The Mentally Ill Should Be Hospitalized, Not Imprisoned

An estimated 8.1 million adults in the United States, or about 3.3 percent of the adult population, suffer from a serious mental illness. Sadly, half are untreated in any given year. The Treatment Advocacy Center, a national nonprofit organization dedicated to making treatment possible for severe mental illness, reports roughly 1.8 million U.S. jail bookings in 2014 involved someone with a serious mental illness. And an estimated 383,000 adults with mental illness are behind bars, which represents 20 percent of the U.S. jail and prison population. At some point in their lives, 40 percent of U.S. adults with serious mental illness will be incarcerated.

Last year an estimated 90,000 U.S. inmates did not stand trial because they were too mentally ill to understand the charges against them. The “forensic beds” used to restore them to competency are in critical supply, forcing mentally ill inmates to deteriorate further as they await treatment.

“This is a terrible situation,” said Sally Satel, a resident scholar at the American Enterprise Institute (AEI) as well as a practicing psychiatrist and lecturer at the Yale University School of Medicine.

Last year an estimated 90,000 U.S. inmates did not stand trial because they were too mentally ill to understand the charges against them.

“The longer they stay, often the more psychotic they get,” Satel explained. “As you can imagine the treatment isn’t very good, and this opens them up to assault, sexual and physical, and worsening of their own situation and also suicide. In fact, suicide is the largest reason for death in jail.”

Satel hosted a recent AEI gathering of scholars and experts on mental illness and incarceration aimed at tackling the problem of a dramatic shortage nationwide of forensic beds used to restore the mentally ill to competency in order to stand trial.

“Because of those crimes, which are largely driven by untreated symptoms, we have a population of inmates behind bars in America today with mental illness today that’s about the size of the city of Oakland, California,” said Doris A. Fuller, chief of research and public affairs at the Treatment Advocacy Center presented on her organization’s report, “Emptying the ‘New Asylums.’”

“we have a population of inmates behind bars in America today with mental illness today that’s about the size of the city of Oakland, California”

The report explored how small, practical changes to the way in which the mentally ill are processed through the criminal justice system could dramatically reduce the nation’s prison population.

“The results were so startling that even we were surprised,” Fuller said. “That doesn’t happen very often.”

The report proposes an evidence-based approach for reducing the crisis, using queuing theory (the study of waiting) to project how minor changes to mental health practices could reduce forensic bed waits for those deemed incompetent to stand trial (IST).

Computer modeling offers a mathematical approach to examining systems as they exist and then projecting the results of introducing small changes into those systems.

“[I]t does not require advanced economics to conclude that staffing existing beds is more economical than building new ones or that diverting people in psychiatric crisis out of the criminal justice system is cheaper than jailing them,” the report states. “The IST bed capacity model described in this paper not only validates that small changes to selected variables could reduce forensic bed waits, it suggests that these waits could be reduced for a relatively modest investment compared with the status quo.”

Also Matthew Chase from the National Association of Counties discussed the impact the bed shortage is having at the county level and the need to align incentives to prompt change. The Boston Globe’s Michael Rezendes discussed his recent reporting of this issue in Massachusetts and the specific changes his work has inspired. In response to reporting by Rezendes, Republican Gov. Charlie Baker proposed reforms in mental health care for approximately 250 men held at the Bridgewater State Hospital, including addressing a funding gap and moving convicted mental health patients at Bridgewater to a mental health unit at a separate prison.

“If we treated people with primary health issues the way we treated people with mental illnesses, not only would there be a plethora of civil lawsuits, there would criminal indictments for gross negligence”

Judge Steve Leifman from the Miami-Dade County Court Criminal Division talked about how the Florida county’s diversion program for competency restoration has lead to significant savings and improved outcomes. He pointed out the enormous costs of untreated mental illness, including $80 billion nationwide spent on county jails, rising costs that go toward incarceration rather than other infrastructure projects like schools.

“If we treated people with primary health issues the way we treated people with mental illnesses, not only would there be a plethora of civil lawsuits, there would criminal indictments for gross negligence,” Leifman said.

“There is no other illness in this world that is permissible to send people out into homelessness in the middle of the night. And nobody bats an eye,” the judge said. “The worst thing is we don’t give people what they need, then we punish them because they don’t behave as society expects them to behave and we never offer them the services to begin with. It’s really a cruel, cruel joke.”

Carrie Sheffield is a senior contributor for Opportunity Lives. You can follow her on Twitter @carriesheffield and on Facebook.