Report Shows County Jails Unequipped to Handle People with Serious Mental Illnesses
Health Letter, October 2016
By Azza AbuDagga, M.H.A., Ph.D.
“Jails have become the ‘asylum of last resort’ and more intensive engagement by staff is required as a result.” — a jail survey respondent
Public Citizen has long shed light on the plight of people who suffer from serious mental illnesses (including schizophrenia, bipolar disorder and major depressive disorder) in the criminal justice system. Our 1992 report, Criminalizing the Seriously Mentally Ill: The Abuse of Jails as Mental Hospitals,[1]jointly prepared with the National Alliance for the Mentally Ill, represented one of the most detailed reports on this issue at that time.
On July 14, in collaboration with the Treatment Advocacy Center, we released a new report titled Individuals With Serious Mental Illnesses in County Jails: A Survey of Jail Staff’s Perspectives.[2] The report is based on the first comprehensive national survey of county jails in more than 20 years. It includes responses from 230 jails across 39 states that relay the challenges faced by front-line workers, including sheriffs, deputies and other staff, who have to care for seriously mentally ill inmates during their incarceration. Over 90 percent of our respondents were experienced staff who have been at their current jails for two years or more.
The report illustrates that the continued unethical practice of “dumping” the seriously mentally ill behind bars is harming this most vulnerable segment of our society and placing a significant burden on jails and their staff.
The root cause of the problem
U.S. state psychiatric hospitals — where people with serious mental illnesses were historically cared for — have been closing or downsizing steadily since the passage of the Community Mental Health Centers (CMHC) Act of 1963. The number of state psychiatric beds per 100,000 people has dropped from nearly 340 in 1955[3] to only 12 by the first quarter of 2016.[4] A previous study showed that a seriously mentally ill person would be 10 times more likely to find a state psychiatric bed for treatment in 1955 than in 2004.[5] At the same time, funding for community-based mental health treatment programs that were mandated by the CMHC Act has fallen considerably short of meeting the needs of the seriously mentally ill population.
As a result, the only option for thousands of seriously mentally ill individuals has been to wander the streets,[6] forgotten and untreated. These individuals commit minor crimes, including food-related thefts or trespassing to find a place to sleep, just to survive on the streets.[7],[8] Thus, they land in jails and rack up lengthy incarceration times awaiting a state psychiatric bed where they can receive treatment.
Scope of the problem
Our report found that the vast majority of jails are forced to deal with this problem: 96 percent reported having inmates with serious mental illnesses during the previous year.
Overall, about one in five jails reported that 16 percent or more of their inmates were seriously mentally ill. The problem is worse in large jails, as nearly a third of those jails reported that 16 percent or more of their inmates were seriously mentally ill. The problem is getting worse, as three-quarters of the jails reported seeing more or far more seriously mentally ill inmates compared to five to 10 years ago. Furthermore, a third of the jails described the recidivism rate for these inmates as higher or much higher than that of the general inmate population.
Most jails reported major problems with the seriously mentally ill inmates, including the necessity of watching them more closely for suicide, their need for additional attention, their disruption of normal jail activities and their being abusive of, or abused by, other inmates (see figure).
Percentage of Jails Reporting Special Problems Caused or Encountered by Seriously Mentally Ill Inmates
Jail staff are overwhelmed
Our survey respondents emphasized that although the failure of the mental health system to provide treatment for the seriously mentally ill population has forced jails into becoming de facto mental health facilities, the jails are not equipped to handle this responsibility.
The jail staff reported that they lack the proper training to deal with the seriously mentally ill inmates: “We are challenged on a daily basis to try and provide care that our training hasn’t prepared us for,” said one jail staff respondent.
Overall, almost half of the jails indicated that only 2 percent or less of the initial training they provide to their sheriff’s deputies and staff was allotted to issues specifically dealing with these inmates. Similarly, about 60 percent of jails indicated that only two hours or less of their annual training is provided on this topic.
Due to budget and resource constraints, not enough treatment is provided for people with serious mental illnesses in jails. For example, only 42 percent of the jails reported offering psychiatric medications, although these medications are essential to stabilizing the conditions of many individuals with serious mental illnesses. Only a third of the jails reported providing some sort of individual psychiatric care, and barely 10 percent reported providing group psychotherapy to these inmates.
In the absence of adequate treatment, nearly 70 percent of the jails reported segregating their seriously mentally ill inmates — a practice that can be harmful to many of these inmates if it involves prolonged isolation.[9]
Our jail respondents reported that they try to accommodate the inmates with serious mental illnesses. Yet just 4 percent reported hiring deputies with experience in dealing with these inmates, and a little over a quarter reported hiring non-law-enforcement staff (including nurses and social workers) to accommodate these inmates.
Only about a third of the jails reported diverting inmates with serious mental illnesses to facilities other than jails. Less than a quarter of the jails said that they offer a support system to help mentally ill inmates transition into the community following their release.
Solutions
On a telephone press conference on the day we released our report, we called for making mental health treatment a priority at the local, state and national levels, so that our society can treat, not imprison, those who are struggling with mental illnesses.
Our report recommended expanding community-based mental health treatment programs and increasing the number of state psychiatric hospital beds.
We called for jails to implement jail-based and court-based diversion programs to channel seriously mentally ill people to treatment in the community. We stressed that jails are obligated to provide appropriate mental health treatment for mentally ill people in their custody. We also recommended that jails implement pre-release care planning to end the “revolving door” in and out of the justice system for these inmates.
We recommended additional evidence-based solutions to divert mentally ill people away from the criminal justice system in the first place:
- Extensive training of the police force about how to recognize offenders with mental illnesses and refer them into treatment programs.
- Systems that screen newly admitted jail inmates for serious mental illnesses and send them for proper mental health treatment outside jails.
You can read this report and listen to the telephone press conference associated with its release here.
References
[1] Torrey EF, Stieber J, Ezekiel J, et al. Criminalizing the Seriously Mentally Ill: The Abuse of Jails as Mental Hospitals. A Joint Report of the National Alliance for the Mentally Ill and Public Citizen’s Health Research Group; 1992. https://www.citizen.org/criminalizingtheseriouslymentallyill. Accessed August 26, 2016.
[2] AbuDagga A, Wolfe S, Carome M, Phatdouang A, Torrey EF. Individuals With Serious Mental Illnesses in County Jails: A Survey of Jail Staff’s Perspectives. A Research Report from Public Citizen’s Health Research Group and the Treatment Advocacy Center; 2016. https://www.citizen.org/hrg2330. Accessed August 26, 2016.
[3] Chaimowitz G. The criminalization of people with mental illness. Can J Psychiatry. 2012;57(2):1–6.
[4] Fuller DA, Sinclair E, Geller J, et al. Going, Going, Gone: Trends and Consequences of Eliminating State Psychiatric Beds, 2016. Arlington, VA: Treatment Advocacy Center; 2016.http://www.tacreports.org/storage/documents/going-going-gone.pdf. Accessed August 26, 2016.
[5] Torrey E, Kennard A, Eslinger D, et al. More Mentally Ill Persons Are in Jails and Prisons Than Hospitals: A Survey of the States. Arlington, VA: Treatment Advocacy Center and National Sheriffs’ Association; 2010.
[6] Lamb HR. Deinstitutionalization and the homeless mentally ill. Psychiat Serv. 1984;35(9):899-907
[7] Torrey EF. Jails and prisons—America’s new mental hospitals. Am J Public Health. 1995;85(12):1611–1613.
[8] Torrey EF, Stieber J, Ezekiel J, et al. Criminalizing the Seriously Mentally Ill: The Abuse of Jails as Mental Hospitals. A Joint Report of the National Alliance for the Mentally Ill and Public Citizen’s Health Research Group; 1992. https://www.citizen.org/criminalizingtheseriouslymentallyill. Accessed August 26, 2016.
[9] Fellner J. A corrections quandary: Mental illness and prison rules. Harvard Civil Rights. 2006;41(1999):391-412.