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.”