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More Mentally Ill Persons are in Jails and Prisons than Hospitals: A Survey of the States

by E. Fuller Torrey, Aaron D. Kennard, Don Enslinger, Richard Lamb, and James Pavle

ABSTRACT:  This report argues that "America's jails and prisons have become our new mental hospitals."  Data gathered through the U.S. Bureau of Justice Statistics and the Substance Abuse and Mental Health Services Administration are used to note the following points: Serious mentally ill persons are three times more likely to be found in jails or prisons than in mental hospitals; the percentage of serious mentally ill persons in jails and prisons has tripled in the past decade; 40 percent of persons with serious mental illness have been in jail or prison at some point in their lives; and hospital beds for seriously mentally ill persons are "extremely difficult" to find.

The report observes, "Jails and prisons are not created to be de facto mental hospitals. They are not structurally appropriate for patients, and the staffs are not recruited as psychiatric caretakers.  Not surprisingly, there are many problems associated with placing large numbers of mentally ill individuals into jails and prisons." Among the problems identified in the report are the following:  Released mentally ill prisoners receive little psychiatric aftercare and consequently often return to jail or prison at a higher rate than non-mentally ill former prisoners; mentally ill prisoners are more expensive to manage because of higher staffing levels and greater needs for  psychiatric examinations and medications (jails and prisons also attract more litigation as a result of inadequate mental health care); mentally ill prisoners have longer jail or prison stays; and mentally ill prisoners are often more serious management problems, more likely to commit suicide, and often the target of abuse from staff as well as other inmates.

The report makes six recommendations: Assisted outpatient treatment should be used more to assure released prisoners receive and take properly prescribed medications;  mental health courts should be used more widely to give offenders the alternatives of a treatment plan or incarceration; state surveys should be conducted every five years to count the number of seriously mentally ill prisoners in jails and prisons for the purpose of directing federal funding to states with the lowest level of incarcerating mentally ill offenders;  states should shift funding from local and state mental health agencies to county and state corrections agencies as state-funded psychiatric beds are shut down; alter federal fiscal incentives that encourage states to simply empty psychiatric beds, leaving these patients to become involved with criminal justice institutions such as jails and prisons; and states should affirm interventions based on "need for treatment" standards rather than on assessments of dangerousness.

Posted Fri, Jan 28 2011 1:00 PM by Tracey Vessels


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