Friday, July 10, 2009

SA jail shrink: Free-world services for mentally ill a must

The San Antonio Express-News ran a lengthy and informative profile this week of Dr. Sally Taylor, head of psychiatric services at the Bexar County Jail ("Doc puts inmates mental health first," July 5). In particular the reporter (whose name I could only guess at pronouncing) highlights Taylor's role in passing new legislation to allow jails to force mentally ill patients to take their psych meds. The article opens:

It's become a given among mental health professionals that jails are now the largest psychiatric hospitals in the country. In Bexar County, as in others around the nation, roughly one out of four inmates suffers from some kind of mental illness.

That translates into some 800 inmates at the county jail being treated for a psychiatric disorder — hundreds more than patients being cared for at the San Antonio State Hospital.

Dr. Sally Taylor, administrator of psychiatric services at Bexar County Jail, has been on the front lines of the struggle to treat and rehabilitate mentally ill prisoners. ...

By all accounts, Taylor has been a tireless advocate for the mentally ill in San Antonio, working with local advocacy groups to reduce stigma about mental illness, encourage churches to address mental disorders and promote education and community awareness about mental disease.

Recently, she worked with other mental health groups on legislation to compel mentally ill prisoners to take their medication.

This is important for those who have been found incompetent to stand trail and are in jail awaiting transfer to an inpatient competency restoration program.

This will allow treatment for those with severe mental illness who are a danger to self or others or who lack the capacity to understand the risk of refusing treatment, and who have been excluded from court ordered treatment simply because they are located in jail.

It might even help some inmates enough that they could enter outpatient competency restoration.

The bill was signed into law by Gov. Rick Perry.

Taylor bottom-lines the problem of mentally ill offenders at the jail for the Express-News, arguing that only expanded free-world services can solve it. She told the paper that:
much more needs to be done with regard to the long-term needs of mentally ill lawbreakers.

“We do a great job recognizing the (mentally ill) at the front door, but the problem is the back door,” she said. “Bexar County is one of the lowest counties in per capita funding for mental health in Texas, and Texas is 48th or 49th out of the 50 states in terms of funding for mental health.

“You can do all the screening and all the jail diversion that is possible, and I'm completely in favor of that, but you've got to have services for people when you send them out in the world.”

Too often, she said, released mentally ill inmates confront a host of obstacles on the outside that hobble them in being compliant with their medical care. And then they re-offend.

“If somebody comes to the jail because it's a place to sleep and eat, you want to be able to provide that on the outside,” she said. “We don't have enough residential units, we don't have enough housing, we don't have enough supported employment, we don't have support services, we don't have intensive case management. So we drop the ball.”


gravyrug said...

Amen. We've had two mentally ill friend who've stayed with us for a time. One, we had to ask to leave when her illness got to be dangerous for our family. We took her to a place where she could get treatment, but I strongly suspect the treatment was insufficient. I'm not sure what her treatment status is now. The other is still with us, and working hard to deal with it, but the system has made it hard for her to get meds that actually help without drowning her in side effects. There are too many people needing help, and not nearly enough staff to do the helping.

Anonymous said...

Jails are an inappropriate and expensive place for broad mental health services. Too often people who come to the attention of police and brought to jails in every county in Texas are homeless mentally ill people who have become a nuisance.

We need mental health treatment centers where the mentally ill can be treated and maintained if they are unable to stabilize their own lives. To continue using jails in this way is ineffective (probably counterproductive) and wastes confinement capacity and public resources.

The "Haven for Hope" in San Antonio is a step in the right direction to managing both homeless and mentally ill population.

Anonymous said...

Forcing them to take meds won't help. The first thing people assume when a person with a mental illness takes a turn for the worse if that they are not taking their meds. That's often a false assumption. The meds just don't work nearly as well as most psychiatrist pretend. Forced drugging of people isn't the answer.

Texas is 48th or 49th out of the 50 states in terms of funding for mental health.

That is the real problem. There are treatment methods that are safer and more effective than medication. Many psychiatrist have little knowledge of any treatment method that doesn't require a prescription. For example, electroconvulsive therapy is safer, has fewer side effects and is signicantly more effective at treatment depression with psychosis than medication. Yet I've seen doctors in the state hospital system who know nothing of it beyond the way it was abused in the 70s. Some of these doctors don't keep up with current research and get most of their information from the drug reps.

The entire psychiatric profession should hang it's head in shame.

Anonymous said...

I agree with 4:02 that forced drugging for those in jail, some of whom have never been convicted of anything, is a dangerous infringement of liberty.

But I disagree that we need more mental health funding. That would be a massive waste of money that would just encourage family members of the mentally ill to move here and drain the system.

Anonymous said...

4:36 - I wasn't aware that there was any mass relocation plans in force by the family members of the mentally ill so they can drain the system of any state. But good idea, I'll be sure to do some research and come up with the top 10 states that actually spend money on treating a health problem as a health problem instead of a criminal justice one. 'Bout time I was out of here anyway.

Anonymous said...

Anon 4:02, I question your sanity. Were you possibly being sarcastic in your comments about ECT? Or are you simply clueless? I was subjected to ECT in the mid 1980s by a psychiatrist who decided that my depression after an accident was so severe that I was at risk of suicide if I did not receive it. I was not in a mental state that I could refuse. It turned me into a near zombie who lost years of memories and dropped my IQ 25 points. I have never returned to my pre ECT level of functioning. If you think that there are fewer side effects than there are with pills, you are sadly mistaken. No pill has ever continued to affect me 27 years later.

Anonymous said...

It is obvious we need FEWER jails and more treatment and rehab centers. When will we get "jail builders" off our payrolls. We still have the largest population of citizens incarcerated IN THE WORLD. Our homeless, mentally ill, addicts and non-violent offenders deserve better. Our society would be better if we treated the less fortunate as we would ourselves and IF our "Protect and Defend" policemen were directed to do just that. We must provide decent facilities. Take a look at what Chicago has provided for the homeless - "Green and beautiful" no less.

Anonymous said...

Show me the research that building tons of treatment centers will work. I doubt it.