The story details some of the functional barriers to stopping the revolving door - particularly a lack of supervision after release to ensure offenders are taking their meds, and lack of housing and transportation to allow some level of normalcy and the ability to go to doctor visits and probation meetings.
During a recent survey, county officials found that more than 400 of the jail's 11,000 inmates were homeless and suffered from a major mental illness: schizophrenia, bipolar disorder or a chronic depressive-psychotic disorder. They were among 1,900 inmates on psychotropic medications.
When the mentally ill homeless leave jail — and leave behind its mental health care staff — many stop taking medication and end up on the street again. Treatment resumes only when they commit a crime and return to jail or their dementia overwhelms them and they are brought to an emergency psychiatric center.
Treating the mentally ill as they cycle through jail and emergency psychiatric wards is expensive. A county budget analyst estimates that it costs $80,000 a year, per person.
At the jail, spending on mental health care has risen to $24 million annually, and the combined cost of incarcerating and treating the mentally ill is $87 million annually.
"The jails have become the psychiatric hospitals of the United States," said Clarissa Stephens, an assistant director of the county's budget and management services office who has been studying the jail's mental health costs. ...
A June survey of more than 11,000 inmates revealed:
- About one-quarter suffer from mental illness or once suffered from it.
- Of those on medication, 978 suffered from schizophrenia, bipolar disorder or a severe depressive-psychotic disorder.
- Of the 978 with a major mental health disorder, 423 likely were homeless.
- Of the 423 homeless with a major mental health disorder, 97 percent had been arrested at least once before during their lifetimes; 43 percent had a prior arrest during the last 10 years.
On the day of the survey, the jail's mentally ill homeless inmates included:
- A 39-year-old woman booked 45 times since 2001.
- A man, 26, booked 30 times since 1999.
- A man, 52, booked 33 times since 1992.
- A man, 25, booked 20 times since 2001.
Some of the mentally ill — many of whom also are substance abusers — keep committing crimes and getting rearrested, in part, because few are properly supervised when they are released, said David Buck, a Baylor College of Medicine associate professor and president of Healthcare for the Homeless-Houston.
This population defies the usual methods of the criminal justice system. When you're homeless, hungry and crazy, going to jail has little deterrent effect. Offenders who go off their meds when they leave lockup will likely miss probation meetings and appointments for treatment without some outside assistance. Finally, those who can't hold a job inevitably will steal or victimize others in order to get by.
There really does need to be a more structured community supervision system for the mentally ill that includes greater support and field supervision - particularly for "frequent fliers" who are in and out of the jail year after year.
County jails have become de facto mental heath treatment centers, not just in Houston or Texas but throughout the United States. Diversion programs for the mentally ill rank among the most cost effective reforms counties can undertake because failure to confront the problem with preventive steps necessitates treating them in jail - particularly for those who've been in and out of the jail over and over. Given that Harris County already spends $80,000 per year per person who goes through their jail and emergency room psych wards, a LOT of community based services could be provided for a similar amount of money.