Wednesday, July 23, 2008

Using jails for mental health treatment an expensive, counterproductive approach

The Houston Chronicle yesterday published an excellent feature by Bill Murphy ("Finding escape behind bars, July 22,") focused on mental health treatment at the Harris County Jail, reporting that:

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.

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.

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.


Anonymous said...

I selected a group of jail inmates that had been booked three or more times in a year and tried to figure out what they had in common.

What they have in common is they don't do anything serious enough to attract the attention of the county attorney. Their mean time between returns to jail is about 60 days and that is too long for the jail staff to think they are a serious problem that should be dealt with.

Their crime profiles are similar to those you described in your post. They are responsible for a substantial fraction of the bookings so they generate significant ordinary costs and when you add the costs of the drugs they use they are very expensive prisoners that deserve attention for no other reason than cost control.

I live in a community that does not want mentally ill persons in jail but they are still there (not as many as before we started a MH diversion program). As you noted as soon as they leave jail many of them stop taking their medication and sooner or later they return to jail. To break this cycle we may have to violate their civil rights.

Anonymous said...

I will just add that in my experience, juvenile detention facilities experience the exact same problems as the number of mentally ill kids increases year after year. Getting MHMR intervention depends on where you live. The problem is growing fast year after year.


Anonymous said...

Grits: I have been told for years by reliable sources that much of the blame for our having to use jails for mental health treatment can be directly traced back to Reagan who, while Governor of California, closed many of that State's mental health facilities, dumping those patients out on the streets to subsequently become the problem of law enforcement and the criminal justice system. Then, when he became President, Reagan oversaw the reduction of federal mental health funding, resulting in other states being forced to do what California had done.

It is much more expensive to deal with this problem in the jails rather in the hospitals. MH diversion programs, just like substance abuse diversion programs, DO work and should be increased. Treatment at the source is much more efficient. It's a classic "You can pay me now or payme later" scenario.

Anonymous said...

vnnlamxlYes... Something needs to be done. Last week(Wednesday) we had a young man die in the Potter County jail following a scuffle and subsequent arrest at the probation office. No doubt he had a mental health issue. The situation was totally mishandled. They found him dead in his jail cell the following Saturday.Probation officers should be trained or at least stay in close contact with a TCOOMMI officer when dealing with offenders with mental health issues.The actual cause of death is not known at this point. Attorney Jeff Blackburn, is ordering an independent autopsy.