Sunday, June 28, 2009

Number of mentally ill in jail a community 'barometer'

The executive director of the Harris County MHMR Authority, Steven Schnee, has an effective op ed in the Houston Chronicle today declaring that the scope of mentally ill people in the Harris County jail foretells a coming crisis:
The Harris County Jail is now the largest mental health facility in Texas. Approximately 2,400 inmates a day are now diagnosed with a psychiatric illness that medically justifies the provision of psychiatric medications. There are almost as many psychiatrically ill inmates in the jail on psychiatric medications as there are patients in all of the Department of State Health Services hospital beds across the entire state.

Let that reality sink in.

How is this occurring? Several critical factors contribute to this disturbing trend. First, many individuals with a serious mental illness need early access to appropriate professional diagnosis and treatment and, often, supports to achieve and maintain stability in their psychiatric condition. These conditions aren’t, as a general rule, cured by medication. Stabilized, yes — cured, no. These individuals need education about the condition, available treatment options, impact on personal capabilities, stability and maintenance over time, etc. — all of which are made more difficult by the nature of these disorders affecting the information-processing organ of the body — the brain. These are neuro-chemical — disorders of the brain. And, if one throws into the mix that many untreated or undertreated folks with mental illness self-medicate with street substances, alcohol or both to ease the internal pain, one has a recipe for people recycling in and out of the criminal justice system because their behaviors run afoul of the law.

The discrepancy between the funded treatment capacity (8,500 per month) for only the three eligible diagnoses of schizophrenia, bipolar disorder and major depression (let alone all the other serious psychiatric conditions for which people end up in jail) is huge. A conservative estimate of the incidence/prevalence of these three diagnoses in Harris County is 170,000. ...

The risks to our society at multiple levels are huge. Economically, socially, to compete on the world stage, we can’t afford to continue the incredible loss and waste of human potential. And though the focus of this article is on the adult justice system, a similar reality is unfolding within the juvenile justice system.

Keep an eye on the jail — it is truly a barometer of the health of our community.


scott said...

I have a question, perhaps I am ADD, or somesuch. My job, as a landscape design and installer has me using something other than a calendar to plan my day.

If it rains, I can't work, if I plan to do something, but I have other outstanding work to do I have real prerequisites. If we break a sprinkler line, we really can't move forward till we fix things.

Anyway, this disconnection with a schedule has made it hard for me to recognize my court date. Furthermore, what difference does it make if I don't pay my registration? I don't get un-fair use of the road. When I do finally renew, I've paid not only for the whole year--it's not pro-rated down when you're behind. So how does not paying a ticket, then heaping FTA charges fit?

In other cases violations give you something extra, this is not such a case. I twice tried to go get my registration renewed and faced 2 hour lines, once waited for 2 hours for the computer to turn on.

When I've gone to pay my fines during the lunch hour there is often a 2 hour wait. Isn't this crappy service CONTEMPT by Court.

Seriously, if they courts can't serve us, how can they make us wait for hours to pay a fine? Isn't this becoming a separate punishment?

How can these County Commissioners hire more constables when they can't service the tickets? Further, have you written on Constables increasingly entering into Traffic patrol and other duties which I think are not historically consistent with their historical role?

Finally, I know there were people in school who got to take tests without time limits. How many people do we have receiving excessive punishments for being disorganized, or having ADD?

Shouldn't "cruel and unusual" punishment enter into the equation when being late to renew registration costs hundreds of dollars when, assuming one pays the $75/yr eventually, they got no extra benefit, in fact likely paid a fee--double jeopardy?

Soronel Haetir said...

One thing I've wondered for a long time now on such issues, how much of it can be traced to changes in family structures? I know people used to keep their mentally ill relatives locked away in a basement or closet. While this may or may not be a good situation when compared with living in formal incarceration it did keep people off the streets and away from law enforcement.

I see nursing homes as a somewhat similar situation as well, people now expect the government to provide what once was normal family care.

I do wonder how much more frequent such conditions are, rather than people being willing to talk about it instead of locking their crazy cousin away in the house.

Anonymous said...

In the 1980's funding for mental institutions was drastically reduced. Patients who needed structured care were thrown out on the streets, and soon, because they could not function untreated on the streets, were thrown in jail. And that's where they are now. Recently a Tulian, who was psychologically/emotionally disturbed, died in prison. He was incarcerated because he swallowed some drugs rather than giving them up to the police. He was charged with concealing evidence, or some such crime, and, since he had had run-ins with the law before, was sentenced to what amounted to and literally turned out to be a life sentence. The current DA (not McEachern), said he knew the guy didn't belong in prison, but neither did he belong on the streets, and prison was the only place he had for him.

We need some genuinely compassionate conservatives to provide some structured treatment options for people like my aforementioned friend. It will cost some money, but probably no more than or not much more than prison.

"Inasmuch as you have done it for the least of these, you have done it for me." (Matthew 25:40).

I wish right-wing religionists would take these words of Jesus seriously.

REv. Kiker in Tulia

Anonymous said...

I believe that the problem that occurred in the 1970's and 1980's was not only lack of funding for mental institutions but substantial changes in the law.

Many mentally ill family members were not locked away at home but in these places, some for whole lifetimes. Many of these places were warehouses that offered little treatment and terrible living conditions. The turning out of patients from these facilities at that time was done because of the abuses that were rendered by that system.

While I do agree that some suffer so significantly from mental illness that they need an institutionalized environment, much more can and should be done to provide substantial services at an outpatient level.

JSN said...

The ugly truth is that is costs about $75 per inmate-day to detain a person in jail and it costs more than that to place a mentally ill person in a residential treatment facility.

sunray's wench said...

But locking mentally ill people away in prison or jail is not the answer. Jailers and prison staff are not trained to deal with mental illness; an inmate who is mentally ill does not respond in the same way to commands as those who can think rationally, and when an officer is having a bad day, the mix is a green light for one or both to be hurt and the inmate almost certainly being punished more severely simply for not being able to respond like mentally healthy people can.

I am currently looking at care and provision for the elderly and sick within prisons across the US and one of the initial things that stands out is that only a tiny percentage of DoCs even have specific care plans in place for the elderly and infirm, despite the very simple maths that if you lock more people up for life, then you are evetually going to have an old, sick and expensive population to look after.

Soronel Haetir, you say that people now expect the state or government to pick up the tab. But in the case of many sick and infirm inmates whose families are willing to take back the responsibility of caring for their elderly and sick felonious relatives, the state almost always refuses until the very last minute. Someone is wanting their cake and eating it too, and a lot of elderly and sick inmates and their families are being used in a point scoring game that they dont understand and dont have a chance of influencing.

Anonymous said...

I don't think it is really about finding more appropriate places to lock mentally ill people up. The problem is what are you going to do with them when they get out.

It's the revolving door syndrom that needs some serious reevaluation. Unless a mentally ill person has committed a crime, a danger to themselves, or others. Locking them up anywhere, even if you think it might be better for them is not an option.

Supportive services for the families. Transportation to and from doctor's appts. and help getting their meds. Better case management. THERAPY ect. ect. ect....

It's a complicated problem, more so than drug addiction, if that were possible. Because so many have so many different needs.

Anonymous said...

Our society has chosen to use incarceration as the best punishment for the criminally insane, because it makes the most sense. Treatment is usually more expensive(on a cost per day basis)

I don't see it as a big deal to have a diversionary program for a small number of first time offenders to get treatment. These are specialty items for the criminal justice system. But the bread and butter will always be incarceration for the mentally ill criminal.