Quick: Name the largest provider of mental health care in America. If you guessed “our prisons and jails,” you would be right.
A 2006 U.S. Department of Justice study found that three out of four female inmates in state prisons, 64% of all people in jail, 56% of all state prison inmates and 45% of people in federal prison have symptoms or a history of mental disorder.
America’s approach when the mentally ill commit nonviolent crimes — locking them up without addressing the problem — is a solution straight out of the 1800s. When governments closed state-run psychiatric facilities in the late 1970s, it didn’t replace them with community care, and by default, the mentally ill often ended up in jails. There are roughly as many people in Anchorage, Alaska, or Trenton, New Jersey, as there are inmates with severe mental illness in American prisons and jails, according to one 2012 estimate. The estimated number of inmates with mental illness outstrips the number of patients in state psychiatric hospitals by a factor of 10.
Don’t look now, but here is another criminal system reform brought by funding of legalized marijuana. Pleading poverty and staffing shortages, Colorado sheriffs went to lawmakers seeking permission to hold mentally ill suspects in jails longer. State lawmakers instead outlawed the practice entirely, steering just over $9 million — with $6 million coming from marijuana tax revenue — to pay for local crisis centers and transportation programs designed to keep those in mental distress out of the criminal justice system.
Few people think jail is an appropriate place for someone in a mental health crisis. Most jails, especially small rural facilities, do not have mental health staffers on site. For the suicidal, law enforcement agencies have few options other than periodically stopping by the cell to check on the person and putting potentially violent individuals in restraints and seclusion. Once someone has been held for 24 hours, he or she has to be charged, transferred to a treatment facility or released. “People should not, because of their mental illness, be in jail,” said Jennie Simpson, a public health analyst with Substance Abuse and Mental Health Services Administration, the federal agency that oversees national behavioral health policies.
There are no national figures on how many people are held each year in jail just because they have nowhere else to go in a mental health crisis. Reports from the federal agency overseeing hospitals — the Centers for Medicare and Medicaid Services — offer a glimpse. Since 2011, at least 22 hospitals in 16 states have been cited by CMS for failing to stabilize patients in need of mental health help, instead handing them over to law enforcement to wait for a psychiatric evaluation or a bed. The hospitals span the country, from Alabama and South Dakota to New York and Ohio.
Rather than holding inmates in jail longer, counties could direct more resources to mental health treatment court (Dane County has such a program) jail diversion program for people with mental illnesses. Data show that those who completed three years of this treatment spent 73 percent less time incarcerated in the three years after admission than they did in the three years prior to admission. Additionally, 89 percent of the clients who completed their court requirements have elected to continue treatment, which reduces the likelihood of future police contact.
Another example is Richland County, South Carolina. About 83 percent of all mental health court graduates have had no further commitments or arrests since successful completion of its program. It is successes like this that provide hope for reducing the number of people with mental illnesses in jail while improving jail conditions for those inside. Any facility changes that move forward should promote these goals.