they cannot take care of themselves, their families should intervene. This has proven to be a good point, in a perfect world where families are always around.
But in reality many of the homeless mentally ill come from broken homes and have no family support to speak of. Some cities have taken the “someone else’s problem” to new levels. Cities such as New York among others have offered “free travel” either by bus or train to leave the city. Offering “better opportunities” elsewhere, where in reality it is a shameless way to ignore the core problem. The mentally ill have had a long history of mistreatment and great innovators making a difference where they can. The current corrections system is not headed for a strong future.
Overpopulation of inmates and understaffed facilities as well as enormous costs associated with running them is growing at an unsustainable pace. The problem is widely known throughout the prison system, but often the conditions only deteriorate. Many countries around the world consider imprisonment only as a last resort. The United States on the other hand, has a prison system that “bulges with low-level nonviolent offenders for whom incarceration is not only unnecessary but also counterproductive” (Fellner, 2007).
The most effective way to ensure the rights of the mentally ill offenders are protected is to try and keep them out of prison in the first place. The United States has only about 5 percent of the world’s population but has almost a quarter of the world’s prisoners. China is ranked second, with about four times the population has almost 1 million less prisoners than the United States (Robinson, 2010). A closer look at the efforts being made in the juvenile system as well points to ineffective diagnosis and financial backing to assist the mentally ill teens.
A 2006 study estimated that out of every 100,000 youths there are less than 9 child psychologists (Carey, 2009). This is mainly due to significant budget cuts in many community mental health programs across the country. Jails and juvenile justice facilities are the new asylums, unfortunately. A debate has intensified as to what constitutes “adequate” mental health care. The juvenile justice system often has little to go on when diagnosing, school records as well as records from other facilities often do not arrive for juveniles. This poses a significant problem when psychiatrists are attempting to prescribe medication for the youth.
There is one side wanting to find the minimum amount of mental health treatment to satisfy the requirement on one side, and the idea that those need proper and complete treatment to make a difference. This of course comes with a much higher price tag. Often when facing a budget crisis, mental health funds get cut. This leads directly to increased corrections system costs and safety concerns as well as an increase of victims to a majority of the crimes. These at risk mentally ill juveniles have a very high rate of becoming those adult offenders incarcerated in the prison system.
A serious rethinking of the purposes of incarceration is required. Studies have shown, with a change in our incarceration costs associated with low level non-violent offenders having an alternative to prison, a substantial amount of space and funds would be available to support a mental health overhaul. Only with innovative and realistic changes can we hope to make a change in the trend that is being seen. Advances in treatment of the mentally ill have developed greatly over the past 40 years. With proper treatment many of the mentally ill in prisons and living on the streets have a chance at a better life.
As the studies have indicated, proactive community based efforts do not necessarily increase cost, but they definitely have a positive impact on the mentally ill (Deferrari, 2010). With the drastic increase in Federal spending, it may be difficult to find means and support to provide mental health facilities with adequate means to help the mentally ill, without a significant change in how the corrections system is operated. In the mean time though, the problem is increasing at an alarming rate. Without proper intervention the future for the unsupported mentally ill is grim. References
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